Predictive Factors for Intensive Care Unit Admission in Children and Young Adults Undergoing Hematopoietic Cell Transplantation

Hematopoietic cell transplantation (HCT) carries significant morbidity and mortality. Defining factors that impact intensive care unit (ICU) admission rates in children and young adults undergoing HCT is required. Retrospective review of allogeneic (n=221) or autologous HCT (n=115) patients from 2013 to 2023 was completed. Subjects were 30 years old or younger, undergoing transplant for malignant or nonmalignant disorders. Clinical and laboratory variables were evaluated. The primary endpoint was ICU admission or death within 180 days following initial HCT. Overall, 22% of allogeneic and 8.9% of autologous HCT recipients required ICU hospitalization within 180 days post-HCT. In allogeneic HCT recipients, age <12 months, inherited metabolic disorders, systemic steroids ≥0.5 mg/kg/day, GVHD grade 3-4, secondary therapy for GVHD, and relapse were associated with increased risk of an event. Relapses (HR: 11.10; 95% CI: 4.23-28.90, P <0.001) and secondary therapy for GVHD (HR: 4.65; 95% CI: 1.39-15.60, P =0.013) remained significant on multivariate analysis. Autologous HCT risk factors included CD34 dose (>10 million CD34/kg) and absolute lymphocyte count on day 28 post-HCT. No other parameter impacted ICU risk. In the allogeneic HCT setting, refractory GVHD or disease relapse were associated with increased ICU admission. In the autologous setting, higher infused cell doses were associated with increased risk for ICU admission.