Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 예후 및 위험인자

Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit

  • 김보은 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 하은주 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 배근욱 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김성국 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 임호준 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 서종진 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 박성종 (울산대학교 의과대학 서울아산병원 소아청소년과)
  • Kim, Bo Eun (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ha, Eun Ju (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Bae, Keun Wook (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Seon Guk (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Im, Ho Joon (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Jong Jin (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seong Jong (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2009.06.05
  • 심사 : 2009.09.11
  • 발행 : 2009.10.15
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초록

목 적:최근 다양한 치료 방법의 발전과 지지요법의 발달로, 소아 종양/혈액 질환 환자의 생존율이 향상되었으나, 적극적이고 다양한 치료를 하게 되면서 이와 관련된 여러 합병증으로 소아 중환자실에 입실하는 경우 또한 많아졌다. 이에 본 연구에서는 소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 임상양상과 사망률을 살펴보고, 소아 종양/혈액 질환 환자에게 적합한 중증도 측정 체계와 사망률에 영향을 미치는 위험 요인에 대해 알아보고자 했다. 방 법:2005년 9월부터 2008년 7월까지 서울아산병원 소아 중환자실에 입실한 소아 종양/혈액 질환 환자 중 3일 이상 재실한 환자를 대상으로 후향적으로 의무기록을 조사했다. 생존군과 비생존군으로 나누어 나이, 성별, 재실 일수에 대하여 조사했고, 기저 질환과 중환자실 입원 이유, 인공호흡기 적용 여부, 투석 및 승압제 투여 여부, CRP 및 ANC에 따른 사망률을 알아보았다. 또, 생존군과 비생존군의 OSF number, SOFA score, PRISM III score, O-PRISM score를 비교하고, 점수에 따른 사망률을 알아보았다. 결 과:총 88예 중 30예가 사망하여 사망률은 34.1%이었다. 남아가 49예, 여아가 39예이었고, 평균 나이는 $7.0{\pm}5.7$세, 평균 재원일수는 $18.1{\pm}22.2$일로 이었다. 기저 질환은 혈액 질환이 68예(77.3%)로 가장 많았으며, 중환자실 입실 이유는 호흡기능 부전이 35예(39.8%)로 가장 많았고, 패혈쇼크가 19예(21.6%)이었다. CRP는 생존군에서 $9.1{\pm}9.0$, 비생존군에서 $16.4{\pm}11.2$로, 비생존군에서 유의하게 높았고(P<0.01), 비생존군에서 인공호흡기 치료나 투석이 필요했던 경우가 많았으며(P<0.01), 조혈모세포 이식을 받은 군의 사망률이 유의하게 높았다(P<0.05). 중증도 측정 체계 중에서는 initial OSF number, highest OSF number, SOFA score, PRISM III score가 비생존군에서 의미있는 증가를 보였고(P<0.01), 이들을 수용자 작업특성곡선을 사용하여 비교하였을 때, highest OSF number가 곡선하면적 0.845로 가장 높았고, 중환자실 입실 24시간 이내에 측정한 PRSIM III score와 SOFA score의 곡선하면적이 각각 0.723, 0.751로 유의한 결과를 보였다. 총 21예에서 조혈모세포 이식을 받았으며 이들의 O-PRISM score는 비생존군에서 높은 경향을 보였으나, 통계적으로 유의하지는 않았다. 결 론: 본 연구에서 소아 중환자실 입실한 소아 종양/혈액 질환 환자 사망의 위험인자로는 CRP, 인공호흡기 치료, 투석, 조혈모세포 이식이 있었으며, 예후 예측지표로는 highest OSF number, PRISIM III score, SOFA score가 의미 있는 것으로 분석되었다.

Purpose:To evaluate the risk factors for mortality and prognostic factors in pediatric hemato-oncology patients admitted to the pediatric intensive care unit (PICU). Methods:We retrospectively reviewed the medical records of pediatric hemato-oncology patients admitted at the PICU of the Asan Medical Center between September 2005 and July 2008. Patients admitted at the PICU for perioperative or terminal care were excluded. Results:Total 88 patients were analyzed. Overall ICU mortality rate was 34.1%. Mean age at PICU admission was $7.0{\pm}5.7$ years and mean duration of PICU stay was $18.1{\pm}22.2$ days. Hematologic diseases contributed to 77.3% of all the primary diagnoses, and the primary cause of admission was respiratory failure (39.8%). The factors related to increased mortality were C-reactive protein level (P<0.01), ventilation or dialysis requirement (P<0.01), and hematopoietic stem cell transplantation (P<0.05). In all, 3 scoring systems were investigated [Number of Organ System Failures (OSF number), the Pediatric Risk of Mortality III (PRISM III) score, and the Sequential Organ Failure Assessment (SOFA) score]; higher score correlated with worse outcome (P<0.01). The Oncological Pediatric Risk of Mortality (O-PRISM) scores of the 21 patients who had received hematopoietic stem cell transplantation were higher among the non-survivors, but not statistically significant (P=0.203). Conclusion:The PRISM III and SOFA scores obtained within 24 hours of PICU admission were found to be useful as early mortality predictors. The highest OSF number during the PICU stay was closely related to poor outcome.

키워드

참고문헌

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피인용 문헌

  1. PRISM III in a Pediatric Intensive Care Unit with Multiple Disease Entities vol.26, pp.3, 2009, https://doi.org/10.4266/kjccm.2011.26.3.123