title: Prognosis of child recipients of hematopoietic stem cell transplantation requiring intensive care.
abstract: OBJECTIVE
  To determine prognostic factors in child recipients of hematopoietic stem cell transplantation from blood or bone marrow (BMT) requiring critical care.
  
  
  METHODS
  Retrospective study of a cohort of patients.
  
  
  METHODS
  Pediatric Intensive Care Unit (PICU) in a university tertiary care center.
  
  
  METHODS
  Child recipients of BMT requiring PICU admission.
  
  
  RESULTS
  Of the 151 children receiving transplants in our institution, 44 (29.1%) had 49 admissions to the PICU. Mechanical ventilation (MV) was required in 34 patients (69.4% of all admissions). Overall mortality was 31/44 (70.4%). Mortality in patients requiring MV and not requiring MV was 26/34 (76.5%) and 5/10 (50%), respectively. The following variables were significantly associated with mortality in the univariate analysis: male gender (P=0.02), older age (P=0.03), acute graft versus host disease (aGVHD) grades III or IV (P=0.01), severe hemorrhagic cystitis (P=0.01), the diagnosis of lung injury (P=0.04), the need for MV (P=0.03) or for renal replacement therapy (P=0.02), the presence of respiratory (P=0.003), cardiovascular (P=0.009) or gastrointestinal (P=0.01) failures, and the failure of > or =3 organs (P=0.01). In the multivariate analysis, the presence of aGVHD grades III or IV, male gender, severe hemorrhagic cystitis, and the failure of > or =3 organs were found to be independent predictors of mortality.
  
  
  CONCLUSIONS
  The need for intensive care is common among child recipients of a BMT. These patients have a high mortality rate but some complications are reversible with critical care support. Certain clinical parameters are useful to establish a realistic prognosis and to optimize the use of the available resources.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Ramón y Cajal, 28034 Madrid, Spain.
authors.forename: Adelaida
authors.initials: A
authors.lastname: Lamas
authors.forename: Enrique
authors.initials: E
authors.lastname: Otheo
authors.forename: Purificación
authors.initials: P
authors.lastname: Ros
authors.forename: José Luis
authors.initials: JL
authors.lastname: Vázquez
authors.forename: María Soledad
authors.initials: MS
authors.lastname: Maldonado
authors.forename: Arturo
authors.initials: A
authors.lastname: Muñoz
authors.forename: Isabel
authors.initials: I
authors.lastname: Martos
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric