Department of Pediatrics, Division of General Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
Department of Pediatrics, Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
Pediatr Crit Care Med. 2023 Apr 1;24(4):e170-e178. doi: 10.1097/PCC.0000000000003153. Epub 2022 Dec 30.
To describe the prevalence of multiple organ dysfunction syndrome (MODS) and critical care utilization in children and young adults with acute myeloid leukemia (AML) who have not undergone hematopoietic cell transplantation (HCT).
Retrospective cohort study of MODS (defined as dysfunction of two or more organ systems) occurring any day within the first 72 hours of PICU admission.
Large, quaternary-care children's hospital.
Patients 1 month through 26 years old who were treated for AML from 2011-2019.
None.
Eighty patients with AML were included. These 80 patients had a total of 409 total non-HCT-related hospital and 71 PICU admissions. The majority 53 of 71 of PICU admissions (75%) were associated with MODS within the first 72 hours. MODS was present in 49 of 71 of PICU admissions (69%) on day 1, 29 of 52 (56%) on day 2, and 25 of 32 (78%) on day 3. The organ systems most often involved were hematologic, respiratory, and cardiovascular. There was an increasing proportion of renal failure (8/71 [11%] on day 1 to 8/32 [25%] on day 3; p = 0.02) and respiratory failure (33/71 [47%] to 24/32 [75%]; p = 0.001) as PICU stay progressed. The presence of MODS on day 1 was associated with a longer PICU length of stay (LOS) (β = 5.4 [95% CI, 0.7-10.2]; p = 0.024) and over a six-fold increased risk of an LOS over 2 days (odds ratio, 6.08 [95% CI, 1.59-23.23]; p = 0.008). Respiratory failure on admission was associated with higher risk of increased LOS.
AML patients frequently require intensive care. In this cohort, MODS occurred in over half of PICU admissions and was associated with longer PICU LOS. Respiratory failure was associated with the development of MODS and progressive MODS, as well as prolonged LOS.
描述未接受造血细胞移植（HCT）的儿童和青少年急性髓系白血病（AML）患者在入住儿科重症监护病房（PICU）的前 72 小时内发生的多器官功能障碍综合征（MODS）和重症监护利用情况。
对 PICU 入院第一天内任何一天发生的 MODS（定义为两个或多个器官系统功能障碍）进行回顾性队列研究。
大型四级儿童保健医院。
2011 年至 2019 年期间接受 AML 治疗的 1 个月至 26 岁的患者。
无。
共纳入 80 例 AML 患者，这些患者共发生 409 例非 HCT 相关的医院和 71 例 PICU 入院。71 例 PICU 入院中有 53 例（75%）与入住 PICU 的前 72 小时内发生的 MODS 有关。49 例（69%）PICU 入院于第 1 天、29 例（56%）于第 2 天和 25 例（78%）于第 3 天出现 MODS。最常涉及的器官系统是血液学、呼吸和心血管系统。肾功能衰竭的比例逐渐增加（第 1 天 8/71 [11%]至第 3 天 8/32 [25%]；p = 0.02）和呼吸衰竭（第 1 天 33/71 [47%]至第 3 天 24/32 [75%]；p = 0.001）随着 PICU 入住时间的延长。第 1 天出现 MODS 与 PICU 住院时间延长相关（β=5.4[95%CI，0.7-10.2]；p = 0.024）和住院时间超过 2 天的风险增加六倍以上（比值比，6.08[95%CI，1.59-23.23]；p = 0.008）。入院时发生呼吸衰竭与延长 LOS 的风险增加相关。
AML 患者经常需要重症监护。在本队列中，MODS 发生在超过一半的 PICU 入院患者中，与 PICU LOS 延长相关。呼吸衰竭与 MODS 的发展和进行性 MODS以及延长的 LOS 相关。
