‘Sepsis’ and multi-organ failure: predictors of poor outcome after hematopoietic stem cell transplantation in children

Abstract

Prognostic scores, such as the PRISM and APACHE II, have been established, predicting with reasonable accuracy the outcome of patients admitted to intensive care units (ICU). In keeping with previous reports, we found, however, that these scores failed to perform in a series of 28 recipients of hematopoietic auto- or allografts (BMT) who required ICU admission for reasons including respiratory (82%) and multi-organ (36%) failure. We therefore retrospectively analyzed the charts of these patients, evaluating predisposing factors and prognostic variables which might confound the validity of these ICU tools which in other clinical scenarios have proven so valuable. Of all the parameters tested, logistic analysis established the following as predictors for poor outcome: increased C-reactive protein (CRP) to > 10 mg/dl (P = 0.04), macroscopic hemorrhage (P = 0.04), hypotension (mean arterial pressure < normal) (P = 0.04) and GVHD > or = III (P = 0.002). Most of these factors are not accounted for by the standard prognostic questionnaires. The development of an 'oncological' or 'post-BMT' risk of mortality score, taking into account these patients' specific clinical problems, might improve the risk assessment for this patient group, and might thus facilitate the timely recognition of those patients most in need of more intensive therapeutic measures.

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

“…In this context, prognostic scoring systems such as the PRISM and APACHE score have been repeatedly evaluated, and most studies have focused on patients who required referral to ICU after BMT. [3][4][5][6][7][8][9][10][11][12][13][14] In these studies, the scores have been calculated only once at referral to ICU, and there are no data available from the literature concerning these scores early after transplantation in the non-ICU setting. The analyses mentioned yielded variable results with regard to prognosis following referral to ICU as did the prognostic scores.…”

“…[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.…”

“…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.…”

Diagnostic and Prognostic Value of Biochemical Markers of Infectious Complications of High-Dose Therapy with Autologous Hematopoietic Stem Cell Transplantation in Malignant Lymphoproliferative Diseases

“…Эти данные не соотносятся с результатами, полу-ченными в ряде других исследований [5,6,[11][12][13][14], в которых СРБ и ПКТ имели и прогностическое, и диагностическое значение. Однако в доступной ли-тературе имеется и противоположная точка зрения, совпадающая на данном этапе исследования с нашей, согласно которой повышенные значения СРБ и ПКТ не коррелируют с развитием инфекции у больных в период нейтропении [10,12,18].…”

“…В дальнейших исследованиях показана про-гностическая значимость СРБ. Так, в одной из работ, опубликованных в 2000 г., показатель СРБ > 100 мг/л коррелировал с плохим прогнозом у пациентов после Маркеры инфекционных осложнений ВДХТ с аутоТГСК трансплантации, переведенных в отделение реани-мации с диагнозами «сепсис» или «полиорганная не-достаточность» [6]. K. Yonemori и соавт., исследуя СРБ, напротив, не увидели прогностического значения маркера [7].…”