Outcome of Hematopoietic Stem Cell Transplant Recipients Admitted to the Intensive Care Unit

Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. Th...

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Vydáno v:	Biology of blood and marrow transplantation Ročník 12; číslo 3; s. 301 - 305
Hlavní autoři:	Kew, Andrea K., Couban, Stephen, Patrick, Ward, Thompson, Kara, White, Darrell
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Elsevier Inc 01.03.2006
Témata:	Adolescent Adult Aged Allogeneic Autologous Female Hematopoietic Stem Cell Transplantation - mortality Humans Intensive care Intensive Care Units Male Middle Aged Neoplasms - complications Neoplasms - mortality Neoplasms - therapy Prognosis Respiratory Insufficiency - complications Respiratory Insufficiency - mortality Respiratory Insufficiency - therapy Retrospective Studies Stem cell transplant Survival Rate Transplantation, Homologous Treatment Outcome Vasoconstrictor Agents - adverse effects Vasoconstrictor Agents - therapeutic use Allogeneic Autologous Intensive care Prognosis Stem cell transplant
ISSN:	1083-8791, 1523-6536
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Abstract	Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. The study was a retrospective review of all patients at the Queen Elizabeth II Health Sciences Center who received an SCT between 1992 and 2001 and were subsequently admitted to the ICU. The primary outcome was overall survival at 12 months after ICU admission. There were 440 SCTs in the study period; 38 of these patients were admitted to the ICU on 42 separate occasions. The primary indication for ICU admission was respiratory failure. The probability of survival at 12 months was 21.6% (95% CI, 8.4%-34.9%). On multivariate analysis, the only statistically significant variable associated with decreased 12-month survival was vasopressor use. The probability of survival for patients receiving vasopressor support was 5% (95% CI, 0%-14.5%) at 30 days and 0% at 12 months, whereas the probability of survival for patients not receiving vasopressor support was 76.5% (95% CI, 56.3%-96.6%) at 30 days and 45.8% (95% CI, 21.5%-69.9%) at 12 months. In this 10-year review of consecutive SCT recipients requiring ICU admission, we found that the outcome of SCT patients requiring ICU admission may not be as poor as previously reported. However, SCT recipients requiring vasopressor support had very poor outcomes. These findings will be important in deciding which SCT patients may benefit from ICU admission and care.
AbstractList	Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. The study was a retrospective review of all patients at the Queen Elizabeth II Health Sciences Center who received an SCT between 1992 and 2001 and were subsequently admitted to the ICU. The primary outcome was overall survival at 12 months after ICU admission. There were 440 SCTs in the study period; 38 of these patients were admitted to the ICU on 42 separate occasions. The primary indication for ICU admission was respiratory failure. The probability of survival at 12 months was 21.6% (95% CI, 8.4%-34.9%). On multivariate analysis, the only statistically significant variable associated with decreased 12-month survival was vasopressor use. The probability of survival for patients receiving vasopressor support was 5% (95% CI, 0%-14.5%) at 30 days and 0% at 12 months, whereas the probability of survival for patients not receiving vasopressor support was 76.5% (95% CI, 56.3%-96.6%) at 30 days and 45.8% (95% CI, 21.5%-69.9%) at 12 months. In this 10-year review of consecutive SCT recipients requiring ICU admission, we found that the outcome of SCT patients requiring ICU admission may not be as poor as previously reported. However, SCT recipients requiring vasopressor support had very poor outcomes. These findings will be important in deciding which SCT patients may benefit from ICU admission and care. Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. The study was a retrospective review of all patients at the Queen Elizabeth II Health Sciences Center who received an SCT between 1992 and 2001 and were subsequently admitted to the ICU. The primary outcome was overall survival at 12 months after ICU admission. There were 440 SCTs in the study period; 38 of these patients were admitted to the ICU on 42 separate occasions. The primary indication for ICU admission was respiratory failure. The probability of survival at 12 months was 21.6% (95% CI, 8.4%-34.9%). On multivariate analysis, the only statistically significant variable associated with decreased 12-month survival was vasopressor use. The probability of survival for patients receiving vasopressor support was 5% (95% CI, 0%-14.5%) at 30 days and 0% at 12 months, whereas the probability of survival for patients not receiving vasopressor support was 76.5% (95% CI, 56.3%-96.6%) at 30 days and 45.8% (95% CI, 21.5%-69.9%) at 12 months. In this 10-year review of consecutive SCT recipients requiring ICU admission, we found that the outcome of SCT patients requiring ICU admission may not be as poor as previously reported. However, SCT recipients requiring vasopressor support had very poor outcomes. These findings will be important in deciding which SCT patients may benefit from ICU admission and care.Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. The study was a retrospective review of all patients at the Queen Elizabeth II Health Sciences Center who received an SCT between 1992 and 2001 and were subsequently admitted to the ICU. The primary outcome was overall survival at 12 months after ICU admission. There were 440 SCTs in the study period; 38 of these patients were admitted to the ICU on 42 separate occasions. The primary indication for ICU admission was respiratory failure. The probability of survival at 12 months was 21.6% (95% CI, 8.4%-34.9%). On multivariate analysis, the only statistically significant variable associated with decreased 12-month survival was vasopressor use. The probability of survival for patients receiving vasopressor support was 5% (95% CI, 0%-14.5%) at 30 days and 0% at 12 months, whereas the probability of survival for patients not receiving vasopressor support was 76.5% (95% CI, 56.3%-96.6%) at 30 days and 45.8% (95% CI, 21.5%-69.9%) at 12 months. In this 10-year review of consecutive SCT recipients requiring ICU admission, we found that the outcome of SCT patients requiring ICU admission may not be as poor as previously reported. However, SCT recipients requiring vasopressor support had very poor outcomes. These findings will be important in deciding which SCT patients may benefit from ICU admission and care.
Author	White, Darrell Kew, Andrea K. Patrick, Ward Couban, Stephen Thompson, Kara
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Cites_doi	10.1164/ajrccm.158.3.9711076 10.1007/BF00262895 10.1056/NEJM199403243301206 10.1177/0310057X0203000336 10.1164/ajrccm/145.3.510 10.1097/00003246-198901000-00002 10.1038/sj.bmt.1701158 10.1164/ajrccm/137.3.682 10.1097/00003246-200004000-00017 10.1016/S0025-6196(12)61310-X 10.7326/0003-4819-125-8-199610150-00001 10.1378/chest.104.2.527 10.1097/00007890-197410000-00001
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SubjectTerms	Adolescent Adult Aged Allogeneic Autologous Female Hematopoietic Stem Cell Transplantation - mortality Humans Intensive care Intensive Care Units Male Middle Aged Neoplasms - complications Neoplasms - mortality Neoplasms - therapy Prognosis Respiratory Insufficiency - complications Respiratory Insufficiency - mortality Respiratory Insufficiency - therapy Retrospective Studies Stem cell transplant Survival Rate Transplantation, Homologous Treatment Outcome Vasoconstrictor Agents - adverse effects Vasoconstrictor Agents - therapeutic use
Title	Outcome of Hematopoietic Stem Cell Transplant Recipients Admitted to the Intensive Care Unit
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