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Lower hospital mortality and complications after pediatric hematopoietic stem cell transplantation
Susan L Bratton1, Heather Van Duker, Kimberly D Statler
1University of Utah School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, USA. Susan.Bratton@hsc.utah.edu
Insights
Pediatric hospital mortality after hematopoietic stem cell transplantation (HSCT) decreased significantly, with reduced complications. However, allogeneic HSCT and cord blood transplants remain high-risk procedures.
Area of Science:
- Pediatric Hematology
- Transplantation Medicine
- Clinical Outcomes Research
Background:
- Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric hematologic and oncologic conditions.
- Assessing mortality risk factors and trends in pediatric HSCT is crucial for improving patient survival.
- Hospital mortality rates and associated complications require continuous evaluation.
Purpose of the Study:
- To identify protective and risk factors for mortality in pediatric patients undergoing HSCT.
- To evaluate changes in hospital mortality rates over time following HSCT.
- To analyze the impact of different HSCT types and complications on patient outcomes.
Main Methods:
- Retrospective cohort study utilizing the 1997, 2000, and 2003 Kids Inpatient Database.
- Analysis included pediatric patients (<19 years) hospitalized in the United States with HSCT procedure codes.
- Statistical analysis assessed mortality risk factors, including HSCT type, mechanical ventilation, dialysis, and sepsis.
Main Results:
- Hospital mortality significantly decreased from 12% in 1997 to 6% in 2003.
- Allogeneic HSCT without T-cell depletion and cord blood HSCT were associated with increased mortality risk.
- Mechanical ventilation, dialysis, and sepsis were independently associated with higher mortality risk.
Conclusions:
- Hospital mortality and key complications (graft-versus-host disease, sepsis, mechanical ventilation) have decreased post-pediatric HSCT.
- Preventing complications remains critical, as invasive support is linked to elevated mortality.
- Ongoing research and improved care strategies are essential for further reducing mortality in pediatric HSCT.
Objective:
To assess protective and risk factors for mortality among pediatric patients during initial care after hematopoietic stem cell transplantation (HSCT) and to evaluate changes in hospital mortality.
Design:
Retrospective cohort using the 1997, 2000, and 2003 Kids Inpatient Database, a probabilistic sample of children hospitalized in the United States with a procedure code for HSCT.
Setting:
Hospitalized patients in the United States submitted to the database.
Patients:
Age, <19 yrs.
Interventions:
None.
Measurements And Main Results:
Hospital mortality significantly decreased from 12% in 1997 to 6% in 2003. Source of stem cells changed with increased use of cord blood. Rates of sepsis, graft versus host disease, and mechanical ventilation significantly decreased. Compared with autologous HSCT, patients who received an allogenic HSCT without T-cell depletion were more likely to die (adjusted odds ratio, 2.4; 95% confidence interval, 1.5, 3.9), while children who received cord blood HSCT were at the greatest risk of hospital death (adjusted odds ratio, 4.8; 95% confidence interval, 2.6, 9.1). Mechanical ventilation (adjusted odds ratio, 26.32; 95% confidence interval, 16.3-42.2), dialysis (adjusted odds ratio, 12.9; 95% confidence interval, 4.7-35.4), and sepsis (adjusted odds ratio, 3.9; 95% confidence interval, 2.5-6.1) were all independently associated with death, while care in 2003 was associated with decreased risk (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.7) of death.
Conclusions:
Hospital mortality after HSCT in children decreased over time as did complications including need for mechanical ventilation, graft versus host disease, and sepsis. Prevention of complications is essential as the need for invasive support continues to be associated with high mortality risk.
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