Risk factors for ICU admission and ICU survival after allogeneic hematopoietic SCT.
A considerable number of patients undergoing allogeneic hematopoietic SCT (HSCT) develop post-transplant complications requiring intensive care unit (ICU) treatment. Whereas the indications and the outcome of ICU admission are well known, the risk factors leading to ICU admission are less well understood. We performed a retrospective single-center study on 250 consecutive HSCT patients analyzing the indications, risk factors and outcome of ICU admission. Of these 250 patients, 33 (13%) were admitted to the ICU. The most common indications for admission to the ICU were pulmonary complications (11, 33%), sepsis (8, 24%), neurological disorders (6, 18%) and cardiovascular problems (2, 6%). Acute GvHD and HLA mismatch were the only significant risk factors for ICU admission in multivariate analysis. Among patients admitted to the ICU, the number of organ failures correlated negatively with survival. Twenty-one (64%) patients died during the ICU stay and the 6-month mortality was 85% (27 out of 33). SAPS II score underestimated the mortality rate. In conclusion, acute GvHD and HLA mismatch were identified as risk factors for ICU admission following allogeneic HSCT. Both, short- and long-term survival of patients admitted to the ICU remains dismal and depends on the number of organ failures.
Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
R
R
Benz
Division of Hematology, University Hospital Zürich, Zürich, Switzerland.
U
U
Schanz
Medical Intensive Care Unit, University Hospital Zürich, Zürich, Switzerland.
M
M
Maggiorini
Division of Immunology and Allergology, Department of Medical Specialities, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
J D
JD
Seebach
Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
G
G
Stussi
D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012120:Respiration Disorders / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D013557:Switzerland; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult