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  • Title: Prognosis of child recipients of hematopoietic stem cell transplantation requiring intensive care.
    Author: Lamas A, Otheo E, Ros P, Vázquez JL, Maldonado MS, Muñoz A, Martos I.
    Journal: Intensive Care Med; 2003 Jan; 29(1):91-6. PubMed ID: 12528028.
    Abstract:
    OBJECTIVE: To determine prognostic factors in child recipients of hematopoietic stem cell transplantation from blood or bone marrow (BMT) requiring critical care. DESIGN: Retrospective study of a cohort of patients. SETTING: Pediatric Intensive Care Unit (PICU) in a university tertiary care center. PATIENTS AND PARTICIPANTS: Child recipients of BMT requiring PICU admission. MEASUREMENTS AND 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.
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