Work

Factors Influencing Outcomes in Stem Cell Transplanted Patients Admitted to the PICU

Year: 2017

Type: article

Abstract: Introduction/Hypothesis: Stem cell transplantation (SCT) is a lifesaving treatment for malignancies, hematologic and immunologic diseases. Outcome after Pediatric Intensive Care Unit (PICU) admission has been historically very poor, considering it sometimes of medical futility. Survival seems nevertheless to have improved over the last decade. Our objective is to identify factors influencing the outcomes as well as better understand those associated with higher mortality after admission to the PICU, hopefully leading to early interventions to prevent further morbidity and mortality. Methods: Retrospective chart review of patients admitted to the PICU from 2012 to 2016 at Texas Children's Hospital. Descriptive (frequencies) and overall survival analysis were done. Results: We included 88 patients (index admissions) to PICU after SCT with a median age of 6 years. Median time of PICU admission after SCT was 2 days. Causes of transplantation were: malignancies (47), HLH (12) and non-malignancies (29) with most patients receiving an allogeneic transplant (66) from an unrelated matched or mismatched (MM) donor (35), matched or MM related donor (15), haploidentical (15) and umbilical cord blood unit (9). Overall survival (OS) was 75% with HLH being of higher mortality (7 of 12 patients dying after admission). 37 patients with malignancies and 21 with non-malignancies survived after admission. All patients survived on the autologous group. 29 patients required mechanical ventilation (MV) with 10 patients surviving the intervention. MV was the most common PICU intervention. 11 patients required renal replacement therapy (RRT) with 7 patients surviving this intervention. When renal replacement therapy and inotropes were added to MV, their OS markedly decreased . Only 1 of 13 patients survived high frequency oscillatory ventilation (HFVO) use. Conclusions: This study shows outcome improvement in SCT patients over time with about 25% OS. Among multiple factors, the increase use of ICU interventions due to multiple organ failure seems to affect the prognosis the most as well as HLH as initial diagnosis. Surprisingly, the use of renal replacement therapy and inotropes by themselves don't seem to be associated with an higher mortality.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2016.12.197