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Temporal trends in critical care utilization and outcomes in allogeneic hematopoietic stem cell transplant recipients

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Abstract

Historically, the prognosis of allogeneic hematopoietic stem cell transplant (allo-HCT) recipients who require intensive care unit (ICU) admission has been poor. We aimed to describe the epidemiological trends of ICU utilization and outcomes in allo-HCT patients. We conducted a retrospective cohort study including adults (≥ 18) undergoing allo-HCT between 01/01/2005 and 31/12/2020 at Mayo Clinic, Rochester. Temporal trends in outcomes were assessed by robust linear regression modelling. Risk factors for hospital mortality were chosen a priori and assessed with multivariable logistic regression modelling. Of 1,249 subjects, there were 486 ICU admissions among 287 individuals. Although older patients underwent allo-HCT (1.64 [95% CI: 1.11 to 2.45] years per year; P = 0.025), there was no change in ICU utilization over time (P = 0.91). The ICU and hospital mortality rates were 19.2% (55/287) and 28.2% (81/287), respectively. There was a decline in ICU mortality (-0.38% [95% CI: -0.70 to -0.06%] per year; P = 0.035). The 1-year post-HCT mortality for those requiring ICU admission was 56.1% (161/287), with no significant difference over time, versus 15.8% (141/891, 71 missing) among those who did not. The frequency and duration of invasive mechanical ventilation (IMV) declined. In multivariable analyses, higher serum lactate, higher sequential organ failure assessment (SOFA) scores, acute respiratory distress (ARDS), and need for IMV were associated with greater odds of hospital mortality. Over time, rates of ICU utilization have remained stable, despite increasing patient age. Several trends suggest improvement in outcomes, notably lower ICU mortality and frequency of IMV. However, long-term survival remains unchanged. Further work is needed to improve long-term outcomes in this population.

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Abbreviations

Allo-HCT :

Allogeneic hematopoietic stem cell transplant

AKI :

Acute kidney injury

APACHE :

Acute physiology and chronic health evaluation

ARDS :

Acute respiratory distress syndrome

AST :

Aspartate transaminase

CI :

Confidence interval

FEV 1 :

Forced expiratory volume in 1 s

GVHD :

Graft-versus-host disease

HCT-CI :

Hematopoietic Cell Transplantation (HCT)-specific Comorbidity Index

ICU :

Intensive care unit

IMV :

Invasive mechanical ventilation

IQR :

Interquartile range

LVEF :

Left ventricular ejection fraction

OR :

Odds ratio

SOFA :

Sequential organ failure assessment

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Acknowledgements

Hemang Yadav and Kiyan Heybati contributed to the study conception and design. Data retrieval was done by Hemang Yadav and Domenic Ochal, and Svetlana Herasevich. Data analysis and table and figure preparation were performed by Kiyan Heybati, Domenic Ochal, and Hemang Yadav. The first draft of the manuscript was written by Kiyan Heybati. All authors contributed to the interpretation of the data and critically appraised the manuscript All authors commented on previous versions of the manuscript and read and approved the final manuscript.​ Hemang Yadav serves as the corresponding author and guarantor for the work.

Funding

This project was supported by Grant Number K23HL151671 (Recipient: Hemang Yadav) from the National Heart, Lung, and Blood Institute of the National Institute of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA

    Kiyan Heybati & Domenic Ochal

  2. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    William Hogan, Hassan Al-Khateeb, Mark Litzow, Mithun Shah, Mehrdad Hefazi Torghabeh & Urshila Durani

  3. College of Health Solutions, Arizona State University, Phoenix, AZ, USA

    David Sklar

  4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Svetlana Herasevich, Philippe Bauer, Ognjen Gajic & Hemang Yadav

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Heybati, K., Ochal, D., Hogan, W. et al. Temporal trends in critical care utilization and outcomes in allogeneic hematopoietic stem cell transplant recipients. Ann Hematol 103, 957–967 (2024). https://doi.org/10.1007/s00277-023-05612-9

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