Outcome and Prognostic Factors of Hematopoietic Stem Cell Transplantation Recipients Admitted to a Medical ICU

Soubani, Ayman O.; Kseibi, Eiad; Bander, Joseph J.; Klein, Jared; Khanchandani, Geeta; Ahmed, Huma; Guzmán, Jorge

doi:10.1378/chest.126.5.1604

Cited by 128 publications

(108 citation statements)

References 34 publications

(11 reference statements)

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“…The admission rate of 3.3% is lower than previous reports that range from 21-44%, [3][4][5][6] and even lower if the literature is restricted to the past 10 years, with AHCT admission rates of 8.6-14.6%. [11][12][13] The ICU mortality rate was 38%, representing 1% of all AHCT patients. Patients with AL amyloidosis had the worst outcome, and univariable logistic regression showed that, within the first 24 h, severity of illness scores, 42 organ failures, need for MV or inotropes, and Gram-negative sepsis were associated with increased in-ICU mortality.…”

Section: Discussionmentioning

confidence: 99%

“…8 Despite the increased tolerability of an autologous compared with an allogeneic HSCT, ICU admission may represent a significant adverse event, although only a small body of literature exists to help guide clinicians as to which patients benefit from intensive care. [9][10][11][12][13] In this study, we describe the outcome of AHCT recipients transferred to the ICU and identify factors associated with mortality.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit

Trinkaus

Lapinsky

Crump

et al. 2008

Bone Marrow Transplant

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patients received autologous hematopoietic cell transplants (AHCT) at Canada's largest transplant center. In this retrospective cohort study of AHCT patients admitted to the intensive care unit (ICU), we describe the outcomes following ICU admission and the variables measured in the first 24 h of ICU admission associated with overall ICU mortality. Results indicate a 3.3% ICU admission rate (n ¼ 34) with 13 deaths (1% overall mortality rate, 38% in ICU mortality rate). The worst outcome was in AL amyloid patients of whom 28% were admitted to the ICU, with an ICU mortality rate of 55%. The Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE II) score in the first 24 h were statistically associated with mortality by univariate analysis. Other variables measured at 24 h and associated with ICU mortality included multiorgan failure, mechanical ventilation, inotropic support 44 h and Gram-negative sepsis. Our data indicate that ICU admission in the autotransplant population is rare and that it is influenced by underlying diagnosis, with AL amyloid patients having the highest risk. Our observations may assist clinical decision-making regarding the continuation of intensive care delivered 24 h after ICU admission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit

Trinkaus

Lapinsky

Crump

et al. 2008

Bone Marrow Transplant

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show abstract

“…13 Other variables have been associated with poor outcome in adults, haemodynamic instability, gastrointestinal bleeding, infection, multi-organ failure, increased length of ICU stay and interval between transplant and ICU admission. 6,[13][14][15][16][17] In children, additional factors associated with poor prognosis include severe haemorrhagic cystitis, lung injury and failure of more than three organ systems. 18 One paediatric study has also demonstrated a difference in prognosis with different sources of stem cells.…”

Section: Introductionmentioning

confidence: 99%

Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders

Cole

Johnstone

Pearce

et al. 2011

Bone Marrow Transplant

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Haematopoietic SCT (HSCT) is curative for many children with primary immunodeficiencies or other nonmalignant conditions. Outcome for those admitted to intensive care following HSCT for oncology diagnoses has historically been very poor. There is no literature available specifically regarding the outcome for children with primary immunodeficiency requiring intensive care following HSCT. We reviewed our post-HSCT admission to intensive care over a 5-year period. A total of 111 children underwent HSCT. Median age at transplant was 1 year 4 months. The most common diagnosis was SCID. In all, 35% had at least one intensive care admission and 44% survived to be discharged from intensive care. Also, 73% of admission episodes requiring invasive ventilation but no inotropes or renal replacement therapy resulted in survival to discharge. Children undergoing HSCT for immunological diagnoses had a high rate of admission to intensive care. No factors were identified that could predict the need for admission. Invasive ventilation alone has a much better outcome than that in historical series. However, the need for multi-organ system support was still associated with a poor outcome. This information is useful when counselling families of children that have deteriorated and been admitted to intensive care during the HSCT procedure.

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“…Poor outcomes have particularly been associated with patients who have had HSCT (especially with myeloablative conditioning) [1][2][3] and patients who required mechanical ventilation [4][5][6]. Although a number of haematology centres from outside the UK have now demonstrated improved outcomes in patients requiring intensive care unit (ICU) support [7,8], the continuing perception of poor outcomes in this patient group may continue to adversely affect their chances of being admitted to some ICUs.…”

Section: Introductionmentioning

confidence: 99%

Impact of critical care reconfiguration and track-and-trigger outreach team intervention on outcomes of haematology patients requiring intensive care admission

et al. 2009

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Outcome and Prognostic Factors of Hematopoietic Stem Cell Transplantation Recipients Admitted to a Medical ICU

Cited by 128 publications

References 34 publications

Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit

Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit

Outcome of children requiring intensive care following haematopoietic SCT for primary immunodeficiency and other non-malignant disorders

Impact of critical care reconfiguration and track-and-trigger outreach team intervention on outcomes of haematology patients requiring intensive care admission

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