title: Risk Factors Associated with Severity and Outcomes in Pediatric Patients with Hemorrhagic Cystitis.
abstract: OBJECTIVE
  Hemorrhagic cystitis is a complication of treatment of pediatric cancer with considerable variation in severity and morbidity. This study presents an analysis of hemorrhagic cystitis severity and treatment outcomes in a large pediatric population.
  
  
  METHODS
  Patients with hemorrhagic cystitis treated at St. Jude Children's Research Hospital® were identified from 1990 to 2010. Demographic data were gathered along with information pertaining to initial primary diagnosis, hemorrhagic cystitis diagnosis and treatment, and mortality. Statistical analyses were performed to evaluate associations between risk factors and severity of hemorrhagic cystitis as well as treatment outcomes.
  
  
  RESULTS
  Of the 285 patients who met inclusion criteria 54% were male. Mean age was 11.41 years. Mean time from initial primary diagnosis to hemorrhagic cystitis onset was 29 months. Noninvasive treatment was performed in 246 patients (86%) and operative intervention was required in 14 (4.9%). Bivariate analysis demonstrated that pelvic radiation therapy (p = 0.0002), any radiation therapy (p = 0.005), acute lymphocytic leukemia (p = 0.01), bone marrow transplantation (p = 0.0225), cyclophosphamide exposure (p = 0.0419) and BK virus positivity (p = 0.0472) were predictors of higher grade hemorrhagic cystitis. Factors correlating with the need for invasive management on bivariate analysis included pelvic radiation therapy (p = 0.0266), bone marrow transplantation (p = 0.0007), hematological malignancy (p = 0.0066), ifosfamide exposure (p = 0.0441) and male gender (p = 0.0383). Multivariate analysis showed independent effects of pelvic radiation therapy (p = 0.001) and delayed onset of hemorrhagic cystitis (p = 0.0444).
  
  
  CONCLUSIONS
  Severity of hemorrhagic cystitis and failure of noninvasive management correlate with several identifiable risk factors. Prospective identification of patients with these risk factors may allow for targeted early intervention in those at highest risk.
authors.affiliation: Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Derrick
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Elleson
authors.initials: E
authors.lastname: Schurtz
authors.affiliation: Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tourville
authors.affiliation: Department of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Children's Foundation Research Institute, Memphis, Tennessee.
authors.forename: Tamekia
authors.initials: T
authors.lastname: Jones
authors.affiliation: Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Allison
authors.initials: A
authors.lastname: Boemer
authors.affiliation: Division of Urology, Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Division of Pediatric Urology, Department of Urology, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: danagiel@gmail.com.
authors.forename: Dana
authors.initials: D
authors.lastname: Giel
mesh_terms: D002648:Child; D003556:Cystitis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: cystitis; hemorrhage; risk factors; treatment failure; urinary bladder