Bonig et al identified risk factors associated with a poor outcome for a pediatric patient who has had a hematopoietic stem cell transplant (HSCT). This can help identify a patient who may benefit from more aggressive management or a novel therapy. The authors are from Heinrich Heine University in Dusseldorf.
Patient selection: age < 19 years, within 1 year of a hematopoietic stem cell bone marrow transplant
Parameters:
(1) grade of graft vs host disease (GVHD)
(2) hemorrhage
(3) blood pressure
(4) C-reactive protein (CRP)
Parameter |
Finding |
Points |
grade of GVHD |
0, I or II |
0 |
|
III or IV |
1 |
hemorrhage |
none or microscopic |
0 |
|
macroscopic |
1 |
blood pressure |
normotensive or hypertensive |
0 |
|
hypotension |
1 |
C reactive protein |
<= 10 mg/dL |
0 |
|
> 10 mg/dL |
1 |
where:
• The paper reports CRP in mg/dL. 10 mg/dL is equivalent to 100 mg/L, which is quite high (normal levels is < 10 mg/L).
• Hypotension was defined as a subnormal mean arterial pressure but a precise cutoff was not reported.
total number of risk factors for a poor outcome =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The higher the number of risk factors the worse the outcome.
Additional factors associated with a poor outcome:
(1) transplant from an unrelated donor (no long term survivors in this group)
(2) multi-organ failure
Specialty: Critical Care, Emergency Medicine, Hematology Oncology, Surgery, general
ICD-10: ,