Welcome to the 9th EAPS Congress Programme Scheduling

Abstract Body

Pediatric cancer patients admitted to a pediatric intensive care unit (PICU) form a unique population with specific critical care needs due to their underlying malignancy and treatment-related toxicities. Development of intensified and new treatment protocols have revolutionized oncology in the past decade and pediatric 5-year all-cancer survival currently has progressed to almost 80%. These treatment protocols are however associated with severe side effects. Given the improved survival rates and advances in therapeutic options, it is expected that in the near future more pediatric cancer patients will require treatment at the PICU for cancer-related complications, treatment-related toxicities, and severe infections.

Our ability to identify cancer patients likely to benefit from PICU management is still limited. Granular data on risk factors for PICU admission, PICU resource utilization, and patient outcomes are still lacking. Time-limited trials have been one of the major changes regarding ICU admission of adult cancer patients. The strategy consists of unlimited ICU management with a full-code status for a limited period. During this time, everything should be done. Subsequently, the continuation or introduction of life-sustaining therapies in patients whose conditions worsen may not be beneficial. Patients and their families are essential partners in all decisions. Whether such trials may help guide decision-making at the PICU need to be determined.

Background and Aims

Renal dysfunction is a major complication of allogenic hematopoietic stem cell transplantation (alloHSCT). The risk of kidney damage are directly related to the conditioning method, previous comorbidities and basal creatinine levels.

Methods

Descriptive retrospective study of renal complications presented by paediatric patients undergoing alloHSCT, admitted to PICU for 10 years.

Results

A total of 112 patients undergoing 132 alloHSCT are analyzed. 54/112 patients were admitted to PICU(48%). Age: 0.5-17years (average: 8.57), Type of alloHSCT: 19 related(haploidentical 13) and 49unrelated.

The 54 patients needed 68 PICU admissions. Causes of admission: respiratory failure(41.1%), neurological disorders(22.7%), sepsis(21.2%), acute kidney injury(AKI) (6%) and liver failure(6%). pSOFA:5.67, PELOP-2:5.55, OPRISM:12.97. Patients showed at admission a significant increase in creatinine(p=0.007) and a decrease in glomerular filtration(p <0.001). AKI affected 32 children, 11stage KDIGO1, 4stage KDIGO2 and 7stage KDIGO3. Significant differences in admission mortality were found in patients with KDIGO3(p=0.036), in the multivariate study, they've and increased probability of death(OR:6.08, p=0.014).

During the stay at PICU, 27 patients presented AKI. 6 KDIGO1, 10 KDIGO2 and 26 KDIGO3. 27patients require dialysis techniques(40.9%): Continuous renal replacement(27), conventional dialysis(1), combined techniques(3). Mean duration days of therapy: 19.56±18.14days. Significant differences in mortality were found in patients with AKI(p=0.002), KDIGO 3(p=0.011) and those in need of dialysis(p<0.001).

Average stay: 27.35days. Survival: 41.7% at 11years.

Conclusions

Children requiring PICU admission after alloHSCT have a significant increase in creatinine levels and a significant decrease in glomerular filtration on admission. In multivariate analysis, the highest degree of acute kidney disease (KDIGO 3) is a risk factor significantly associated with mortality.