title: Outcome of hematopoietic stem cell transplant recipients admitted to the intensive care unit.
abstract: Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. The study was a retrospective review of all patients at the Queen Elizabeth II Health Sciences Center who received an SCT between 1992 and 2001 and were subsequently admitted to the ICU. The primary outcome was overall survival at 12 months after ICU admission. There were 440 SCTs in the study period; 38 of these patients were admitted to the ICU on 42 separate occasions. The primary indication for ICU admission was respiratory failure. The probability of survival at 12 months was 21.6% (95% CI, 8.4%-34.9%). On multivariate analysis, the only statistically significant variable associated with decreased 12-month survival was vasopressor use. The probability of survival for patients receiving vasopressor support was 5% (95% CI, 0%-14.5%) at 30 days and 0% at 12 months, whereas the probability of survival for patients not receiving vasopressor support was 76.5% (95% CI, 56.3%-96.6%) at 30 days and 45.8% (95% CI, 21.5%-69.9%) at 12 months. In this 10-year review of consecutive SCT recipients requiring ICU admission, we found that the outcome of SCT patients requiring ICU admission may not be as poor as previously reported. However, SCT recipients requiring vasopressor support had very poor outcomes. These findings will be important in deciding which SCT patients may benefit from ICU admission and care.
authors.affiliation: Department of Medicine, Dalhousie University, and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. andrea.kew@cdha.nshealth.ca
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Kew
authors.forename: Stephen
authors.initials: S
authors.lastname: Couban
authors.forename: Ward
authors.initials: W
authors.lastname: Patrick
authors.forename: Kara
authors.initials: K
authors.lastname: Thompson
authors.forename: Darrell
authors.initials: D
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents