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Pericardial effusion following hematopoietic stem cell transplantation in children: Incidence, risk factors, and outcomes
Author(s) -
Tinianow Alex,
Gay James C.,
Bearl David W.,
Connelly James A.,
Godown Justin,
Kitko Carrie L.
Publication year - 2020
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13748
Subject(s) - medicine , interquartile range , hematopoietic stem cell transplantation , transplantation , hazard ratio , retrospective cohort study , cohort , single center , incidence (geometry) , surgery , confidence interval , physics , optics
PCE is a complication of HSCT that has previously been described in small single‐center studies. This study aimed to assess the frequency of, risk factors for, and outcomes of children with a PCE following HSCT across a large multi‐center cohort. All patients ≤21 years undergoing first HSCT (1/2005‐9/2015) were identified from the Pediatric Health Information System. ICD‐9 codes were used to identify patients with a PCE during or following the transplant encounter. Multivariable modeling assessed risk factors for developing a PCE and assessed the impact of PCE on patient outcome. Of 10 455 included patients, 739 (7.1%) developed a PCE (median 69 days post‐HSCT, interquartile range 33‐165 days). PCE developed more commonly in allogeneic vs autologous HSCT recipients (9.1% vs 2.9%, P < .001). Among allogeneic HSCT recipients, independent risk factors for PCE included thrombotic microangiopathy (AHR 2.94, 95% CI 2.16‐4.00), heart failure (AHR 2.07, 95% CI 1.61‐2.66), PCE pre‐HSCT (AHR 1.92, 95% CI 1.19‐3.09), arrhythmia (AHR 1.76, 95% CI 1.44‐2.16), graft‐versus‐host disease (AHR 1.31, 95% CI 1.05‐1.62), female sex (AHR 1.28, 95% CI 1.07‐1.52), and malignancy (AHR 1.28, 95% CI 1.02‐1.60). Allogeneic HSCT patients with PCE demonstrated worse survival than those without PCE (5‐year survival 50.8% vs 76.9%, P < .001). PCE was independently associated with mortality (AHR 1.96, 95% CI 1.62‐2.37) following allogeneic HSCT and was not impacted by pericardial intervention. PCE occurs more commonly in patients following allogeneic (vs autologous) HSCT and is associated with inferior outcomes.