Rowan Courtney M, Nitu Mara E, Moser Elizabeth A S, Swigonski Nancy L, Renbarger Jamie L
Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26561. Epub 2017 Apr 25.
Respiratory failure in the pediatric hematopoietic cell transplant (HCT) recipient is the leading cause for admission to the intensive care unit and carries a high mortality rate. The objective of this study is to investigate the association of clinical risk factors with the development of respiratory failure in the pediatric allogeneic HCT recipient.
This is a single-center, retrospective review of allogeneic pediatric HCT from 2008 to 2014. Multiple variables were examined. The primary outcome was respiratory failure. Percent weight gain was investigated at multiple time points. Bivariate and multivariate regression was used.
Of the 87 allogeneic HCT recipients, 22 (25%) developed respiratory failure. Mortality for entire cohort was 13.8%. All who died were intubated prior to death. The group with respiratory failure had significantly higher percent weight gain increase at multiple time points: peak weight prior to discharge or intubation (P = 0.008), weight at discharge or intubation (P = .001), and weight at day 43 (median day for intubation) (P = 0.02). Odds ratio (OR) for respiratory failure increased with increasing percentage peak weight gain: 10% increase (3.1 [1.1, 9.0]), 15% increase (4.1 [1.5, 11.2]), and 20% (8.3 [2.4. 28.9]). Fifty percent of all patients required supplemental O . OR for respiratory failure in patients requiring more than 1 l supplemental O is 25.3 (6.5, 98.7).
Percent weight gain and need for supplemental oxygen is highly associated with the development of respiratory failure in pediatric HCT recipients, representing predictors of acute respiratory failure in pediatric HCT. These data could be incorporated into an algorithm that should be developed, implemented, and validated in a prospective, multicenter fashion.
小儿造血细胞移植（HCT）受者发生呼吸衰竭是入住重症监护病房的主要原因，且死亡率很高。本研究的目的是调查临床危险因素与小儿异基因HCT受者呼吸衰竭发生之间的关联。
这是一项对2008年至2014年小儿异基因HCT进行的单中心回顾性研究。检查了多个变量。主要结局是呼吸衰竭。在多个时间点调查体重增加百分比。采用双变量和多变量回归分析。
87例异基因HCT受者中，22例（25%）发生呼吸衰竭。整个队列的死亡率为13.8%。所有死亡患者在死亡前均已插管。发生呼吸衰竭的组在多个时间点的体重增加百分比显著更高：出院或插管前的峰值体重（P = 0.008）、出院或插管时的体重（P = 0.（此处原文有误，推测为0.001））以及第43天（插管的中位天数）的体重（P = 0.02）。呼吸衰竭的比值比（OR）随着峰值体重增加百分比的增加而升高：增加10%（3.1 [1.1, 9.0]）、增加15%（4.1 [1.5, 11.2]）和增加20%（8.3 [2.4, 28.9]）。所有患者中有50%需要补充氧气。需要补充超过1升氧气的患者发生呼吸衰竭的OR为25.3（6.5, 98.7）。
体重增加百分比和补充氧气的需求与小儿HCT受者呼吸衰竭的发生高度相关，是小儿HCT急性呼吸衰竭的预测指标。这些数据可纳入一个算法中，该算法应以前瞻性、多中心的方式进行开发、实施和验证。
