PURPOSE: The outcomes of allogeneic hematopoietic stem cell transplant (HSCT) recipients requiring admission to the ICU have been generally poor. We noted a 20% ICU survival rate among patients admitted to our ICU between 2000 and 2002. The purpose of our study was to evaluate the impact of modifications to our HSCT cytoreduction and supportive care over the last 6 years on patient outcomes and clinical predictors.
METHODS: Using hospital and ICU databases, we retrospectively analyzed all adult patients who underwent allogeneic HSCT at MSKCC in 2002–2007 and were admitted to the ICU during the transplant hospitalization. Only patients admitted for their first HSCT and only the first ICU admission data were analyzed. The influence of clinical parameters on ICU and hospital survival were assessed. Separate analyses were also performed for patients transplanted 2002–2005 and 2006–2007 when antimicrobial prophylaxis changed. SPSS 11 Statistics Software was used for data analysis.
RESULTS: During the 6-year study period, 443 HSCTs were performed. 151 patients were transferred to the ICU, and 52/151 met inclusion criteria. Of these, 48% survived the ICU stay and 25% were alive to hospital discharge. Relative risks for survival in the ICU, at discharge, and at 1 year are shown in Table 1. Univariate analysis revealed that mechanical ventilation, missmatched donors and peripheral blood stem cell (PBSC) transplantation were significant risk factors for death. Causes for transfer -and death, and microbiologic profiles are shown in Table 2. Only the incidence of gram- positive bacteremia changed significantly after 2005.
CONCLUSION: The short term prognosis of adult HSCT patients transferred to the ICU has improved. Requirement for mechanical ventilation remains the strongest predictor of poor outcome. The proportion of patients transferred to our ICU over the past 6 years remained stable (∼11%). We observed a decrease in the proportion of gram-positive bacteremia which we attribute to Vancomycin prophylaxis beginning in 2006.
CLINICAL IMPLICATIONS: Our findings suggest that the improvement in survival justifies aggressive ICU care of critically ill HSCT patients.
DISCLOSURE: Sebastian Mayer, No Financial Disclosure Information; No Product/Research Disclosure Information