Hospital survival following pediatric HSCT: changes in complications, ICU therapies and outcomes over 10 years.
Hospital survival following pediatric HSCT: changes in complications, ICU therapies and outcomes over 10 years.
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DOI：
10.3389/fped.2023.1247792
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发表时间：
2023
影响因子：
2.6
通讯作者：
中科院分区：
文献类型：
--
作者：
造血干细胞移植（HSCT）是一种越来越多地用于治疗恶性和非恶性儿科疾病的疗法。 HSCT 并发症，包括感染、器官功能障碍和移植物抗宿主病 (GVHD)，通常需要重症监护病房 (ICU) 治疗，并且与死亡率相关。我们的目的是确定国家数据集中十年期间与 (1) 生存率和 (2) 生存率变化相关的 HSCT 特征、并发症和 ICU 治疗。使用了 Health Facts（Cerner Corporation，堪萨斯城，密苏里州）数据库 2009 年至 2018 年的全国样本。纳入标准为年龄 30 天至 <22 岁和 HSCT 程序代码。对于 HSCT > 1 次的患者，首先进行分析。数据包括人口统计、住院时间 (LOS)、医院结果、移植类型和适应症。 HSCT 并发症包括 GVHD 和感染。 ICU 治疗包括正压通气 (PPV)、血管活性输注和透析。主要结局是存活至出院。统计方法包括双变量分析和多变量逻辑回归。 473 名患者接受了 HSCT，存活率为 93%。 62% 是同种异体（89% 存活率），38% 是自体（98% 存活率）。 33%的同种异体HSCT发生GVHD。所有 HSCT 中 26% 发生感染。 ICU 治疗包括 PPV（11% 的患者）、血管活性药物（25%）和透析（3%）。生存率降低与同种异体 HSCT (p<0.01)、GVHD (p=0.02)、感染 (p<0.01) 和 ICU 治疗 (p<0.01) 相关。生存率从 89% (2009-2013) 提高到 96% (2014-2018) (p<0.01)。同种异体存活率提高（82%–94%，p<0.01），而自体存活率没有变化。随着时间的推移，生存率的提高与感染的减少（33%–21%，p<0.01）和血管活性输注的增加（20%–28%，p=0.05）相关。在多变量分析中，较晚的时间段与生存率的提高相关（p<<0.01，调整后的 OR 4.28）。从 2009 年到 2018 年，HSCT 的医院生存率从 89% 提高到 96%。与死亡率相关的因素包括同种异体 HSCT、GVHD、感染和 ICU 治疗。提高生存率与减少感染和增加血管活性药物的使用同时发生。
Hematopoietic stem cell transplantation (HSCT) is an increasingly utilized therapy for malignant and non-malignant pediatric diseases. HSCT complications, including infection, organ dysfunction, and graft-versus-host-disease (GVHD) often require intensive care unit (ICU) therapies and are associated with mortality. Our aims were to identify the HSCT characteristics, complications and ICU therapies associated with (1) survival, and (2) survival changes over a ten-year period in a national dataset. A national sample from the Health Facts (Cerner Corporation, Kansas City, MO) database from 2009 to 2018 was utilized. Inclusion criteria were age 30 days to <22 years and HSCT procedure code. For patients with >1 HSCT, the first was analyzed. Data included demographics, hospital length of stay (LOS), hospital outcome, transplant type and indication. HSCT complications included GVHD and infections. ICU therapies were positive pressure ventilation (PPV), vasoactive infusion, and dialysis. Primary outcome was survival to discharge. Statistical methods included bivariate analyses and multivariate logistic regression. 473 patients underwent HSCT with 93% survival. 62% were allogeneic (89% survival) and 38% were autologous (98% survival). GVHD occurred in 33% of allogeneic HSCT. Infections occurred in 26% of all HSCT. ICU therapies included PPV (11% of patients), vasoactive (25%), and dialysis (3%). Decreased survival was associated with allogeneic HSCT (p < 0.01), GVHD (p = 0.02), infection (p < 0.01), and ICU therapies (p < 0.01). Survival improved from 89% (2009–2013) to 96% (2014–2018) (p < 0.01). Allogeneic survival improved (82%–94%, p < 0.01) while autologous survival was unchanged. Survival improvement over time was associated with decreasing infections (33%–21%, p < 0.01) and increasing vasoactive infusions (20%–28%, p = 0.05). On multivariate analysis, later time period was associated with improved survival (p < 0.01, adjusted OR 4.28). Hospital survival for HSCT improved from 89% to 96% from 2009 to 2018. Factors associated with mortality included allogeneic HSCT, GVHD, infections and ICU therapies. Improving survival coincided with decreasing infections and increasing vasoactive use.
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影响因子：
20.3
作者：
Hockenbery, David M.;Cruickshank, Scott;McDonald, George B.
通讯作者：
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影响因子：
4.1
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45.3
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45.3
作者：
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通讯作者：
Pasquini, Marcelo C.
影响因子：
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作者：
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