Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients
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Intensive care unit (ICU) admission of allogeneic hematopoietic stem cell transplant (HSCT) recipients is associated with relatively poor outcome. Since longitudinal data on this topic remains scarce, we analyzed reasons for ICU admission as well as short- and long-term outcome of critically ill HSCT recipients.
A total of 942 consecutive adult patients were transplanted at Hannover Medical School from 2000 to 2013. Of those, 330 patients were at least admitted once to the ICU and included in this retrospective study. To analyze time-dependent improvements, we separately compared patient characteristics as well as reasons and outcome of ICU admission for the periods 2000–2006 and 2007–2013.
The main reasons for ICU admission were acute respiratory failure (ARF) in 35%, severe sepsis/septic shock in 23%, and cardiac problems in 18%. ICU admission was clearly associated with shortened survival (p < 0.001), but survival of ICU patients after hospital discharge reached 44% up to 5 years and was comparable to that of non-ICU HSCT patients. When ICU admission periods were compared, patients were older (48 vs. 52 years; p < 0.005) and the percentage of ARF as leading cause for ICU admission decreased from 43% in the first to 30% in the second period. Over time ICU and hospital survival improved from 44 to 60% (p < 0.01) and from 26 to 43% (p < 0.01), respectively. The 1- and 3-year survival rate after ICU admission increased significantly from 14 to 32% and from 11 to 23% (p < 0.01).
Besides ARF and septic shock, cardiac events were especially a major reason for ICU admission. Both short- and long-term survival of critically ill HSCT patients has improved significantly in recent years, and survival of HSCT recipients discharged from hospital is not significantly affected by a former ICU stay.
KeywordsHematopoietic stem cell transplantation Intensive care Outcome Respiratory failure
Acute lymphoblastic leukemia
Acute myeloid leukemia
- APACHE II
Acute physiology and chronic health evaluation II
Acute respiratory distress syndrome
Acute respiratory failure
Chronic lymphatic leukemia
Chronic myeloid leukemia
Concomitant organ dysfunction
European Society for Blood and Marrow Transplantation
Hematopoetic stem cell transplantation
Intensive care unit
Invasive mechanical ventilation
Leading organ dysfunction
Multiple organ dysfunction syndrome
Peripheral blood stem cells
Compliance with ethical standards
Informed consent and ethical approval
Informed consent for data collection was obtained from all individual participants (according to EBMT Registry forms) and approved by the local ethics committee. Our study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments.
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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