Prognostic factors and outcome of pediatric allogeneic hematopoietic stem cell transplant patients admitted in intensive care unit

Abstract

Background : Multiple studies have shown outcome and prognostic factors of mortality for childhood allogeneic hematopoietic stem cell transplantation (HSCT) patients requiring pediatric intensive care unit (PICU) care but there is no such study from India. In our study we analyzed the data in our centre. Methods : Retrospective analysis of data from bone marrow unit and PICU of our hospital was done. We reviewed all charts to find out the indication of admission, outcome and probable prognostic factors. Results : A total of 152 patients underwent allogeneic HSCT in last 2 years. 22 patients were admitted in PICU out of which 17 (77.2%) patients were of non malignant disorders and 5 cases (22.7%) of acute leukemia. Admissions were for various transplant related complications including multiorgan dysfunction syndrome/MODS (40.9%), respiratory distress or failure (40.9%) and neurological complication (18.2%). Total 16 patients (72.7%) expired and 6 were discharged. 1 patient died within 1 month of PICU discharge. Bacterial sepsis and septic shock (43.7%) was the commonest etiology of death followed by disseminated adenovirus infection (18.7%). All of the MODS patients expired and those with only neurological problem were discharged. On statistical analysis delayed neutrophil recovery (p=0.01), MODS (p=0.00), use of vasoactive support (p=0.00), high plasma creatinine (p=0.00), low platelet count (p=0.00) and bacterial septic shock (p=0.02) were important predictor of mortality. Conclusion : In our study, pediatric allogeneic HSCT recipients who were admitted in PICU had high mortality. Sepsis was the one of the commonest etiology for MODS leading to poor outcome. Prevention of sepsis and early transfer in PICU can reduce overall mortality in HSCT patients.