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. 2013 Nov 20;31(33):4207-14.
doi: 10.1200/JCO.2013.50.5867. Epub 2013 Oct 14.

Hematopoietic cell transplantation-specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit

Ulas D Bayraktar  1 , Elizabeth J Shpall, Ping Liu, Stefan O Ciurea, Gabriela Rondon, Marcos de Lima, Marylou Cardenas-Turanzas, Kristen J Price, Richard E Champlin, Joseph L Nates
Affiliations

Hematopoietic cell transplantation-specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit

Ulas D Bayraktar et al. J Clin Oncol. .

Abstract

Purpose: To investigate the prognostic value of the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) in patients who received transplantation admitted to the intensive care unit (ICU).

Patients and methods: We investigated the association of HCT-CI with inpatient mortality and overall survival (OS) among 377 patients who were admitted to the ICU within 100 days of allogeneic stem-cell transplantation (ASCT) at our institution. HCT-CI scores were collapsed into four groups and were evaluated in univariate and multivariate analyses using logistic regression and Cox proportional hazards models.

Results: The most common pretransplantation comorbidities were pulmonary and cardiac diseases, and respiratory failure was the primary reason for ICU admission. We observed a strong trend for higher inpatient mortality and shorter OS among patients with HCT-CI values ≥ 2 compared with patients with values of 0 to 1 in all patient subsets studied. Multivariate analysis showed that patients with HCT-CI values ≥ 2 had significantly higher inpatient mortality than patients with values of 0 to 1 and that HCT-CI values ≥ 4 were significantly associated with shorter OS compared with values of 0 to 1 (hazard ratio, 1.74; 95% CI, 1.23 to 2.47). The factors associated with lower inpatient mortality were ICU admission during the ASCT conditioning phase or the use of reduced-intensity conditioning regimens. The overall inpatient mortality rate was 64%, and the 1-year OS rate was 15%. Among patients with HCT-CI scores of 0 to 1, 2, 3, and ≥ 4, the 1-year OS rates were 22%, 17%, 18%, and 9%, respectively.

Conclusion: HCT-CI is a valuable predictor of mortality and survival in critically ill patients after ASCT.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Subgroup analyses of inpatient mortality and overall survival comparing patients with Hematopoietic Cell Transplantation–Specific Comorbidity Index (HCT-CI) scores ≥ 2 versus patients with scores of 0 to 1. Forest plot demonstrates the odds ratios (OR) for inpatient mortality. HR, hazard ratio; ICU, intensive care unit; MDS, myelodysplastic syndrome.
Fig 2.
Fig 2.
Kaplan-Meier plots of overall survival in patients with Hematopoietic Cell Transplantation–Specific Comorbidity Index (HCT-CI) scores of 0 to 1, 2, 3, and ≥ 4.
See this image and copyright information in PMC

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