title: Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients.
abstract: Intensive care unit (ICU) admission is associated with high mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Whether mortality has decreased recently is unknown. The 497 adult allogeneic HSCT recipients admitted to three ICUs between 1997 and 2011 were evaluated retrospectively. Two hundred and nine patients admitted between 1997 and 2003 were compared with the 288 patients admitted from 2004 to 2011. Factors associated with 90-day mortality were identified. The recent cohort was characterized by older age, lower conditioning intensity, and greater use of peripheral blood or unrelated-donor graft. In the recent cohort, ICU was used more often for patients in hematological remission (67% vs 44%; P<0.0001) and without GVHD (73% vs 48%; P<0.0001) or invasive fungal infection (85% vs 73%; P=0.0003) despite a stable admission rate (21.7%). These changes were associated with significantly better 90-day survival (49% vs 31%). Independent predictors of hospital mortality were GVHD, mechanical ventilation (MV) and renal replacement therapy (RRT). Among patients who required MV or RRT, survival was 29% and 18%, respectively, but dropped to 18% and 6% in those with GVHD. The use of ICU admission has changed and translated into improved survival, but advanced life support in patients with GVHD usually provides no benefits.
authors: 1] Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.
authors: E
authors: E
authors: Lengliné
authors: 1] Biostatistic Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] ECSTRA team, CRESS (UMR 1153), Inserm, Université Paris Diderot Paris, France.
authors: S
authors: S
authors: Chevret
authors: Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.
authors: A-S
authors: AS
authors: Moreau
authors: Medical Intensive Care Unit, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris France.
authors: F
authors: F
authors: Pène
authors: Intensive Care Unit, Institut Gustave Rousy, Villejuif, France.
authors: F
authors: F
authors: Blot
authors: Hematology Department, Institut Gustave Roussy, Villejuif, France.
authors: J-H
authors: JH
authors: Bourhis
authors: 1] Hematology Department, Hôpital Necker, AP-HP, Université Paris Descartes, Paris France [2] Institut National du Cancer, Boulogne Billancourt, France.
authors: A
authors: A
authors: Buzyn
authors: Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.
authors: B
authors: B
authors: Schlemmer
authors: 1] Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] INSERM UMR 1160, Paris France.
authors: G
authors: G
authors: Socié
authors: 1] Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France [2] ECSTRA team, CRESS (UMR 1153), Inserm, Université Paris Diderot Paris, France.
authors: E
authors: E
authors: Azoulay
mesh_terms: D000328:Adult; D064591:Allografts; D003422:Critical Care / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D061349:Unrelated Donors