Post hematopoietic stem cell transplant (HSCT) outcomes in pediatric intensive care unit, experience from a referral center for cellular therapy and hematopoietic stem cell transplantation

Background
Patients who underwent hematopoietic stem cell transplantation (HSCT) are considered at high risk for pediatric intensive care unit (PICU) admission. Therefore, this study aimed to assess outcomes and mortality-related risk factors among pediatric HSCT recipients admitted to the PICU.


Methods
This retrospective cohort study was conducted at a Saudi Arabian tertiary care center and involved pediatric patients (aged 4 weeks to 14 years) who underwent HSCTs between January 2015 and December 2019 and were admitted to the PICU.


Results
Of the 173 pediatric HSCT recipients admitted to the PICU, 65.3% were admitted for respiratory failure. Graft-versus-host disease and chronic infections affected 48.6% and 71.7% of the cases, respectively. Pulmonary hemorrhage and veno-occlusive disease occurred in 15.0% and 32.4% of the patients, respectively. Ventilation and inotropic support were administered to 79.8% and 41.0%, respectively. Acute kidney injury (AKI) occurred in 47.4% of the patients, of which 23.2% required continuous renal replacement therapy/hemodialysis. The PICU survival rate was 59.0% (102/173), and the mortality rate was 41.0% (71/173). In the univariate analysis, chronic infection, pulmonary hemorrhage, ventilation, inotropic support, AKI, higher PRISM III score, and prolonged PICU stay were associated with mortality (P < 0.05). In the multivariable analysis, only prolonged PICU stay (P = 0.016), AKI (P = 0.040), inotropic support (P < 0.001), and ventilation (P = 0.017) showed potential association with mortality.


Conclusion
Early recognition and targeted interventions for these complications are crucial for improving outcomes in this vulnerable population. More research is needed to validate these findings and optimize care practices for HSCT recipients in the PICU setting.