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Published on: May 19, 2023
Critical Care Outcomes in Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Pediatric Intensive Care
Emel Uyar1, Gamze Gürsoy2, İkbal Ok Bozkaya3
1Department of Pediatric Intensive Care, Bilkent City Hospital, Ankara, Turkey.
Insights
Pediatric hematopoietic stem cell transplantation (HSCT) patients admitted to the pediatric intensive care unit (PICU) have a high mortality rate. Early intervention for organ failure and appropriate respiratory support are critical for survival.
Area of Science:
- Pediatric intensive care
- Hematopoietic stem cell transplantation
- Critical care medicine
Background:
- Hematopoietic stem cell transplantation (HSCT) is a vital pediatric treatment, but recipients face significant risks, often necessitating pediatric intensive care unit (PICU) admission.
- Identifying mortality predictors in these vulnerable patients is crucial for enhancing outcomes.
- This study investigates the characteristics and outcomes of pediatric HSCT patients requiring PICU care.
Purpose of the Study:
- To evaluate clinical features, risk factors, and outcomes of pediatric HSCT patients admitted to the PICU.
- To identify predictors of mortality in this high-risk population.
- To assess the impact of organ failure and supportive therapies on patient survival.
Main Methods:
- A retrospective, single-center study analyzed pediatric HSCT recipients admitted to a tertiary PICU from August 2019 to October 2023.
- Patients with PICU stays under 24 hours were excluded.
- Logistic regression identified independent risk factors for mortality.
Main Results:
- The study included 40 pediatric HSCT recipients admitted to the PICU, with an 80% mortality rate.
- Sepsis, respiratory failure, and multiple organ dysfunction syndrome (MODS) were primary admission reasons.
- High PELOD scores predicted mortality; all patients needing mechanical ventilation, inotropes, or renal replacement therapy died, while non-invasive ventilation correlated with survival.
Conclusions:
- Organ failure is a major determinant of mortality in pediatric HSCT patients requiring intensive care.
- Proactive monitoring and early intervention are essential for improving outcomes.
- Structured post-HSCT surveillance, especially for those with prior PICU admissions, is vital for early detection of organ dysfunction and optimizing critical care.
Background:
Hematopoietic stem cell transplantation (HSCT) has become an essential curative strategy for various malignant and non-malignant pediatric diseases. However, HSCT recipients remain highly vulnerable to complications, often requiring pediatric intensive care unit (PICU) admission. Identifying key risk factors and predictors of mortality is crucial for improving patient outcomes. This study aims to evaluate the clinical characteristics, risk factors, and outcomes of pediatric HSCT patients requiring PICU admission, focusing on organ failure, respiratory and cardiovascular dysfunction, and the impact of supportive therapies.
Methods:
This retrospective, single-center study included pediatric HSCT recipients admitted to a tertiary PICU between August 2019 and October 2023. Patients with PICU stays shorter than 24 h were excluded. Clinical and demographic characteristics, HSCT-related parameters, PICU admission criteria, and patient outcomes were analyzed. Logistic regression models were applied to identify independent risk factors associated with mortality.
Results:
Among 40 HSCT recipients requiring PICU admission, the overall mortality rate was 80%, exceeding previously reported rates. Sepsis, respiratory failure, and multiple organ dysfunction were the primary reasons for admission. Elevated PELOD scores were strong predictors of mortality. All patients requiring mechanical ventilation, inotropic support, or renal replacement therapy died (p < 0.001), whereas all patients managed with non-invasive ventilation survived, underscoring the importance of early and appropriate respiratory support.
Conclusion:
Organ failure significantly impacts mortality in pediatric HSCT recipients, emphasizing the need for early intervention and proactive monitoring. Structured post-HSCT surveillance, particularly for patients with prior PICU admissions, is critical for identifying early signs of organ dysfunction and optimizing intensive care management.
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