Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission after Hematopoietic Stem Cell Transplantation: A Single-Center Experience

Marta Pillon; Angela Amigoni; Annaelena Contin; Manuela Cattelan; Elisa Carraro; Emiliana Campagnano; Manuela Tumino; Elisabetta Calore; Antonio Marzollo; Chiara Mainardi; Maria Paola Boaro; Marta Nizzero; Andrea Pettenazzo; Giuseppe Basso; Chiara Messina

doi:10.1016/j.bbmt.2017.04.016

Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission after Hematopoietic Stem Cell Transplantation: A Single-Center Experience

Biol Blood Marrow Transplant. 2017 Aug;23(8):1335-1341. doi: 10.1016/j.bbmt.2017.04.016. Epub 2017 Apr 28.

Authors

Affiliations

¹ Pediatric Hematology and Oncology, Department of Woman's and Child's Health, University-Hospital of Padua, Padua, Italy. Electronic address: marta.pillon@unipd.it.
² Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital of Padua, Padua, Italy.
³ Pediatric Hematology and Oncology, Department of Woman's and Child's Health, University-Hospital of Padua, Padua, Italy.
⁴ Department of Statistical Sciences, University of Padua, Padua, Italy.

PMID: 28461212
DOI: 10.1016/j.bbmt.2017.04.016

Abstract

To describe incidence, causes, and outcomes related to pediatric intensive care unit (PICU) admission for patients undergoing hematopoietic stem cell transplantation (HSCT), we investigated the risk factors predisposing to PICU admission and prognostic factors in terms of patient survival. From October 1998 to April 2015, 496 children and young adults (0 to 23 years) underwent transplantation in the HSCT unit. Among them, 70 (14.1%) were admitted to PICU. The 3-year cumulative incidence of PICU admission was 14.3%. The main causes of PICU admission were respiratory failure (36%), multiple organ failure (16%), and septic shock (13%). The overall 90-day cumulative probability of survival after PICU admission was 34.3% (95% confidence interval, 24.8% to 47.4%). In multivariate analysis, risk factors predisposing to PICU admission were allogeneic HSCT (versus autologous HSCT, P = .030) and second or third HSCT (P = .018). Characteristics significantly associated with mortality were mismatched HSCT (P = .011), relapse of underlying disease before PICU admission (P < .001), acute respiratory distress syndrome at admission (P = .012), hepatic failure at admission (P = .021), and need for invasive ventilation during PICU course (P < .001). Our data indicate which patients have a high risk for PICU admission after HSCT and for dismal outcomes after PICU stay. These findings may provide support for the clinical decision-making process on the opportunity of PICU admission for severely compromised patients after HSCT.

Keywords: Bone marrow transplantation; Hematopoietic stem cell transplantation; Mortality; Outcome; Pediatric intensive care unit; Risk factors.

Publication types

Clinical Trial

MeSH terms

Adolescent
Adult
Allografts
Child
Child, Preschool
Critical Care*
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation*
Humans
Incidence
Infant
Male
Multiple Organ Failure* / etiology
Multiple Organ Failure* / mortality
Multiple Organ Failure* / therapy
Patient Admission*
Respiratory Insufficiency* / etiology
Respiratory Insufficiency* / mortality
Respiratory Insufficiency* / therapy
Retrospective Studies
Risk Factors
Shock, Septic* / etiology
Shock, Septic* / mortality
Shock, Septic* / therapy
Survival Rate