Variables Affecting Mortality in Hematopoietic Stem Cell Transplanted Patients Requiring Admission to Pediatric Intensive Care

Brió-Sanagustin S, Fraga-Rodríguez G, Badell-Serra I, Coca-Fernández E, Rodríguez-Martínez M, Burgueño-Rico R, Castillo-Gómez F, López-Torija I, Boronat-Guerrero S

1Hospital de la Santa Creu i Sant Pau (HSCSP) and Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU) Barcelona, Universitat Autònoma Barcelona, Spain
2Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain

^*Correspondance to: Sonia Brió Sanagustin 

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Abstract:

Introduction: Mortality is high for pediatric patients undergoing allogeneic Hematopoietic Stem Cell Transplantation (HSCT) who require admission to the Pediatric Intensive Care Unit (PICU).
Objective: The primary objective of this study was to describe and analyze risk factors for PICU admission in patients undergoing allogeneic HSCT and to investigate the factors associated with a poorer prognosis. Secondary objectives were to determine clinical characteristics, reasons for admission, and evolution of admitted patients, and evolution parameters associated with a poor
prognosis.
Design: Observational, retrospective, descriptive, analytical study. Between 2008 and 2017, 132 allogeneic HSCT interventions were performed at Hospital de Santa Creu i Sant Pau (Barcelona) in 112 patients, 54 (48.2%) of whom (accounting for 68 transplants) required PICU admission. Data was evaluated on patient demographics, HSCT, and health status on PICU admission and during PICU stay.
Results: The overall actuarial survival rate was 41.7% at 12 years. Of the 54 patients who required PICU admission, the main reasons were respiratory failure (41.1%), followed by neurological (22.7%) or hemodynamic (21.2%) disorders, and kidney (6.0%) or liver (6.0%) failure. Admission was associated with an infectious process in 71.2% of cases. On PICU admission, the univariate analysis showed significantly increased weight (p=0.007), creatinine (p=0.007), bilirubin (p<0.001), and international normalized ratio (p<0.001) values, and a significantly decreased glomerular filtration rate (p<0.001). Lower survival was associated with the O-PRISM (p=0.018), pSOFA (p=0.018), PELOD (p=0.010), and PIM-3 (p=0.015) prognostic scale scores, the SatO2/FiO2 ratio (p=0.004), and the need for invasive (p=0.010) or non-invasive (p=0.021) mechanical ventilation. Greater mortality was associated with vasoactive support (p=0.01), inotropic support (p=0.03), and maximum acute kidney injury (KDIGO-3) (p=0.036). Significant in the multivariate analysis for PICU admission were the O-PRISM (OR=8.162, p=0.004) and KDIGO-3 (OR=6.008, p=0.036) scores.
During PICU stay, significantly higher mortality was associated with the need for mechanical ventilation (invasive, p<0.001; non-invasive, p=0.001; high-frequency, p<0.001) and administration of inhaled nitric oxide (p<0.001). A poor prognosis was associated with pneumonia (p=0.036), acute respiratory distress syndrome (p<0.001), pneumothorax (p=0.028), pulmonary hemorrhage
(p=0.008), cardiac massage (p<0.001), inotropic/vasoactive support (p<0.001), septic shock (p=0.008), hemorrhagic shock (p<0.001), and arrhythmias (p<0.001). Acute kidney injury (p=0.002), dialysis (p<0.001), a low Glasgow Coma Scale (GCS) score (p<0.001), and cerebral hemorrhaging (p=0.028) were associated with increased mortality. Significant in the multivariate analysis for PICU stay were infection (OR=9.284, p=0.017) and a low GCS score (OR=10.704, p=0.001).
Conclusion: Our findings can help identify which allogeneic HSCT patients have a higher risk of mortality on PICU admission and during PICU stay. Identifying patients at greater risk can contribute to slowing the progression of critical illness while still reversible, and even to adjusting procedures and avoiding medication overuse during PICU stay.

Keywords:

Stem cell transplantation; Pediatric intensive Care; Prognostic factors

Cite the Article:

Brió-Sanagustin S, Fraga-Rodríguez G, Badell-Serra I, Coca-Fernández E, Rodríguez-Martínez M, Burgueño-Rico R, et al. Variables Affecting Mortality in Hematopoietic Stem Cell Transplanted Patients Requiring Admission to Pediatric Intensive Care.
Clin Oncol. 2023;8:1990..