Background Tumor lysis syndrome (TLS) is serious complication of anticancer chemotherapy, leading to substantial morbidity and mortality in adults and pediatric patients. Objective To report the incidence and outcomes of TLS in pediatric patients with hematologic malignancies at a center in Pakistan. Methods Retrospective chart review of 317 pediatric patients with hematologic malignancies during January 2008-December 2013. Demographic features and clinical and laboratory parameters of TLS, with immediate and 6-month outcomes were determined using a semi-structured questionnaire. Results Median age at diagnosis was 9 years, with the 79.2% patients being male. Laboratory TLS was present in 36 patients (11.4%), with 27 (8.5%) developing clinical TLS and 13 (4.1%) requiring intensive care support. Hyperphosphatemia was the most frequent metabolic abnormality (14.2%), followed by hypocalcemia (13.9%), hyperuricemia (12.6%), and hyperkalemia (1.3%). 45 patients (14.2%) developed acute kidney injury (AKI). Patients who developed TLS had a signi cantly higher white blood cell count at initiation of chemotherapy (142.0 x 10 9 /L [SD, 173.1] vs 31.5 x 10 9 /L [SD, 58.0]; P = .01) and a higher incidence of AKI (58.3% vs 8.5% of patients; P < .001). Limitations Retrospective design of study, high rate of loss to follow-up, and unavailability of lactate dehydrogenase levels in a majority of patients. Conclusion The incidence of TLS pediatric hematologic malignancies was 11.4% at our center. The main cause of death was sepsis. Hyperphosphatemia was the common metabolic derangement and hyperkalemia was the least common. TLS warrants intensive supportive care to prevent further morbidity and decrease mortality.

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Background Cryptococcal Meningitis (CM) is the most common presentation of invasive cryptococcosis. Seen in patients with and without HIV, CM is associated with significant morbidity and mortality. We present findings from a nationwide analysis of patients admitted with CM in the United States between 2007 and 2016. Methods The national inpatient sample (NIS) database was queried for all inpatient visits for Cryptococcal Meningitis between January 2007 and December 2016. Logistic regression models were used to determine risk factors for mortality, prolonged admissions, and delays in obtaining an initial lumbar puncture. Results The number of admissions for CM decreased during the study interval, from 3590 in 2007 to 2830 in 2016. Mortality did not change over this period (9.9%), however length of stay and inpatient cost significantly increased (P = 0.003 and P &lt; 0.001 respectively). The proportion of patients with HIV declined from 70.7% to 54.0% (P &lt; 0.001). HIV patients had a lower risk of mortality (OR = 0.77, CI 0.68–0.86, P &lt; 0.001), whereas Africa-American, Hispanic and Native American ethnicities had a significantly increased association with mortality. Delay in lumbar puncture beyond the first 24 hours was independently associated with mortality, with an OR of 1.55 (CI 1.31–1.82, P &lt; 0.001). . Patients admitted on a weekend, those of African-American ethnicity, and those without a known history of HIV were more likely to have delays in obtaining an early LP. Conclusion Inpatient mortality for patients with CM continues to remain high, with an increasing proportion of patients without underlying HIV infection. We found significant deviations in management of CM from IDSA guidelines, and an independent association of delay in early lumbar puncture with worsened patient outcomes. Disclosures All Authors: No reported disclosures

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