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Published on: December 5, 2025
Oxygenation index predicts mortality in pediatric stem cell transplant recipients requiring mechanical ventilation
Courtney M Rowan1, Kerry M Hege, Richard H Speicher
1Department of Pediatric Pulmonary, Critical Care and Allergy, Riley Hospital for Children, Indianapolis, IN, USA.
Insights
The Oxygenation Index (OI) can predict mortality in critically ill children after a hematopoietic stem cell transplant (HSCT). A higher OI during mechanical ventilation indicates increased risk of death in these vulnerable patients.
Area of Science:
- Pediatric critical care medicine
- Hematopoietic stem cell transplantation (HSCT)
- Pulmonary complications
Background:
- Mortality remains high in pediatric HSCT recipients, with pulmonary complications posing a significant challenge.
- Early identification of factors predicting mortality is crucial for improving survival rates in this population.
Purpose of the Study:
- To investigate the Oxygenation Index (OI) as a predictor of mortality in critically ill pediatric HSCT recipients.
- To determine the association between OI values and intensive care unit (ICU) mortality.
Main Methods:
- Retrospective review of pediatric HSCT recipients admitted to the ICU between 2002 and 2010.
- Analysis of mechanical ventilation data, including High-Frequency Oscillatory Ventilation (HFOV), and OI values.
- Statistical analysis to assess the association between OI and ICU mortality.
Main Results:
- Seventy percent mortality was observed in mechanically ventilated patients.
- An OI of ≥ 20 was associated with 94% mortality, and an OI of ≥ 25 with 100% mortality.
- Each unit increase in maximum OI during ventilation increased the odds of death by 13% (OR = 1.13, p = 0.03). An OI of 20 demonstrated 89% sensitivity and 83% specificity for predicting mortality.
Conclusions:
- The Oxygenation Index (OI) is a strong predictor of ICU mortality in pediatric HSCT recipients.
- OI monitoring during mechanical ventilation can aid in risk stratification and clinical decision-making for these patients.
- Further research may focus on integrating OI into early warning systems for critically ill pediatric HSCT patients.
Abstract:
The mortality in the ICU for pediatric HSCT recipients remains high. Early pulmonary complications continue to be an obstacle to the survival. We hypothesize OI is a predictor for mortality in critically ill pediatric HSCT recipients. Retrospective review of pediatric HSCT recipients between 2002 and 2010 who required intensive care during the same hospital admission as their transplant. Twenty-eight patients accounted for 31 ICU admissions. Twenty-six (84%) admissions required mechanical ventilation. Ten (38%) mechanically ventilated admissions were placed on HFOV. Mortality of those mechanically ventilated was 70%. An OI ≥ 20 at any point during ventilation was associated with 94% mortality, while an OI ≥ 25 had 100% mortality. There was a significant association between maximum OI at any point during mechanical ventilation and ICU mortality, with the odds of dying increasing by 13% for each unit increase of max OI (OR = 1.13, 95% CI = 1.01-1.26, p = 0.03). An OI of 20 had a sensitivity of 0.89 and specificity of 0.83 for predicting mortality. OI has a strong association with ICU mortality among pediatric stem cell recipients.
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