Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12857/116018
Title: Risk Factors and Outcomes Related to Pediatric Intensive Care Unit Admission after Hematopoietic Stem Cell Transplantation: A Single-Center Experience
Authors: Pillon, Marta 
Amigoni, Angela 
Contin, Annaelena
Cattelan, Manuela 
Carraro, Elisa 
Campagnano, Emiliana
Tumino, Manuela 
Calore, Elisabetta 
Marzollo, Antonio 
Mainardi, Chiara 
Boaro, Maria Paola 
Nizzero, Marta
Pettenazzo, Andrea 
Basso, Giuseppe 
Messina, Chiara 
Keywords: Bone marrow transplantation;Hematopoietic stem cell transplantation;Mortality;Outcome;Pediatric intensive care unit;Risk factors
Keywords Plus: CHILDREN REQUIRING ADMISSION;BONE-MARROW-TRANSPLANTATION;IDIOPATHIC PNEUMONIA;PROGNOSTIC-FACTORS;MECHANICAL VENTILATION;MORTALITY;RECIPIENTS;SUPPORT;DISEASE;ONCOLOGY
Mesh headings: Critical Care;Hematopoietic Stem Cell Transplantation;Multiple Organ Failure;Patient Admission;Respiratory Insufficiency;Shock, Septic
Secondary Mesh headings: Adolescent;Adult;Allografts;Child;Child, Preschool;Disease-Free Survival;Female;Humans;Incidence;Infant;Male;Retrospective Studies;Risk Factors;Survival Rate
Issue Date: Aug-2017
Publisher: ELSEVIER SCIENCE INC
Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 
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.
URI: http://hdl.handle.net/20.500.12857/116018
ISSN: 10838791
DOI: 10.1016/j.bbmt.2017.04.016
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