title: The intensive care management process in patients with hematopoietic stem cell transplantation and factors affecting their prognosis.
abstract: OBJECTIVE
  Hematopoietic stem cell transplantation (HSCT) recipients may require further management in intensive care unit (ICU). The ICU outcome of the HSCT recipients is claimed to have improved significantly over the last two decades. Our aim was to investigate the ICU outcome of the HSCT recipients who required management in ICU, together with the factors that are likely to affect the results.
  
  
  METHODS
  We retrospectively investigated the ICU outcome of 48 adults (≥18 years of age) who received HSCT in the bone marrow transplant unit of our hospital and required admission to ICU between 01 January 2007 and 31 December 2010. The data were retrieved from the databases of the adult bone marrow transplantation unit and the ICU.
  
  
  RESULTS
  Sixty-one percent of the patients were male with a median age of 39 years (28-46.75) in the study cohort. Leukemia (54%) and lymphoma (27%) were the leading underlying disorders. The type of HSCT was autologous in 14.6% and allogeneic in 85.4% of the patients. The reason for admission to ICU was acute respiratory failure in 85.5% of the HSCT recipients and 75% had sepsis/septic shock. The mean duration of ICU stay was 104.5 (48-168) hours. Sixty-nine percent of the patients died during their ICU stay while 31% survived. Besides the several statistically significant differences between the patients who survived or died in ICU in univariate analysis, baseline Acute Physiology and Chronic Health Evaluation (APACHE II) score (odds ratio 1.38, 95% confidence interval: 1.06-1.79) and requirement of vasopressors in the ICU (odds ratio 72.29, 95% confidence interval:4.47-1169.91) were found to be independent risk factors for mortality in multivariate analysis.
  
  
  CONCLUSIONS
  Baseline APACHE II score and requirement of vasopressors during ICU stay were the most significant independent risk factors for mortality in HSCT recipients who required ICU management in our center.
authors.forename: Nazlıhan
authors.initials: N
authors.lastname: Boyacı
authors.forename: Gulbin
authors.initials: G
authors.lastname: Aygencel
authors.forename: Melda
authors.initials: M
authors.lastname: Turkoglu
authors.forename: Zeynep Arzu
authors.initials: ZA
authors.lastname: Yegin
authors.forename: Kadir
authors.initials: K
authors.lastname: Acar
authors.forename: Gulsan Turkoz
authors.initials: GT
authors.lastname: Sucak
mesh_terms: D018806:APACHE; D000328:Adult; D003422:Critical Care / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008223:Lymphoma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000150:complications; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications; D016896:Treatment Outcome
keywords: Hematopoietic stem cell transplantation; Intensive care unit; Mortality; Risk factors