SESSION TYPE: Hematologic Problems in the ICU
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: Hematopoietic stem cell transplantation (HSCT) is performed globally to treat hematologic malignancies and selected solid tumors. Because of life-threatening complications, approximately 15.7% of HSCT recipients are admitted to the intensive care unit (ICU). Risk factors for ICU admission are not well defined. The goal of this study is to determine risk factors for ICU admission in HSCT recipients.
METHODS: We performed a retrospective cohort study of all adults who received HSCT from 2003-2010. We collected data at baseline including race, age at HSCT, gender, indication for HSCT, disease status category (early, intermediate, advanced), transplant type (autologous, allogeneic), stem cell source (bone marrow, peripheral blood), conditioning regimen (myeloablative, non-myeloablative, reduced intensity conditioning [RIC]), total body irradiation (TBI) conditioning, Cytomegalovirus (CMV) serology, and Karnofsky score. ICU admission status for each patient was determined. We used Student’s t, Mann-Whitney U, and Chi-squared tests to determine risk factors associated with ICU admission by univariate analysis. We also performed a multivariate logistic regression analysis by entering into the models factors associated with ICU admission at a p value of 0.1 or lower by univariate analysis. Odds ratio (OR) and the 95% confidence interval (CI) were calculated. P values < 0.05 were considered statistically significant.
RESULTS: A total of 2405 adults received HSCT, of whom 591 (24.6%) were admitted to an ICU. Factors associated with ICU admission at a p value of 0.1 or lower by univariate analyses were allogeneic transplant, TBI, conditioning regimen, and Karnofsky score. Multiple logistic regression analysis showed the independent risk factors associated with ICU admission were allogeneic transplant (p=0.004; OR, 95% CI=1.931, 1.241-3.005) and Karnofsky score (p=0.005; OR, 95% CI=0.989, 0.982-0.997).
CONCLUSIONS: Lower Karnofsky score and allogeneic transplant are independent risk factors for ICU admission.
CLINICAL IMPLICATIONS: ICU admissions are often required by those with worsening clinical status. Identification of low Karnofsky score and allogeneic transplant as risk factors for ICU admission may help clinicians to focus prevention of clinical deterioration on such groups.
DISCLOSURE: The following authors have nothing to disclose: Shahnaz Ajani, Mark Litzow, William Hogan, Steve Peters, Bekele Afessa
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