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KMID : 0604020110260040226
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Korean Journal of Critical Care Medicine
2011 Volume.26 No. 4 p.226 ~ p.231
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Prediction of Prognosis for Children Cared in Intensive Care Unit (ICU) after Hematopoietic Stem Cell Transplantation (HSCT)
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Choi Hye-Sun
Lee Eun-Jung
Lee Jae-Wook
Jang Pil-Sang
Chung Nack-Gyun
Cho Bin
Kim Hack-Ki
Jeong Chang-Mo
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Abstract
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Background: Pediatric Index of Mortality 2 (PIM2) is a useful scoring system for the prediction of prognosis, and Oncological Pediatric Risk of Mortality (O-PRISM) for ICU support in children with HSCT. We investigated prognostic prediction and risk factors for survival through early detection of admission to ICU after HSCT.
Methods: We reviewed retrospectively medical records of children cared for in ICU after HSCT between 2004 and 2010. Patients who died within 2 hours after admittance to ICU were excluded. We analyzed the worst parameters in ICU by a t-test, Cox-regression, multiple logistic regression and a receiver operating characteristics curve (ROC).
Results: 54 children, with fifty-five disease events, were admitted to ICU after HSCT. Sixteen children were diagnosed with high-risk disease status and 8 with non-malignant diseases. Stem cells were sourced from 14 matched siblings, 22 unrelated donors and 19 cord bloods. The median duration in ICU was 8.5 days (0.5?110). The reasons for admission to ICU were 32 pulmonary, 14 neurologic, and 9 hemodynamic events. Six patients (11.1%) survived after intensive care. The factor indicating discharge with survival was mental status (p = 0.04), although other factors included FiO2, prothrombin time, potassium, and pupil reflex in univariate analysis. In multiple logistic regression, there were significant factors of PaCO2 (p = 0.028), O-PRISM (p = 0.039), and PIM2 (p = 0.004) for prognosis. For prediction of prognosis, O-PRISM (p = 0.019) was superior to PIM2 (p = 0.435) in intensive care children after HSCT.
Conclusions: O-PRISM might be a predictable scoring system for children with ICU support, and the Glasgow coma scale and PaCO2 were more reliable prognostic factors in the post-HSCT period.
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KEYWORD
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hematopoietic stem cell transplantation, intensive care, pediatric
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