Lower hospital mortality and complications after pediatric hematopoietic stem cell transplantation
Lower hospital mortality and complications after pediatric hematopoietic stem cell transplantation
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DOI：
10.1097/01.ccm.0b013e318161fac1
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发表时间：
2008-03-01
影响因子：
8.8
通讯作者：
Keenan, Heather T.
中科院分区：
文献类型：
--
作者：
Bratton, Susan L.;Van Duker, Heather;Keenan, Heather T.
目的：评估儿童患者造血干细胞移植（HSCT）术后初始护理期间死亡率的保护因素和危险因素，并评估住院死亡率的变化。设计：回顾性队列研究使用1997年、2000年和2003年儿童住院患者数据库，这是一个在美国接受HSCT治疗的儿童的概率样本。设置：提交到数据库的美国住院患者。患者：年龄< 19岁。干预措施:没有。测量结果和主要结果：医院死亡率从1997年的12%显著下降到2003年的6%。干细胞的来源随着脐带血使用的增加而改变。脓毒症、移植物抗宿主病和机械通气的发生率显著降低。与自体造血干细胞移植相比，接受同种异体造血干细胞移植而不消耗t细胞的患者更容易死亡（校正优势比为2.4；95%可信区间为1.5,3.9），而接受脐带血造血干细胞移植的儿童医院死亡风险最高（校正优势比为4.8；95%可信区间为2.6,9.1）。机械通气（调整优势比为26.32,95%可信区间为16.3-42.2）、透析（调整优势比为12.9,95%可信区间为4.7-35.4）和脓毒症（调整优势比为3.9,95%可信区间为2.5-6.1）均与死亡独立相关，而2003年的护理与死亡风险降低相关（调整优势比为0.4,95%可信区间为0.2-0.7）。儿童造血干细胞移植后的住院死亡率随着时间的推移而降低，并发症包括需要机械通气、移植物抗宿主病和败血症也随之降低。预防并发症是至关重要的，因为需要侵入性支持仍然与高死亡率风险相关。
Objective: To assess protective and risk factors for mortality among pediatric patients during initial care after hematopoietic stem cell transplantation (HSCT) and to evaluate changes in hospital mortality.Design: Retrospective cohort using the 1997, 2000, and 2003 Kids Inpatient Database, a probabilistic sample of children hospitalized in the United States with a procedure code for HSCT.Setting: Hospitalized patients in the United States submitted to the database.Patients: Age, < 19 yrs.Interventions: None.Measurements and Main Results: Hospital mortality significantly decreased from 12% in 1997 to 6% in 2003. Source of stem cells changed with increased use of cord blood. Rates of sepsis, graft versus host disease, and mechanical ventilation significantly decreased. Compared with autologous HSCT, patients who received an allogenic HSCT without T-cell depletion were more likely to die (adjusted odds ratio, 2.4; 95% confidence interval, 1.5, 3.9), while children who received cord blood HSCT were at the greatest risk of hospital death (adjusted odds ratio, 4.8; 95% confidence interval, 2.6, 9.1). Mechanical ventilation (adjusted odds ratio, 26.32; 95% confidence interval, 16.3-42.2), dialysis (adjusted odds ratio, 12.9; 95% confidence interval, 4.7-35.4), and sepsis (adjusted odds ratio, 3.9; 95% confidence interval, 2.5-6.1) were all independently associated with death, while care in 20,03 was associated with decreased risk (adjusted odds ratio, 0.4; 95% confidence interval, 0.2-0.7) of death.Conclusions. Hospital mortality after HSCT in children decreased over time as did complications including need for mechanical ventilation, graft versus host disease, and sepsis. Prevention of complications is essential as the need for invasive support continues to be associated with high mortality risk.