Objective To investigate risk factors for pediatric intensive care unit (PICU) admission among children with acute lymphoblastic leukemia (ALL) and risk factors for receipt of life-sustaining therapy (LST) in the PICU. Methods Clinical data of ALL patients treated at the Children's Medical Center of the Second Xiangya Hospital from June 2016 to June 2021 were retrospectively reviewed. Patients were categorized into PICU and non-PICU groups according to PICU admission. Multivariable logistic regression was applied to identify risk factors for PICU admission. The cumulative probability of PICU admission was estimated using Kaplan-Meier curves. PICU patients were further stratified into LST and non-LST groups according to whether LST was received, and multivariable logistic regression was used to identify risk factors for receiving LST. Results A total of 200 children with ALL were included; 42 (21.0%) were admitted to the PICU at least once, with 48 total admissions. Multivariable logistic regression analysis showed that hyperleukocytosis at diagnosis and lactate dehydrogenase (LDH) >500 U/L were independent risk factors for PICU admission (both P<0.05). Kaplan-Meier curves demonstrated that T-cell ALL and hyperleukocytosis were associated with higher cumulative PICU admission rates. Univariate analysis showed that C-reactive protein, albumin, and respiratory failure were significantly associated with the receipt of LST (all P<0.05). Further multivariable logistic regression analysis revealed that respiratory failure was significantly associated with an increased risk of receiving LST (OR=13.254, P=0.027). Conclusions Children with ALL who have hyperleukocytosis at diagnosis and LDH >500 U/L have a higher risk of PICU admission; respiratory failure is an independent risk factor for receipt of LST among PICU-admitted ALL patients.