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

Abstract

Summary:The O-PRISM score was introduced for risk assessment in children transferred to intensive care following BMT. The aim of this study is to determine the prognostic value of a serial evaluation of the O-PRISM score. Ninety-three children, 58 allogeneic-related and 35 unrelated BMT, were evaluated. At weekly intervals, the O-PRISM was calculated based on the standard PRISM score and the three additional variables CRP, GVHD and hemorrhage. Overall survival was 0.51 ؎ 0.05 (48/93 patients). Seventeen children died of recurrent disease and 28 of BMTrelated complications. High O-PRISM scores significantly correlated with adverse outcome. The relative risks of DOC of patients with scores у10 compared to patients with lower scores were: day 0: 3.9 (95% confidence-interval: 1.1-13.7, P = 0.02), day 7: 2.0 (0.7-6.2, P = 0.20), day 14: 5.2 (1.9-14.0, P = 0.001), day 21: 5.6 (1.9-16.5, P = 0.001), day 28: 11.5 (3.8-100.9, P Ͻ 0.001), day 35: 7.3 (1.9-27.7, P = 0.001). As early as day 0, children with scores у10 points showed a higher cumulative incidence of DOC than patients with lower scores (0.69 ؎ 0.15 vs 0.27 ؎ 0.05, P = 0.02). The O-PRISM score represents a useful clinical parameter for serial risk assessment following BMT. As it indicates fatal events early, it may be helpful for parent information and even more for the early establishment of intensified supportive treatment. The O-PRISM score may therefore be a valuable parameter for the evaluation of different strategies for BMT and supportive treatment.

Surveillance of nosocomial infections in paediatric recipients of bone marrow or peripheral blood stem cell transplantation during neutropenia, compared with adult recipients

“…20,21 More than half our patients had at least one serious, potentially life-threatening infection. These infections have to be regarded as NIs.…”

Validation of the Pediatric Index of Mortality 3 in a Single Pediatric Intensive Care Unit in Korea

“…A general mortality prediction model might be inappropriate for use with patients in specialized oncological ICUs. Instead, a disease-specific scoring system, reflecting specific prognosis, might be more useful (27). …”

Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit*

“…The O-PRISM score which was specifically developed as a prognostic score for PICU survival among pediatric HSCT patients includes CRP as one of only three variables added to the traditional PRISM score (31). In a subsequent paper from the group that developed the O-PRISM score, CRP levels that remained elevated after leukocyte engraftment (day ϩ 28 and beyond) correlated with poor prognosis, whereas temporarily high CRP levels during marrow aplasia did not significantly affect outcome (32). Similarly, in our cohort, higher CRP at CRRT end was associated with an increased risk of death.…”