title: Different Impact of the Number of Organ Failures and Graft-Versus-Host Disease on the Outcome of Allogeneic Stem Cell Transplantation Recipients Requiring Intensive Care.
abstract: BACKGROUND
  Admission of allogeneic stem cell transplantation (SCT) recipients to the intensive care unit (ICU) remains controversial, especially when graft-versus-host disease (GVHD) is present.
  
  
  METHODS
  We performed a retrospective study to assess prognostic factors of survival in all allogeneic SCT recipients admitted to the ICU between 2002 and 2013 in our center which has flexible admission criteria, especially regarding GVHD.
  
  
  RESULTS
  Of 349 patients who underwent allogeneic SCT during the study period, 92 patients (26%) were admitted to the ICU. Intensive care unit and hospital discharge rates were 66% and 46%, respectively, whereas 1 year survival was 24%. Acute GVHD, either grade III to IV (30 patients, 33%) or refractory (12 patients, 13%) had a nonsignificant impact on hospital mortality (odds ratio [OR], 2.1; P = 0.1; OR, 5, P = 0.05, respectively). Fifty percent of patients required invasive mechanical ventilation, 30% required vasopressors, 17% required renal replacement therapy, and 28% had liver impairment (bilirubin >34 μmol/L), each of these parameters defining organ failure. Mortality was closely associated with the number of organ failures as hospital discharge rates were 69%, 50%, 42%, and 0% among patients with 0 (26 patients), 1 (26 patients), 2 (26 patients), and 3 to 4 (14 patients) organ failures, respectively (OR, 2.7; 95% confidence interval, 1.6-4.6; P < 0.001 according to the number of organ failures).
  
  
  CONCLUSIONS
  Early mortality of allogeneic SCT recipients admitted to the ICU is especially influenced by the number of organ failures and therefore patients with 0 to 2 organ failures should be considered if required. Refractory GVHD affects survival but not within the confined ICU admission.
authors.affiliation: 1 Maladies du Sang, CHU d'Angers, Angers, France. 2 Réanimation Médicale, CHU d'Angers, Angers, France. 3 Centre de Recherche Clinique, CHU d'Angers, Angers, France. 4 Plateforme SNP, Transcriptome et Epigénomique, CHU d'Angers, Angers, France. 5 INSERM U892/CNRS 6295, Université d'Angers, Angers, France.
authors.forename: Corentin
authors.initials: C
authors.lastname: Orvain
authors.forename: Francois
authors.initials: F
authors.lastname: Beloncle
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Hamel
authors.forename: Sylvain
authors.initials: S
authors.lastname: Thépot
authors.forename: Mélanie
authors.initials: M
authors.lastname: Mercier
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Farhi
authors.forename: Sylvie
authors.initials: S
authors.lastname: Francois
authors.forename: Philippe
authors.initials: P
authors.lastname: Guardiola
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.forename: Mathilde
authors.initials: M
authors.lastname: Hunault-Berger
authors.forename: Alain
authors.initials: A
authors.lastname: Mercat
authors.forename: Norbert
authors.initials: N
authors.lastname: Ifrah
authors.forename: Aline
authors.initials: A
authors.lastname: Tanguy-Schmidt
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003422:Critical Care; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome