Pediatric Hematopoietic Cell Transplant Patients Who Survive Critical Illness Frequently Have Significant but Recoverable Decline in Functional Status.

Pediatric Hematopoietic Cell Transplant Patients Who Survive Critical Illness Frequently Have Significant but Recoverable Decline in Functional Status.

Biol Blood Marrow Transplant. 2017 Nov 08;:

Authors: Zinter MS, Holubkov R, Steurer MA, Dvorak CC, Duncan CN, Sapru A, Tamburro RF, McQuillen PS, Pollack MM

Abstract
BACKGROUND: The number of pediatric hematopoietic cell transplant (HCT) patients who survive pediatric intensive care unit (PICU) admission is increasing, yet little is known about their functional morbidity after PICU discharge. We hypothesized that relative to controls, pediatric HCT patients who survive PICU admission would have greater rates of new functional morbidity at the time of PICU discharge, and only a minority of these patients would return to their functional baseline by the end of the hospitalization.
METHODS: We performed a retrospective cohort study with secondary data analysis of the Trichotomous Outcomes in Pediatric Critical Care (TOPICC) dataset. The pediatric HCT cohort was identified by querying ICD-9 diagnostic codes. A control group consisted of previously healthy patients matched 4:1 on age, sex, and illness severity, as estimated by the Pediatric Risk of Mortality (PRISM) score. We benchmarked our findings by comparing to a previously healthy group of children with lower respiratory tract infections. Functional impairment was measured by the Functional Status Scale, wherein new morbidity was defined as an increase of ≥3 points relative to the pre-hospital baseline.
RESULTS: Relative to matched controls, HCT patients had similar admission PRISM score (p=0.516) but greater PICU mortality (12.9% [11/85] vs. 6.2% [21/340], p=0.035). However, among those who survived to PICU discharge, HCT patients had similar rates of new morbidity at PICU discharge (14.9% [11/74] vs. 17.2% [55/319], p=0.622) and similar rates of resolution of new morbidity by hospital discharge (54.5% [6/11] vs. 60.0% [33/55], p=0.737). Relative to the LRTI comparison group, HCT patients had both greater admission PRISM score (p<0.001) and greater PICU mortality (12.9% [11/85] vs. 1.6% [5/308], p<0.001). However, among those who survived to PICU discharge, HCT patients again displayed similar rates of new morbidity at PICU discharge (14.9% [11/74] vs 22.1% [67/303], p=0.168) as well as resolution of new morbidity by hospital discharge (54.5% [6/11] vs. 71.6% [48/67], p=0.299).
CONCLUSIONS: For pediatric HCT patients, PICU survival with new functional morbidity is as prevalent an outcome as PICU mortality. Although pediatric HCT patients have greater PICU mortality than age-, sex-, and PRISM-matched controls, they have similar rates of new functional morbidity at PICU discharge and similar resolution of new functional morbidity at hospital discharge. Future interventions focused on improving functional status in pediatric HCT survivors of critical illness are warranted.

PMID: 29128553 [PubMed - as supplied by publisher]

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