Risk Factors for Mortality and Pre-ICU Fluid Balance Among Critically Ill Hematopoietic Stem Cell Transplant Patients

Abstract

Objective: To examine if fluid balance surrounding pediatric intensive care unit (PICU) admission in hematopoietic stem cell transplant (HSCT) patients was associated with mortality, ventilator-free days, and intensive care unit (ICU)-free days. To explore other population-specific factors associated with poor outcome. Materials and Methods: Retrospective review of HSCT patients admitted to 2 quaternary PICUs, Children’s Hospital Los Angeles and University of California San Francisco Benioff Children’s Hospital from January 2009 to December 2014. Results: Of 144 patients, 92 were identified with complete fluid balance data available. No difference in fluid balance between survivors and nonsurvivors in the 24 hours preceding PICU admission ( P = .81) or when the first 24 hours of PICU stay were taken into account ( P = .48) was identified. There was no difference in ventilator-free or ICU-free days. Comparing Pediatric Index of Mortality (PIM)-2, Pediatric Risk of Mortality (PRISM)-3, and a multivariable model using independent risk factors identified through multivariable analysis, the receiver operating characteristic plot for the multivariable model (area under the curve = 0.844 [95% confidence interval: 0.77-0.92]) was superior to both PIM-2 and PRISM-3 in discriminating mortality. Conclusions: Fluid balance immediately preceding and early in the course of admission was not associated with mortality in PICU HSCT patients. A subset of variables was identified which better discriminated mortality in this cohort than accepted PICU severity of illness scores.

Prognostic factors and predictive scores for 6-months mortality of hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit

“…Suitable scoring systems for post-HSCT pediatric patients provide a possibility to estimate outcome and the individual mortality risk and may be used to guide clinical decision making. Pediatric Critical Illness Score (PCIS), Pediatric Logistic Organ Dysfunction (PELOD) and the updated version of Pediatric Risk of Mortality (PRISM-3) were of prognostic value for HSCT recipients on PICUs ( 6 , 12 , 13 , 16 ), whereas others such as the Pediatric Multiorgan Dysfunction score (PMOD) or the Pediatric Index of Mortality score (PIM-2) showed conflicting data ( 2 , 6 , 10 , 16 ). The Oncological Pediatric Risk of Mortality (O-PRISM) score was found to be superior to the Pediatric Risk of Mortality score (PRISM) in a number of studies ( 1 ).…”