title: Outcome of adult umbilical cord blood transplant patients admitted to a medical intensive care unit.
abstract: Umbilical cord blood transplant (UCBT) has emerged as an alternate source of stem cells for transplantation in patients with hematologic malignancies. However, outcomes of adult UCBT patients requiring ICU admission remain unknown. In order to identify predictors of ICU transfer and mortality in UCBT patients, the course and outcome of all adult (> or = 16 years old) patients who underwent UCBT between 1 January 1998 and 31 December 2003 at University Hospitals of Cleveland were analyzed. Forty-four patients underwent UCBT during the study period and 25 (57%) required ICU transfer. Use of a myeloablative preparative regimen was a significant predictor of ICU transfer (P = 0.03). An infusion of higher numbers of nucleated cells was protective from ICU transfer (P = 0.05). For those patients transferred to the ICU, mortality was 72%. The univariate predictors of mortality, at the time of ICU admission were a high APACHE III score (P = 0.0004), use of vasopressors (P = 0.03), and a low platelet count (P = 0.03). We conclude that transfer of UCBT patients to an ICU may be predicted by their preparative regimen, while ICU mortality may be predicted by physiologic parameters upon admission.
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University Hospitals of Cleveland, Cleveland 44106-5067, OH, USA.
authors.forename: N
authors.initials: N
authors.lastname: Naeem
authors.forename: A
authors.initials: A
authors.lastname: Eyzaguirre
authors.forename: J A
authors.initials: JA
authors.lastname: Kern
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: R B
authors.initials: RB
authors.lastname: Hejal
authors.forename: M J
authors.initials: MJ
authors.lastname: Laughlin
authors.forename: E F O
authors.initials: EF
authors.lastname: Kern
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000009:adverse effects; D010343:Patient Admission / Q000706:statistics & numerical data; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013921:Thrombocytopenia; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D019653:Myeloablative Agonists; D014662:Vasoconstrictor Agents