Introduction of the oncological pediatric risk of mortality score (O-PRISM) for ICU support following stem cell transplantation in children

Abstract

Summary:Prognostic scoring systems based on physiological parameters have been established in order to predict the outcome of ICU patients. It has been demonstrated that the predictive value of these scores is limited in patients following hematopoietic stem cell transplantation (HSCT). Therefore, we evaluated patients from the Dü sseldorf pediatric stem cell transplantation center with regard to predisposing factors and prognostic variables for ICU treatment and outcome. Between January 1989 and December 1998, 180 HSCT have been performed. The clinical, laboratory and HSCT-related parameters such as conditioning treatment, engraftment, GVHD, infections and HSCT toxicity were prospectively recorded and retrospectively analyzed. Established pediatric scoring systems (PRISM, TISS, P-TISS) were applied. Twenty-eight patients required intensive care (16 male, 12 female, median age: 10.9 years (range: 0.4 to 18.9 years), five autologous, 13 allogeneic-related and 10 unrelated transplanted patients). Ventilator-dependent respiratory failure was the most frequent cause of admission to the ICU (n ‫؍‬ 23). Fourteen of 28 patients were discharged from ICU, and six of 28 patients achieved a long-term survival (110 to 396 weeks). At admission to the ICU, impaired cardiovascular status, high CRP levels and presence of macroscopic bleeding were each associated with fatal outcome (P Ͻ 0.05). The Pediatric Risk of Mortality (PRISM) score was not prognostically significant at the 0.

Serial evaluation of the oncological pediatric risk of mortality (O-PRISM) score following allogeneic bone marrow transplantation in children

“…[5][6][7][8][9][11][12][13][14] These studies produced variable results, and in most reports, the scores failed to accurately predict the outcome of patients after BMT. [5][6][7]9,[11][12] In addition, the scoring systems showed a tendency to underestimate mortality in the post-BMT setting. 8,12 This may be attributed to the fact that these scoring systems do not take BMTrelated parameters into account.…”

“…15,16 In addition, infection and gastrointestinal hemorrhage have been described as prognostically unfavorable. 5,17 On the basis of these studies, it has been proposed that some of these patients might benefit from earlier intensification of supportive therapy and timely referral to the intensive care unit (ICU). 5,18,19 However, to date there are no validated and standardized clinical parameters that allow early identification of patients who might benefit from early referral.…”

“…5,17 On the basis of these studies, it has been proposed that some of these patients might benefit from earlier intensification of supportive therapy and timely referral to the intensive care unit (ICU). 5,18,19 However, to date there are no validated and standardized clinical parameters that allow early identification of patients who might benefit from early referral. This dilemma is reflected in the significant variability of the proportion of patients referred to ICU follow-ing BMT, which is probably due to different referral strategies in different BMT centers.…”

“…20,21 Led by this consideration, we introduced the Oncological Pediatric Risk of Mortality (O-PRISM) Score, which combines the Pediatric Risk of Mortality (PRISM) score with BMT-related parameters that have been prognostically relevant in the analysis of prognostic factors after referral to ICU (Table 1). 5 In this previous analysis, we evaluated BMT patients at the time of admission to ICU. In this article, we present the data on the serial evaluation of the O-PRISM score in 93 patients after allogeneic BMT, treated at the Düsseldorf Pediatric Stem Cell Transplantation Center during a 10-year period.…”

“…3,4 Considerable research has focused on those patients who require intensive care treatment following BMT, and it has been demonstrated repeatedly that the development of MOD is associated with poor outcome. [3][4][5][6][7][8][9][10][11][12][13][14] In several reports, acute GVHD has been identified as the major risk factor associated with MOD and the need of ICU treatment. 15,16 In addition, infection and gastrointestinal hemorrhage have been described as prognostically unfavorable.…”