title: Hematopoietic cell transplantation-specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit.
abstract: OBJECTIVE
  To investigate the prognostic value of the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) in patients who received transplantation admitted to the intensive care unit (ICU).
  
  
  METHODS
  We investigated the association of HCT-CI with inpatient mortality and overall survival (OS) among 377 patients who were admitted to the ICU within 100 days of allogeneic stem-cell transplantation (ASCT) at our institution. HCT-CI scores were collapsed into four groups and were evaluated in univariate and multivariate analyses using logistic regression and Cox proportional hazards models.
  
  
  RESULTS
  The most common pretransplantation comorbidities were pulmonary and cardiac diseases, and respiratory failure was the primary reason for ICU admission. We observed a strong trend for higher inpatient mortality and shorter OS among patients with HCT-CI values ≥ 2 compared with patients with values of 0 to 1 in all patient subsets studied. Multivariate analysis showed that patients with HCT-CI values ≥ 2 had significantly higher inpatient mortality than patients with values of 0 to 1 and that HCT-CI values ≥ 4 were significantly associated with shorter OS compared with values of 0 to 1 (hazard ratio, 1.74; 95% CI, 1.23 to 2.47). The factors associated with lower inpatient mortality were ICU admission during the ASCT conditioning phase or the use of reduced-intensity conditioning regimens. The overall inpatient mortality rate was 64%, and the 1-year OS rate was 15%. Among patients with HCT-CI scores of 0 to 1, 2, 3, and ≥ 4, the 1-year OS rates were 22%, 17%, 18%, and 9%, respectively.
  
  
  CONCLUSIONS
  HCT-CI is a valuable predictor of mortality and survival in critically ill patients after ASCT.
authors.affiliation: All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ulas D
authors.initials: UD
authors.lastname: Bayraktar
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Ciurea
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Marylou
authors.initials: M
authors.lastname: Cardenas-Turanzas
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Price
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006521:Hepatitis, Chronic / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D015995:Prevalence; D015996:Survival Rate; D014184:Transplantation, Homologous; D055815:Young Adult