Intensive Care Unit Admissions Among Children After Hematopoietic Stem Cell Transplantation: Incidence, Outcome, and...

Area of Science:

• Pediatric Hematology
• Critical Care Medicine
• Transplantation Immunology

Background:

• Hematopoietic stem cell transplantation (HSCT) is a critical treatment for pediatric diseases.
• Post-transplant complications can be severe, necessitating intensive care.
• Understanding risk factors for pediatric intensive care unit (PICU) admission and survival is crucial.

Purpose of the Study:

• To determine the incidence of life-threatening complications requiring PICU admission in children undergoing HSCT.
• To identify risk factors associated with PICU admission and long-term survival.
• To analyze post-transplantation events in a pediatric cohort.

Main Methods:

• Retrospective analysis of 299 children who underwent HSCT between 2005 and 2011.
• Identification of risk factors for PICU admission and survival using univariate and multivariate analyses.
• Evaluation of specific complications such as engraftment syndrome (ES), graft-versus-host disease (GvHD), and transplant-associated thrombotic microangiopathy (TA-TMA).

Main Results:

• 23% of patients (68/299) required PICU admission.
• Significant risk factors for PICU admission included ES, acute GvHD, TA-TMA, and posterior reversible encephalopathy syndrome (PRES).
• Negative impact on survival was associated with age, allogeneic transplant, engraftment failure, acute GvHD, TA-TMA, and hemorrhagic cystitis.

Conclusions:

• Engraftment syndrome, acute GvHD, TA-TMA, and PRES are significant predictors of PICU admission in pediatric HSCT recipients.
• Age, allogeneic transplant type, engraftment failure, acute GvHD, TA-TMA, and hemorrhagic cystitis negatively affect long-term survival.
• This study provides critical insights into life-threatening complications and survival outcomes in pediatric HSCT.