Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis.
BACKGROUND
Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations.


METHODS
We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from 1 January 1992 to 31 March 2002. The primary endpoint was mortality at 1 year.


RESULTS
A total of 2,653 patients received bone marrow transplantation; 504 of which received ICU care during a subsequent hospitalization. Patients receiving any major procedure during their ICU stay had higher 1-year mortality than those patients who received no ICU procedure (87% versus 44%, P < 0.0001). Death rates at 1 year were highest for those receiving mechanical ventilation (87%), pulmonary artery catheterization (91%), or hemodialysis (94%). In combination, the strongest independent predictors of death at 1 year were mechanical ventilation (odds ratio, 7.4; 95% confidence interval, 4.8 to 11.4) and hemodialysis (odds ratio, 8.7; 95% confidence interval, 2.1 to 36.7), yet no combination of procedures uniformly predicted 100% mortality.


CONCLUSIONS
The prognosis of bone marrow transplant recipients receiving ICU care during subsequent hospitalizations is very poor but should not be considered futile.
Scales
Damon C
DC
Department of Critical Care, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, Ontario, Canada, M4N 3M5. damon.scales@utoronto.ca
Thiruchelvam
Deva
D
Kiss
Alexander
A
Sibbald
William J
WJ
Redelmeier
Donald A
DA
D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002407:Catheterization, Swan-Ganz; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D006435:Renal Dialysis; D012121:Respiration, Artificial