Prognostic factors in children requiring admission to an intensive care unit after hematopoietic stem cell transplant.
The objectives of this study are to identify prognostic factors of survival to discharge in pediatric hematopoietic stem cell transplant (HSCT) recipients requiring intensive care unit (ICU) admission, and to determine the utility of the Oncological Pediatric Risk of Mortality (O-PRISM) in predicting death of these patients. A retrospective cohort of 125 pediatric HSCT recipients from October 1992 to September 2002 was analysed to evaluate risk factors of mortality in those admitted to ICU after HSCT. Nineteen patients (median age 7.8 years, 14 boys) required 24 ICU admissions post-HSCT. The most frequent underlying diseases were acute myeloid leukemia (n=5). The survival rate on discharge from ICU was 54%. In univariate analysis, risk factors of mortality included earlier requirement of ICU admission post-HSCT (median 34 versus 166 days, p=0.002), a longer delay before ICU admission (median 12 versus 5 h, p=0.02), lack of neutrophil (p=0.011) or platelet engraftment (p=0.008), macroscopic hemorrhage (p<0.001), tachypnoea (p=0.033), hypoxemia (p=0.031), renal impairment (p=0.011), coagulopathy (p=0.012), mechanical ventilation (p<0.001), and an increasing number of organ failures (p=0.003). Macroscopic hemorrhage and mechanical ventilation remained significant in multivariate analysis. Both PRISM and O-PRISM scores were significant composite prognosticators. It was concluded that mortality of post-HSCT children requiring ICU admission is high, especially in those with poor prognosticators.
Cheuk
Daniel Ka Leung
DK
Department of Pediatric and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong. cheukk1@hkusua.hku.hk
Ha
Shau Yin
SY
Lee
So Lun
SL
Chan
Godfrey Chi Fung
GC
Tsoi
Nai Shun
NS
Lau
Yu Lung
YL
D000293:Adolescent; D000704:Analysis of Variance; D002423:Cause of Death; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007938:Leukemia / Q000601:surgery*; D008297:Male; D009369:Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000706:statistics & numerical data