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Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit

Korean Journal of Pediatrics 2009;52(10):1153-1160.
Published online October 15, 2009.
Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit
Bo Eun Kim, Eun Ju Ha, Keun Wook Bae, Seongguk Kim, Ho Joon Im, Jong Jin Seo, Seong Jong Park
Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 예후 및 위험인자
김보은, 하은주, 배근욱, 김성국, 임호준, 서종진, 박성종
울산대학교 의과대학 서울아산병원 소아과학교실
Abstract
Purpose
: To evaluate the risk factors for mortality and prognostic factors in pediatric hemato-oncology patients admitted to the pediatric intensive care unit (PICU).
Methods
: We retrospectively reviewed the medical records of pediatric hemato-oncology patients admitted at the PICU of the Asan Medical Center between September 2005 and July 2008. Patients admitted at the PICU for perioperative or terminal care were excluded.
Results
: Total 88 patients were analyzed. Overall ICU mortality rate was 34.1%. Mean age at PICU admission was 7.0¡¾ 5.7 years and mean duration of PICU stay was 18.1¡¾22.2 days. Hematologic diseases contributed to 77.3% of all the primary diagnoses, and the primary cause of admission was respiratory failure (39.8%). The factors related to increased mortality were C-reactive protein level (P<0.01), ventilation or dialysis requirement (P<0.01), and hematopoietic stem cell transplantation (P<0.05). In all, 3 scoring systems were investigated [Number of Organ System Failures (OSF number), the Pediatric Risk of Mortality III (PRISM III) score, and the Sequential Organ Failure Assessment (SOFA) score]; higher score correlated with worse outcome (P<0.01). The Oncological Pediatric Risk of Mortality (O-PRISM) scores of the 21 patients who had received hematopoietic stem cell transplantation were higher among the non-survivors, but not statistically significant (P=0.203).
Conclusion
: The PRISM III and SOFA scores obtained within 24 hours of PICU admission were found to be useful as early mortality predictors. The highest OSF number during the PICU stay was closely related to poor outcome.
Key Words: Pediatric intensive care units, Mortality, Outcome assessment, Hematology, Medical oncology, Respiratory insufficiency, Septic shock, C-reactive protein


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