Intensive care unit experience of haemopoietic stem cell transplant patients
Article first published online: 18 JUL 2012
© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 42, Issue 7, pages 748–754, July 2012
How to Cite
Agarwal, S., O'Donoghue, S., Gowardman, J., Kennedy, G., Bandeshe, H. and Boots, R. (2012), Intensive care unit experience of haemopoietic stem cell transplant patients. Internal Medicine Journal, 42: 748–754. doi: 10.1111/j.1445-5994.2011.02533.x
Conflict of interest: None.
- Issue published online: 18 JUL 2012
- Article first published online: 18 JUL 2012
- Accepted manuscript online: 1 JUN 2011 01:35AM EST
- Received 19 January 2011; accepted 18 May 2011.
- haemopoietic stem cell transplant;
- intensive care unit;
- organ failure;
- critical illness
Background: Previous research at our institution (1988–1998) established an intensive care unit (ICU) and hospital mortality between 70% and 80% in haemopoietic stem cell transplant (HSCT) patients requiring ICU admission.
Aims: This study explored mortality in a more contemporary cohort while comparing outcomes to published literature and our previous experience.
Methods: Retrospective chart review of HSCT patients admitted to ICU between December 1998 and June 2008.
Results: Of 146 admissions, 53% were male, with a mean age of 44 years, an Acute Physiologic and Chronic Health Evaluation II score of 28 and Sepsis Organ Failure Assessment score of 11. Fifty-six per cent had graft versus host disease (GVHD), with respiratory failure (67%) being the most common admission diagnosis. All but one received mechanical ventilation. The ICU and hospital mortality were 42% (72% 1988–1998 cohort) and 64% (82% 1998–1998 cohort) respectively. The 6- and 12-month survivals were 29% and 24% respectively for the 1998–2008 cohort. Dying in ICU was independently predicted by fungal infection (P= 0.02) and early onset of organ failure (P < 0.001), while GVHD (P= 0.04) predicted survival. Mortality at 12 months was independently predicted by the acute physiology score (P= 0.002), increasing number of organ failures (P= 0.001), and cytomegalovirus positive serology (P= 0.005), while blood stream infection (P= 0.003), an antibiotic change on admission to the ICU (P= 0.007) and a diagnosis of non-Hodgkin lymphoma (P= 0.02) predicted survival.
Conclusion: Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long-term survival.