Outcome and prognostic indicators of patients with hematopoietic stem cell transplants admitted to the intensive care unit

Abstract

The prognosis of patients with hematopoietic stem cell transplants (HSCTs) who require admission to the intensive care unit (ICU) has been regarded as extremely poor. We sought to re-evaluate recent outcomes and predictive factors in a retrospective cohort study. Among the 605 adult patients that received an HSCT between 2001 and 2006, 154 required admission to the ICU. Of these, 47% were discharged from the ICU, 36% were discharged from the hospital, and 19% survived 6 months. Allogeneic transplant, mechanical ventilation, vasopressor-use, and neutropenia were each associated with increased mortality, and the mortality of patients with all four characteristics was 100%. Hemodialysis was also associated with increased mortality in a Kaplan-Meier analysis but did not appear important in a multivariate tree analysis. A final Cox model confirmed that allogeneic transplant, mechanical ventilation, and vasopressor-use were each independent risk factors for mortality in the 6 months following ICU admission.

Figure 1

(a) Number and timing of patients receiving mechanical ventilation following ICU admission. (b) Number and timing of patients receiving vasopressor following ICU admission. (c) Number and timing of patients receiving hemodialysis after ICU admission.

Figure 2

Survival in the 6 months following ICU admission is generally better in autologous HSCT patients compared to allogeneic HSCT patients.

Figure 3

Kaplan Meier survival curves for 6 months after admission to ICU depending on requirement for ventilation, vasopressor-use, hemodialysis, and the presence of neutropenia.

Figure 4

6-month mortality model for 154 HSCT patients who were admitted to the ICU. Out of the 154 HSCT patients who were admitted to the ICU, 81% were not alive 6 months after ICU admission. Patients who had all 4 prognostic indicators (allogeneic transplant, mechanical ventilation, vasopressor-use, and neutropenia) had 100% mortality.

Figure 5

Kaplan-Meier 6-month survival curve separated by timing of ICU admission. HSCT Admission Group is patients who were admitted to the ICU during the course of their initial admission for HSCT, Early Readmission Group is patients who have been discharged from the hospital since their HSCT but still within 100 days of their transplant, and Late Readmission Group is patients who have been discharged from the hospital since their HSCT but who are greater than 100 days out from their transplant.

Figure 6

Kaplan meier curves during 6 months after admission to the ICU depending on the presence of GVHD for HSCT Admission Group (log rank test, P = .03).