Bleeding in critically ill children with malignancy or hematopoietic cell transplant: A single-center prospective cohort study Journal Article
| Authors: | Levasseur, J.; Fikse, L.; Mauguen, A.; Killinger, J. S.; Karam, O.; Nellis, M. E. |
| Article Title: | Bleeding in critically ill children with malignancy or hematopoietic cell transplant: A single-center prospective cohort study |
| Abstract: | OBJECTIVES: To determine the incidence of bleeding in critically ill children with malignancy and to describe associated patient characteristics, interventions, and clinical outcomes. DESIGN: Prospective cohort study. SETTING: PICU in a specialized cancer hospital. PATIENTS: Children with malignancy or hematopoietic cell transplant 0–18 years of age were admitted to the PICU from November 2020 to November 2021. INTERVENTIONS: None. MEASUREMENTS: Patient demographic data, laboratory values, and PICU outcome data were collected. Bleeding was classified according to the Bleeding Assessment Scale in Critically Ill Children. MAIN RESULTS: Ninety-three bleeding patients were enrolled, and a total of 322 bleeding days were recorded. The median (interquartile range [IQR]) age was 5.8 (2.9–11.8) years and 56% (52/93) of the patients were male. There were 121 new bleeding episodes, in 593 at-risk person-days, translating into a 20% incidence rate per day (95% CI, 17–24%). The incidence of severe, moderate, and minimal bleeding was 2% (95% CI, 1–3), 4% (95% CI, 3–6), and 14% (95% CI, 12–17), respectively. Of the new bleeding episodes, 9% were severe, 25% were moderate and 66% were minimal. Thrombocytopenia was the only laboratory value independently associated with severe bleeding (p = 0.009), as compared to minimal and moderate bleeding episodes. History of radiation therapy was independently associated with severe bleeding (p = 0.04). We failed to identify an association between a history of stem cell transplant (p = 0.49) or tumor type (p = 0.76), and bleeding severity. Patients were transfused any blood product on 28% (95% CI, 22–34) of the bleeding days. Severe bleeding was associated with increased length of mechanical ventilation (p = 0.003), longer PICU stays (p = 0.03), and higher PICU mortality (p = 0.004). CONCLUSIONS: In this prospective cohort of children with malignancy, the incidence rate of bleeding was 20%. Most events were classified as minimal bleeding. Low platelet count and radiation therapy were variables independently associated with severe bleeding episodes. Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. |
| Keywords: | child; preschool child; school child; child, preschool; cancer surgery; retrospective studies; major clinical study; mortality; treatment duration; postoperative care; neurosurgery; laparotomy; prospective study; prospective studies; neoplasm; neoplasms; bleeding; thoracotomy; thrombocytopenia; incidence; cohort analysis; hematopoietic stem cell transplantation; retrospective study; childhood cancer; prothrombin time; hematologic malignancy; immunotherapy; infant; laboratory test; blood transfusion; hospital admission; malignancy; multivariate analysis; blood cell count; observational study; children; erythrocyte transfusion; univariate analysis; fibrinogen; thrombocyte transfusion; platelet count; artificial ventilation; respiratory failure; critical illness; intensive care units, pediatric; hemostasis; elective surgery; critically ill patient; complication; clinical outcome; hemorrhage; intracranial hypertension; international normalized ratio; transfusion; in-hospital mortality; aminocaproic acid; tranexamic acid; child hospitalization; activated partial thromboplastin time; emergency surgery; humans; human; male; female; article; patient history of radiotherapy; patient history of chemotherapy; hemorrhagic shock; blood component therapy; malignant neoplasm; solid malignant neoplasm; pediatric intensive care unit; pediatric patient; patient history of stem cell transplantation; vasodilatory shock |
| Journal Title: | Pediatric Critical Care Medicine |
| Volume: | 24 |
| Issue: | 12 |
| ISSN: | 1529-7535 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2023-12-01 |
| Start Page: | e602 |
| End Page: | e610 |
| Language: | English |
| DOI: | 10.1097/pcc.0000000000003374 |
| PUBMED: | 37678406 |
| PROVIDER: | scopus |
| PMCID: | PMC10843653 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed (via Conflict of Interest statement) and PDF -- Source: Scopus |
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