title: Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports.
abstract: OBJECTIVE
  Because the overall outcome of critically ill hematologic patients has improved, we evaluated the short-term and long-term outcomes of the poor risk subgroup of allogeneic hematopoietic stem-cell transplantation (HSCT) recipients requiring admission to the intensive care unit (ICU).
  
  
  METHODS
  This was a retrospective multicenter study of allogeneic HSCT recipients admitted to the ICU between 1997 and 2003.
  
  
  RESULTS
  Two hundred nine critically ill allogeneic HSCT recipients were included in the study. Admission in the ICU occurred during the engraftment period (< or = 30 days after transplantation) for 70 of the patients and after the engraftment period for 139 patients. The overall in-ICU, in-hospital, 6-month, and 1-year survival rates were 48.3%, 32.5%, 27.2%, and 21%, respectively. Mechanical ventilation was required in 122 patients and led to a dramatic decrease in survival rates, resulting in in-ICU, in-hospital, 6-month, and 1-year survival rates of 18%, 15.6%, 14%, and 10.6%, respectively. Mechanical ventilation, elevated bilirubin level, and corticosteroid treatment for the indication of active graft-versus-host disease (GVHD) were independent predictors of death in the whole cohort. In the subgroup of patients requiring mechanical ventilation, associated organ failures, such as shock and liver dysfunction, were independent predictors of death. ICU admission during engraftment period was associated with acceptable outcome in mechanically ventilated patients, whereas patients with late complications of HSCT in the setting of active GVHD had a poor outcome.
  
  
  CONCLUSIONS
  Extensive unlimited intensive care support is justified for allogeneic HSCT recipients with complications occurring during the engraftment period. Conversely, initiation or maintenance of mechanical ventilation is questionable in the setting of active GVHD.
authors.affiliation: Medical Intensive Care Unit, Cochin Hospital, AP-HP, Paris, France. frederic.pene@cch.aphp.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.forename: Cécile
authors.initials: C
authors.lastname: Aubron
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: François
authors.initials: F
authors.lastname: Blot
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiéry
authors.forename: Bruno
authors.initials: B
authors.lastname: Raynard
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Gérard
authors.initials: G
authors.lastname: Nitenberg
authors.forename: Agnès
authors.initials: A
authors.lastname: Buzyn
authors.forename: Philippe
authors.initials: P
authors.lastname: Arnaud
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
mesh_terms: D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D005602:France / Q000453:epidemiology; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D010343:Patient Admission; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin