title: Admission of hematopoietic cell transplantation patients to the intensive care unit at the Pontificia Universidad Católica de Chile Hospital.
abstract: Patients undergoing hematopoietic cell transplantation (HCT) can have complications that require management in the intensive care unit (ICU). We conducted a retrospective study of patients undergoing HCT between 2007 and 2011 with admission to the ICU. We analyzed 97 patients, with an average age of 37 (range, 15 to 68). The main indications for HCT were hematologic malignancies (84%, n = 82). Ninety percent (n = 87) received myeloablative conditioning. Thirty-one percent were admitted (autologous transplant recipients 15%, allogeneic transplant recipients 34%, and umbilical cord blood [UCB] transplant recipients 48%) with an average length of stay of 19 days (range, 1 to 73 days). The average time between transplantation and transfer was 15 days. The main causes of admission were acute respiratory failure (63%) and septic shock (20%). ICU mortality was 20% for autologous transplantations and 64% for allogeneic transplantations (adult donor and UCB combined). On average, patients died 108 days after the transplantation (range, 4 to 320 days). One-year overall survival, comparing patients entering the ICU with those never admitted, was 16% versus 82% (P < .0001) for allogeneic transplantations (adult donor and UCB combined) and 80% versus 89% (P = not significant) for autologous transplantations. Acute graft-versus-host disease was significantly associated with death in ICU after UCB HCT. ICU support is satisfactory in about one half of patients admitted, characterized by a short and medium term prognosis not as unfavorable as has been previously reported.
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Karen
authors.initials: K
authors.lastname: Escobar
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: Rojas
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ernst
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bertin
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Bruno
authors.initials: B
authors.lastname: Nervi
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Veronica
authors.initials: V
authors.lastname: Jara
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Ocqueteau
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Sarmiento
authors.affiliation: Department of Hematology Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: pramirez@med.puc.cl.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ramirez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002677:Chile; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000473:pathology; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012008:Recurrence; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
keywords: Hematopoietic cell transplantation; Intensive care unit; Outcomes