title: Characteristics and outcome of patients presenting to the emergency department after autologous/allogeneic stem cell transplantation.
abstract: BACKGROUND
  Hematopoietic stem cell transplantations are still associated with a high risk of complications. Here, we characterize patients after autologous or allogeneic transplantation presenting to the emergency department and investigate factors associated with patients' outcome after hospitalization.
  
  
  METHODS
  Patients who had previously undergone autologous or allogeneic stem cell transplantation were included in this study and data were collected retrospectively. We analyzed patients' characteristics and outcome, and identified factors associated with outcome.
  
  
  RESULTS
  A total of 35% of presenting autologous and 52% of allogeneic patients were hospitalized for more than 7 days. In-hospital mortality was 4% (autologous) and 11% (allogeneic patients). In patients with a history of autologous transplantation, multivariate analysis indicated radiologic signs of pneumonia as an independent factor associated with the endpoint 'hospitalization of more than 7 days' (P<0.001). Furthermore, in multivariate analysis, C-reactive protein levels greater than 5 mg/l (P=0.006), low hemoglobin (P=0.002), and radiologic signs of pneumonia (P=0.004) were associated independently with an increase in the endpoint 'total duration of hospitalization'. In patients with a history of allogeneic transplantation, multivariate analysis indicated radiologic signs of pneumonia (P<0.001) and graft-versus-host-disease (P=0.006) to be associated independently with the endpoint 'hospitalization of more than 7 days'. Furthermore, radiologic signs of pneumonia were associated independently with the endpoints 'ICU treatment' (P<0.001), the 'total duration of hospitalization' (P<0.001), and 'in-hospital mortality' (P=0.002). A low platelet count was associated independently with an increase in the endpoint 'duration of hospitalization' (P=0.001).
  
  
  CONCLUSIONS
  Radiologic signs of pneumonia were associated independently with worse clinical outcomes including hospitalization, the need for ICU treatment, and death.
authors.affiliation: aMedical Department III bInstitute of Medical Statistics and Epidemiology cDepartment of Radiology dMedical Department II, Klinikum rechts der Isar, University Medical Center, München, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Spoerl
authors.forename: Claudia
authors.initials: C
authors.lastname: Hendlmeier
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.forename: Moritz
authors.initials: M
authors.lastname: Wildgruber
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Christian
authors.initials: C
authors.lastname: Peschel
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D000704:Analysis of Variance; D064592:Autografts; D002423:Cause of Death; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005858:Germany; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome