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. 2024 Feb 27;27(4):168.
doi: 10.3892/etm.2024.12457. eCollection 2024 Apr.

Risk factors and predictive model for mortality in patients undergoing allogeneic hematopoietic stem cell transplantation admitted to the intensive care unit

Peihua Wu  1 , Wenxuan Huo  2 , Huiying Zhao  1 , Jie Lv  1 , Shan Lv  1 , Youzhong An  1
Affiliations

Risk factors and predictive model for mortality in patients undergoing allogeneic hematopoietic stem cell transplantation admitted to the intensive care unit

Peihua Wu et al. Exp Ther Med. .

Abstract

Hematological malignant tumors represent a group of major diseases carrying a substantial risk to the lives of affected patients. Risk factors for mortality in critically ill patients have garnered substantial attention in recent research endeavors. The present research aimed to identify factors predicting intensive care unit (ICU) mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Furthermore, the present study analyzed and compared the mortality rate between patients undergoing haploidentical hematopoietic stem cell transplantation (Haplo-SCT) and those undergoing identical sibling donor (ISD) transplantation. A total of 108 patients were included in the present research, 83 (76.9%) of whom underwent Haplo-SCT. ICU mortality was reported in 58 (53.7%) patients, with the values of 55.4 and 48.0% associated with Haplo-SCT and ISD, respectively (P=0.514). The mortality rate of patients undergoing Haplo-SCT was comparable to that of patients undergoing ISD transplantation. The present study found that reduced hemoglobin, elevated total bilirubin, elevated brain natriuretic peptide, elevated fibrinogen degradation products, need for vasoactive drugs at ICU admission, need for invasive mechanical ventilation and elevated APACHE II scores were independent risk factors for ICU mortality. Among patients presenting with 5-7 risk factors, the ICU mortality reached 100%, significantly exceeding that of other patients. The present research revealed that ICU mortality rates remain elevated among patients who underwent allo-HSCT, especially those presenting multiple risk factors. However, the outcome of patients undergoing Haplo-SCT were comparable to those of patients undergoing ISD transplants.

Keywords: haploidentical hematopoietic stem cell transplantation; identical sibling donor transplantation; intensive care unit; mortality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Kaplan-Meier curve showing the 60-day survival probability for (A) all patients; and (B) Haplo-SCT recipients and ISD HSCT recipients. The 60-day survival probabilities for the three aforementioned populations were 37.0% (95% CI, 29.0-47.4%), 38.5% (95% CI, 29.4-50.6%), 32.0% (95% CI, 18.1-56.7%), respectively, (P=0.66). Haplo-SCT, haploidentical hematopoietic stem cell transplantation; ISD, identical sibling donor; CI, confidence interval; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit.
Figure 2
Figure 2
Multivariable analysis of risk factors for ICU mortality (A) for clinical characteristics; and (B) for ICU treatment. All of the variables were collected on the day of ICU admission. BNP, brain natriuretic peptide; FDP, fibrinogen degradation products; APACHII, acute physiologic and chronic health assessment II; ICU, intensive care unit.
Figure 3
Figure 3
Kaplan-Meier curve showing the 60-day survival probability after ICU admission among low-, intermediate- and high-risk groups. The 60-day probability of survival of the low-risk group vs. intermediate-risk group: 62.0% (95% CI, 49.9-77.0%) vs. 23.7% (95% CI, 13.4-41.9%); P<0.001. ICU, intensive care unit.
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