Kim Da Hyun, Ha Eun Ju, Park Seong Jong, Koh Kyung-Nam, Kim Hyery, Im Ho Joon, Jhang Won Kyoung
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Acute Crit Care. 2021 Nov;36(4):380-387. doi: 10.4266/acc.2020.01193. Epub 2021 Nov 26.
Pediatric patients who received hematopoietic stem cell transplantation (HSCT) tend to have high morbidity and mortality. While, the prognostic factors of adult patients received bone marrow transplantation were already known, there is little known in pediatric pateints. This study aimed to identify the prognostic factor for pediatric intensive care unit (PICU) mortality of critically ill pediatric patients with HSCT.
Retrospectively reviewed that the medical records of patients who received HSCT and admitted to PICU between January 2010 and December 2019. Mortality was defined a patient who expired within 28 days.
A total of 131 patients were included. There were 63 boys (48.1%) and median age was 11 years (interquartile range, 4-15 years). The most common HSCT type was haploidentical (38.9%) and respiratory failure (44.3%) was the most common reason for PICU admission. Twenty-eight-day mortality was 22.1% (29/131). In comparison between survivors and non-survivors, the number of HSCTs received, sepsis, oncological pediatric risk of mortality-III (OPRISM-III), pediatric risk of mortality-III (PRISM-III), pediatric Sequential Organ Failure Assessment (pSOFA), serum lactate, B-type natriuretic peptide (BNP) and use of mechanical ventilator (MV) and vasoactive inotropics were significant predictors (P<0.05 for all variables). In multivariate logistic regression, the number of HSCTs received, use of MV, OPRISM-III, PRISM-III and pSOFA were independent risk factors of PICU mortality. Moreover, three scoring systems were significant prognostic factors of 28-day mortality.
The number of HSCTs received and use of MV were more accurate predictors in pediatric patients received HSCT.
接受造血干细胞移植（HSCT）的儿科患者往往具有较高的发病率和死亡率。虽然成人患者接受骨髓移植的预后因素已经为人所知，但儿科患者中了解甚少。本研究旨在确定重症儿科HSCT患者入住儿科重症监护病房（PICU）死亡的预后因素。
回顾性分析2010年1月至2019年12月期间接受HSCT并入住PICU患者的病历。死亡率定义为在28天内死亡的患者。
共纳入131例患者。其中男孩63例（48.1%），中位年龄为11岁（四分位间距，4 - 15岁）。最常见的HSCT类型是单倍体相合移植（38.9%），呼吸衰竭（44.3%）是入住PICU最常见的原因。28天死亡率为22.1%（29/131）。在幸存者和非幸存者之间比较，接受HSCT的次数、脓毒症、儿科肿瘤死亡风险-III（OPRISM-III）、儿科死亡风险-III（PRISM-III）、儿科序贯器官衰竭评估（pSOFA）、血清乳酸、B型利钠肽（BNP）以及使用机械通气（MV）和血管活性正性肌力药物是显著的预测因素（所有变量P<0.05）。在多因素逻辑回归中，接受HSCT的次数、MV的使用、OPRISM-III、PRISM-III和pSOFA是PICU死亡率的独立危险因素。此外，三种评分系统是28天死亡率的显著预后因素。
接受HSCT的次数和MV的使用在儿科HSCT患者中是更准确的预测因素。
