Risk factors associated with pediatric intensive care unit admission and mortality after pediatric stem cell transplant: possible role of renal involvement

Nabil E Hassan, Aly S Mageed, Dominic J Sanfilippo, Dianne Reischman, Ulrich A Duffner, Surender Rajasekaran

Michigan, USA

Author Affiliations: Pediatric Critical Care Medicine, Blood and Bone Marrow Transplant, Helen DeVos Children's Hospital, USA (Hassan NE, Mageed AS, Sanfilippo DJ, Reischman D, Duffner UA, Rajasekaran S)

Corresponding Author: Nabil Hassan, MD, Helen DeVos Children's Hospital, 100 Michigan St NE, MC# 117, Grand Rapids MI 49503, USA (Tel: 616-267-0115; Fax: 616-267-0090; Email: Nabil.Hassan@helendevoschildrens.org)

doi: 10.1007/s12519-012-0391-z

Background: Hematopoietic stem-cell transplant (HSCT) is associated with many risk factors for life-threatening complications. Post-transplant critical illness often requires admission to the pediatric intensive care unit (PICU).

Methods: A retrospective analysis was made on the risk factors associated with PICU admission and mortality of all HSCT patients at Helen DeVos Children's Hospital from October 1998 to November 2008.

Results: One hundred and twenty-four patients underwent HSCT, with 19 (15.3%) requiring 29 PICU admissions. Fifty patients received autologous, 38 matched sibling, and 36 matched un-related donor HSCT, with 10%, 13% and 25% of these patients requiring PICU admission, respectively (P=0.01). Among the HSCT patients, those who were admitted to the PICU were more likely to have renal involvement by either malignancy requiring nephrectomy or a post transplant complication increasing the likelihood of  decreased renal function (21.1% vs. 4.8%, P=0.03). PICU admissions were also more likely to receive pre-transplant total body irradiation  (52.6% vs. 27.6%, P=0.03). Among 29 patients with PICU admission, 3 died on day 1 after admission, and 5 within 30 days (a mortality rate of 17%). Thirty days after PICU admission, non-survivors had a higher incidence of respiratory failure and septic shock on admission compared with survivors (80% vs. 16.7%, P=0.01 and 80% vs. 4.2%, respectively, P=0.001). Two survivors with chronic renal failure underwent renal transplantation successfully.

Conclusions: Total body irradiation and renal involvement are associated with higher risk for PICU admissions after HSCT in pediatric patients, while septic shock upon admission and post-admission respiratory failure are associated with mortality.

Key words: hematopoietic stem-cell transplant; intensive care; renal complications

World J Pediatr 2013;9(2):140-145