Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit:a retrospective longitudinal analysis of 942 patients

TY - JOUR

T1 - Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit:a retrospective longitudinal analysis of 942 patients

AU - Lueck, Catherina

AU - Stadler, Michael

AU - Koenecke, Christian

AU - Hoeper, Marius M

AU - Dammann, Elke

AU - Schneider, Andrea

AU - Kielstein, Jan T

AU - Ganser, Arnold

AU - Eder, Matthias

AU - Beutel, Gernot

PY - 2018/9

Y1 - 2018/9

N2 - PURPOSE: Intensive care unit (ICU) admission of allogeneic hematopoietic stem cell transplant (HSCT) recipients is associated with relatively poor outcome. Since longitudinal data on this topic remains scarce, we analyzed reasons for ICU admission as well as short- and long-term outcome of critically ill HSCT recipients.METHODS: A total of 942 consecutive adult patients were transplanted at Hannover Medical School from 2000 to 2013. Of those, 330 patients were at least admitted once to the ICU and included in this retrospective study. To analyze time-dependent improvements, we separately compared patient characteristics as well as reasons and outcome of ICU admission for the periods 2000-2006 and 2007-2013.RESULTS: The main reasons for ICU admission were acute respiratory failure (ARF) in 35%, severe sepsis/septic shock in 23%, and cardiac problems in 18%. ICU admission was clearly associated with shortened survival (p < 0.001), but survival of ICU patients after hospital discharge reached 44% up to 5 years and was comparable to that of non-ICU HSCT patients. When ICU admission periods were compared, patients were older (48 vs. 52 years; p < 0.005) and the percentage of ARF as leading cause for ICU admission decreased from 43% in the first to 30% in the second period. Over time ICU and hospital survival improved from 44 to 60% (p < 0.01) and from 26 to 43% (p < 0.01), respectively. The 1- and 3-year survival rate after ICU admission increased significantly from 14 to 32% and from 11 to 23% (p < 0.01).CONCLUSIONS: Besides ARF and septic shock, cardiac events were especially a major reason for ICU admission. Both short- and long-term survival of critically ill HSCT patients has improved significantly in recent years, and survival of HSCT recipients discharged from hospital is not significantly affected by a former ICU stay.

AB - PURPOSE: Intensive care unit (ICU) admission of allogeneic hematopoietic stem cell transplant (HSCT) recipients is associated with relatively poor outcome. Since longitudinal data on this topic remains scarce, we analyzed reasons for ICU admission as well as short- and long-term outcome of critically ill HSCT recipients.METHODS: A total of 942 consecutive adult patients were transplanted at Hannover Medical School from 2000 to 2013. Of those, 330 patients were at least admitted once to the ICU and included in this retrospective study. To analyze time-dependent improvements, we separately compared patient characteristics as well as reasons and outcome of ICU admission for the periods 2000-2006 and 2007-2013.RESULTS: The main reasons for ICU admission were acute respiratory failure (ARF) in 35%, severe sepsis/septic shock in 23%, and cardiac problems in 18%. ICU admission was clearly associated with shortened survival (p < 0.001), but survival of ICU patients after hospital discharge reached 44% up to 5 years and was comparable to that of non-ICU HSCT patients. When ICU admission periods were compared, patients were older (48 vs. 52 years; p < 0.005) and the percentage of ARF as leading cause for ICU admission decreased from 43% in the first to 30% in the second period. Over time ICU and hospital survival improved from 44 to 60% (p < 0.01) and from 26 to 43% (p < 0.01), respectively. The 1- and 3-year survival rate after ICU admission increased significantly from 14 to 32% and from 11 to 23% (p < 0.01).CONCLUSIONS: Besides ARF and septic shock, cardiac events were especially a major reason for ICU admission. Both short- and long-term survival of critically ill HSCT patients has improved significantly in recent years, and survival of HSCT recipients discharged from hospital is not significantly affected by a former ICU stay.

KW - Adolescent

KW - Adult

KW - Aged

KW - Critical Care/statistics & numerical data

KW - Critical Illness

KW - Female

KW - Germany/epidemiology

KW - Hematopoietic Stem Cell Transplantation/mortality

KW - Humans

KW - Intensive Care Units/statistics & numerical data

KW - Leukemia/mortality

KW - Longitudinal Studies

KW - Lymphoma/mortality

KW - Male

KW - Middle Aged

KW - Respiratory Insufficiency/mortality

KW - Retrospective Studies

KW - Shock, Septic/mortality

KW - Transplantation, Homologous

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1007/s00134-018-5347-x

DO - 10.1007/s00134-018-5347-x

M3 - SCORING: Journal article

C2 - 30141173

VL - 44

SP - 1483

EP - 1492

JO - INTENS CARE MED

JF - INTENS CARE MED

SN - 0342-4642

IS - 9

ER -