title: Intensive care unit experience of haemopoietic stem cell transplant patients.
abstract: BACKGROUND
  Previous research at our institution (1988-1998) established an intensive care unit (ICU) and hospital mortality between 70% and 80% in haemopoietic stem cell transplant (HSCT) patients requiring ICU admission.
  
  
  OBJECTIVE
  This study explored mortality in a more contemporary cohort while comparing outcomes to published literature and our previous experience.
  
  
  METHODS
  Retrospective chart review of HSCT patients admitted to ICU between December 1998 and June 2008.
  
  
  RESULTS
  Of 146 admissions, 53% were male, with a mean age of 44 years, an Acute Physiologic and Chronic Health Evaluation II score of 28 and Sepsis Organ Failure Assessment score of 11. Fifty-six per cent had graft versus host disease (GVHD), with respiratory failure (67%) being the most common admission diagnosis. All but one received mechanical ventilation. The ICU and hospital mortality were 42% (72% 1988-1998 cohort) and 64% (82% 1998-1998 cohort) respectively. The 6- and 12-month survivals were 29% and 24% respectively for the 1998-2008 cohort. Dying in ICU was independently predicted by fungal infection (P= 0.02) and early onset of organ failure (P < 0.001), while GVHD (P= 0.04) predicted survival. Mortality at 12 months was independently predicted by the acute physiology score (P= 0.002), increasing number of organ failures (P= 0.001), and cytomegalovirus positive serology (P= 0.005), while blood stream infection (P= 0.003), an antibiotic change on admission to the ICU (P= 0.007) and a diagnosis of non-Hodgkin lymphoma (P= 0.02) predicted survival.
  
  
  CONCLUSIONS
  Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long-term survival.
authors.affiliation: Department of Intensive Care Medicine, Haematology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Agarwal
authors.forename: S
authors.initials: S
authors.lastname: O'Donoghue
authors.forename: J
authors.initials: J
authors.lastname: Gowardman
authors.forename: G
authors.initials: G
authors.lastname: Kennedy
authors.forename: H
authors.initials: H
authors.lastname: Bandeshe
authors.forename: R
authors.initials: R
authors.lastname: Boots
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult