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
