Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Pediatr Transplant. 2021 Aug;25(5):e13946. doi: 10.1111/petr.13946. Epub 2020 Dec 12.
We aimed to assess short- and long-term mortality, including factors associated with mortality, for children referred to a pediatric intensive care unit (ICU) at Rigshospitalet, Denmark, following haematopoietic cell transplantation (HCT). Data regarding admission to ICU and mortality following HCT for children below 16 years of age between 2000 and 2017 were retrospectively analyzed. We identified 55 ICU admissions in 39 patients following 46 HCTs. The overall in-ICU, in-hospital, 3-month, and 1-year mortality rates were 33.3%, 43.6%, 46.2%, and 51.3%, respectively. Patients admitted from 2000 to 2010 had a 3-month mortality of 63.2% and 1-year mortality of 68.4%, compared to 30% and 35% (P = .040 and P = .039) for patients admitted from 2011 to 2017. The main reason for ICU admission was respiratory failure (78.2%). Mechanical ventilation (MV) was associated with a higher long-term mortality (P = .044), and use of inotropes or vasopressors was associated with increased mortality at all times (all P > .006). Extracorporeal life support, renal replacement therapy, longer ICU stay, and longer time with MV were not associated with increased mortality. Over the past two decades, mortality was significantly reduced in pediatric HCT patients admitted to the ICU. The cause is probably multifactorial and warrants further studies. Our findings support admissions of critically ill pediatric HCT patients to intensive care with encouraging outcomes of even long-term admissions.
我们旨在评估丹麦里希斯医院接受造血细胞移植（HCT）后转入儿科重症监护病房（ICU）的儿童的短期和长期死亡率，包括与死亡率相关的因素。回顾性分析了 2000 年至 2017 年期间年龄在 16 岁以下接受 HCT 后入住 ICU 和死亡的数据。我们确定了 46 例 HCT 后 39 例患儿中有 55 例入住 ICU。总体 ICU 入住率、住院死亡率、3 个月死亡率和 1 年死亡率分别为 33.3%、43.6%、46.2%和 51.3%。2000 年至 2010 年收治的患者 3 个月死亡率为 63.2%，1 年死亡率为 68.4%，而 2011 年至 2017 年收治的患者 3 个月死亡率为 30%，1 年死亡率为 35%（P=.040 和 P=.039）。入住 ICU 的主要原因是呼吸衰竭（78.2%）。机械通气（MV）与长期死亡率较高相关（P=.044），而使用正性肌力药或血管加压药与所有时间点的死亡率增加相关（均 P>.006）。体外生命支持、肾脏替代疗法、ICU 停留时间较长和 MV 时间较长与死亡率增加无关。在过去的二十年中，接受 ICU 治疗的儿科 HCT 患者的死亡率显著降低。原因可能是多因素的，需要进一步研究。我们的研究结果支持对危重症儿科 HCT 患者进行 ICU 治疗，并对长期入住 ICU 的患者取得了令人鼓舞的结果。
