Predictors of acute respiratory failure after bone marrow transplantation in children

D. G. Nichols, L. K. Walker, J. R. Wingard, K. S. Bender, M. Bezman, M. L. Zahurak, S. Piantadosi, M. Frey-Simon, M. C. Rogers

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Objective: To determine factors associated with acute respiratory failure after bone marrow transplantation which can be identified before the onset of lung disease. Design: Population-based, retrospective study. Setting: A referral-based pediatric intensive care unit and bone marrow transplant center. Patients: Thirty-nine patients with lung disease (abnormal chest radiograph or a need for supplemental oxygen) were identified from a group of 318 pediatric bone marrow transplant patients from 1978 to 1988. Thirty-four of 39 patients with complete data were further classified into patients with mild lung disease (recovery without needing endotracheal intubation, n = 16) and patients with acute respiratory failure (requirement for endotracheal intubation, n = 18). Interventions: Regression analyses were performed to define risk factors for development of respiratory failure (multivariate logistic regression) and for a shortened interval between the identification of lung disease and respiratory failure (Cox proportional hazards analysis). Measurements and Main Results: Ninety-three percent (15/16) of patients with mild lung disease survived. Conversely, only 9% (2/23) of patients with respiratory failure survived. Predictors of respiratory failure included graft vs. host disease (odds ratio 28.3, 95% confidence interval 1.9-421, p = .015), a prelung disease (baseline) circulating creatinine concentration of >1.5 mg/dL (>132.6 μmol/L) (odds ratio 28.4, 95% confidence interval 1.4- 577, p = .029), and male gender (odds ratio 14.6, 95% confidence interval 1- 210, p = .049). Predictors of a shortened time to onset of respiratory failure included baseline serum creatinine value of >1.5 mg/dL (>132.6 μmol/L) (hazard ratio 6.2, 95% confidence interval 1.5-26.5, p = .013) and baseline total bilirubin concentration >1.4 mg/dL (>23.9 μmol/L) (hazard ratio 4.5, 95% confidence interval 0.98-20.7, p = .053). The median time to onset of respiratory failure was 4 days in patients with baseline creatinine values ≥1.5 mg/dL (>132.6 μmol/L) and 5 days in patients with baseline bilirubin concentrations ≥1.4 mg/dL (>23.9 μmol/L) vs. >26 days in patients with creatinine 29 days in patients with bilirubin

Original languageEnglish (US)
Pages (from-to)1485-1491
Number of pages7
JournalCritical Care Medicine
Issue number9
Publication statusPublished - 1994



  • adult respiratory distress syndrome
  • bilirubin
  • bone marrow transplantation
  • creatinine
  • critical illness
  • graft vs. host disease
  • lung
  • multiple organ failure
  • pediatrics
  • pulmonary emergencies
  • respiratory failure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Nichols, D. G., Walker, L. K., Wingard, J. R., Bender, K. S., Bezman, M., Zahurak, M. L., ... Rogers, M. C. (1994). Predictors of acute respiratory failure after bone marrow transplantation in children. Critical Care Medicine, 22(9), 1485-1491.