December 4, 2025Open Access

Critical Care Outcomes in Pediatric Hematopoietic Stem Cell Transplantation: A Single‐Center Pediatric Intensive Care Unit Experience

Key Points

Overall mortality rate among pediatric HSCT patients admitted to the PICU was 80%, indicating significant risk.
Sepsis and respiratory failure were the primary reasons for intensive care admission, linked to mortality risk.
Retrospective cohort analysis of 40 pediatric HSCT recipients within a single tertiary PICU over four years highlighted critical care outcomes.
Findings emphasize the need for early intervention and post-HSCT monitoring to optimize care for vulnerable patients.

Abstract

ABSTRACT Background Hematopoietic stem cell transplantation (HSCT) has become an essential curative strategy for various malignant and non‐malignant pediatric diseases. However, HSCT recipients remain highly vulnerable to complications, often requiring pediatric intensive care unit (PICU) admission. Identifying key risk factors and predictors of mortality is crucial for improving patient outcomes. This study aims to evaluate the clinical characteristics, risk factors, and outcomes of pediatric HSCT patients requiring PICU admission, focusing on organ failure, respiratory and cardiovascular dysfunction, and the impact of supportive therapies. Methods This retrospective, single‐center study included pediatric HSCT recipients admitted to a tertiary PICU between August 2019 and October 2023. Patients with PICU stays shorter than 24 h were excluded. Clinical and demographic characteristics, HSCT‐related parameters, PICU admission criteria, and patient outcomes were analyzed. Logistic regression models were applied to identify independent risk factors associated with mortality. Results Among 40 HSCT recipients requiring PICU admission, the overall mortality rate was 80%, exceeding previously reported rates. Sepsis, respiratory failure, and multiple organ dysfunction were the primary reasons for admission. Elevated PELOD scores were strong predictors of mortality. All patients requiring mechanical ventilation, inotropic support, or renal replacement therapy died ( p < 0.001), whereas all patients managed with non‐invasive ventilation survived, underscoring the importance of early and appropriate respiratory support. Conclusion Organ failure significantly impacts mortality in pediatric HSCT recipients, emphasizing the need for early intervention and proactive monitoring. Structured post‐HSCT surveillance, particularly for patients with prior PICU admissions, is critical for identifying early signs of organ dysfunction and optimizing intensive care management.

Read Full Paperexternally

Mark Helpful

Bookmark

Relay

View Full Paper