title: Risk factors associated with pediatric intensive care unit admission and mortality after pediatric stem cell transplant: possible role of renal involvement.
abstract: BACKGROUND
  Hematopoietic stem-cell transplant (HSCT) is associated with many risk factors for life-threatening complications. Post-transplant critical illness often requires admission to the pediatric intensive care unit (PICU).
  
  
  METHODS
  A retrospective analysis was made on the risk factors associated with PICU admission and mortality of all HSCT patients at Helen DeVos Children's Hospital from October 1998 to November 2008.
  
  
  RESULTS
  One hundred and twenty-four patients underwent HSCT, with 19 (15.3%) requiring 29 PICU admissions. Fifty patients received autologous, 38 matched sibling, and 36 matched un-related donor HSCT, with 10%, 13% and 25% of these patients requiring PICU admission, respectively (P=0.01). Among the HSCT patients, those who were admitted to the PICU were more likely to have renal involvement by either malignancy requiring nephrectomy or a post transplant complication increasing the likelihood of decreased renal function (21.1% vs. 4.8%, P=0.03). PICU admissions were also more likely to receive pre-transplant total body irradiation (52.6% vs. 27.6%, P=0.03). Among 29 patients with PICU admission, 3 died on day 1 after admission, and 5 within 30 days (a mortality rate of 17%). Thirty days after PICU admission, non-survivors had a higher incidence of respiratory failure and septic shock on admission compared with survivors (80% vs. 16.7%, P=0.01 and 80% vs. 4.2%, respectively, P=0.001). Two survivors with chronic renal failure underwent renal transplantation successfully.
  
  
  CONCLUSIONS
  Total body irradiation and renal involvement are associated with higher risk for PICU admissions after HSCT in pediatric patients, while septic shock upon admission and post-admission respiratory failure are associated with mortality.
authors.affiliation: Pediatric Critical Care Medicine, Blood and Bone Marrow Transplant, Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI 49503,USA. Nabil.Hassan@helendevoschildrens.org
authors.forename: Nabil E
authors.initials: NE
authors.lastname: Hassan
authors.forename: Aly S
authors.initials: AS
authors.lastname: Mageed
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Sanfilippo
authors.forename: Dianne
authors.initials: D
authors.lastname: Reischman
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Duffner
authors.forename: Surender
authors.initials: S
authors.lastname: Rajasekaran
mesh_terms: D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors