title: A prognostic index for survival among mechanically ventilated hematopoietic cell transplant recipients.
abstract: The prognosis of recipients of allogeneic hematopoietic cell transplantation (HCT) who require mechanical ventilation (MV) has historically been poor. Of 883 adults undergoing allogeneic HCT at the University of Minnesota between 1998 and 2009, 179 (20%) required MV before day 100 posttransplantation. We evaluated the outcomes of these patients to develop a prognostic index to predict the 100-day post-MV overall survival (OS) based on factors present at the time of MV. The 179 patients were divided at random into a training set (n = 119) and a validation set (n = 60). The 100-day postventilation OS was 17% for the total population. Multivariate Cox regression on the training set identified creatinine <2 mg/dL and platelet count >20 × 10(9)/L as significant predictors of better OS. Recursive partitioning classified patients with these good prognostic criteria into class A (n = 76); all other patients were classified as class B (n = 103). Among class A patients, 100-day OS was 29% in the training set and 30% in the validation set. Corresponding OS in class B patients was 5% and 15%, respectively. This prognostic index should help guide physicians in counseling HCT patients and their families regarding the use of MV and potential outcomes.
authors.affiliation: Blood and Marrow Transplant Program, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota 55455, USA..
authors.forename: Melhem
authors.initials: M
authors.lastname: Solh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Oommen
authors.forename: Rachel Isaksson
authors.initials: RI
authors.lastname: Vogel
authors.forename: Ryan
authors.initials: R
authors.lastname: Shanley
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000473:pathology*; D003404:Creatinine / Q000097:blood*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008137:Longitudinal Studies; D008223:Lymphoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012121:Respiration, Artificial; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D015415:Biomarkers; D003404:Creatinine