Although many inflammatory cytokines are prognostic in sepsis, the utility of 
cytokines in evaluating disease severity in pediatric hematology/oncology 
patients with septic shock was rarely studied. On the other hand, a single 
particular cytokine is far from ideal in guiding therapeutic intervention, but 
combination of multiple biomarkers improves the accuracy. In this prospective 
observational study, 111 episodes of septic shock in pediatric 
hematology/oncology patients were enrolled from 2006 through 2012. Blood samples 
were taken for inflammatory cytokine measurement by cytometric bead array (CBA) 
technology at the initial onset of septic shock. Interleukin (IL)-6 and IL-10 
were significantly elevated in majority of patients, while tumor necrosis factor 
(TNF)-α and interferon (IFN)-γ were markedly increased in patients with high 
pediatric index of mortality 2 (PIM2) score and non-survivors. All the four 
cytokines paralleled the PIM2 score and differentially correlated with 
hemodynamic disorder and fatal outcomes. The pediatric multiplex cytokine score 
(PMCS), which integrated the four cytokines into one score system, was related 
to hemodynamic disorder and mortality as well, but showed more powerful 
prediction ability than each of the four cytokines. PMCS was an independent 
predictive factor for fatal outcome, presenting similar discriminative power 
with PIM2, with accuracy of 0.83 (95% CI, 0.71-0.94). In conclusion, this study 
develops a cytokine scoring system based on CBA technique, which performs well 
in disease severity and fatality prediction in pediatric hematology/oncology 
patients with septic shock.