Document Detail


Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit.
MedLine Citation:
PMID:  20495504     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To assess the long-term benefits of continuous renal replacement therapy (CRRT) in this patient population and to analyze factors associated with survival. Hematopoietic stem cell transplantation is being utilized as curative therapy for a variety of disorders. However, organ dysfunction is commonly associated with this therapy. Continuous renal replacement therapy (CRRT) is increasingly being used in the treatment of this multiorgan dysfunction.
DESIGN: Retrospective cohort study.
SETTING: A free-standing, tertiary care, pediatric oncology hospital.
PATIENTS: Twenty-nine allogeneic hematopoietic stem cell transplantation patients who underwent 33 courses of CRRT in the intensive care unit between January 2003 and December 2007.
INTERVENTIONS: Cox proportional hazards regressions models were used to examine the relationship between demographic and clinical variables and length of survival.
MEASUREMENTS AND MAIN RESULTS: The median length of survival post CRRT initiation was 31 days; only one patient survived >6 mos. Factors associated with increased risk of death included: higher bilirubin and blood urea nitrogen levels before and at 48 hrs into CRRT, lower Pao2/Fio2 ratios at 48 hrs of CRRT, and higher C-reactive protein levels, as well as lower absolute neutrophil counts at CRRT end.
CONCLUSION: In this single-center study, CRRT was not associated with long-term survival in pediatric allogeneic hematopoietic stem cell transplantation patients. Clinical data exist, both before and during CRRT, that may be associated with length of survival. Lower C-reactive protein levels at CRRT end were associated with longer survival, suggesting that the ability to attenuate inflammation during CRRT may afford a survival advantage. These findings require confirmation in a prospective study.
Authors:
Surender Rajasekaran; Deborah P Jones; Yvonne Avent; Michele L Shaffer; Lama Elbahlawan; Nan Henderson; Raymond C Barfield; R Ray Morrison; Robert F Tamburro
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  11     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2011-03-24     Revised Date:  2011-09-12    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  699-706     Citation Subset:  IM    
Affiliation:
St. Jude Children's Research Hospital, Memphis, TN, USA. surender.rajasekaran@spectrum-health.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cause of Death
Child
Female
Hematopoietic Stem Cell Transplantation* / adverse effects,  mortality
Humans
Intensive Care Units, Pediatric
Male
Neoplasms / mortality,  therapy
Proportional Hazards Models
Renal Replacement Therapy* / adverse effects,  mortality
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2010 Nov;11(6):754-5   [PMID:  21057267 ]
Pediatr Crit Care Med. 2011 Jul;12(4):482; author reply 482-3   [PMID:  21799319 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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