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(Chest. 2004;126:1604-1611.)
© 2004 American College of Chest Physicians

Outcome and Prognostic Factors of Hematopoietic Stem Cell Transplantation Recipients Admitted to a Medical ICU*

Ayman O. Soubani, MBBS, FCCP; Eiad Kseibi, MD; Joseph J. Bander, MD; Jared L. Klein, MD; Geeta Khanchandani, MD; Huma P. Ahmed, MD and Jorge A. Guzman, MD

* From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs. Soubani, Kseibi, Bander, Khanchandani, Ahmed, and Guzman), and Stem Cell Transplantation Section (Dr. Klein), Wayne State University School of Medicine, Detroit, MI.

Correspondence to: Ayman O. Soubani, MBBS, FCCP, Harper University Hospital, Division of Pulmonary, Critical Care and Sleep Medicine, 3990 John R- 3 Hudson, Detroit, MI 48201; e-mail: asoubani{at}med.wayne.edu

Objective: To assess the outcome of adult hematopoietic stem cell transplantation (HSCT) recipients who were admitted to a medical ICU (MICU), and to identify the measurable predictors of their MICU outcome.

Design: Retrospective chart review study.

Setting: MICU in a tertiary care, university-affiliated medical center with a comprehensive cancer program.

Patients: Consecutive adult HSCT recipients admitted to the MICU between January 1998 and June 2001.

Measurements and main results: Eighty-five patients were admitted to the MICU, representing 11.4% of patients who had undergone HSCT during the study period. The mean (± SD) age at MICU admission was 46.6 ± 11.4 years (women, 67%; men, 33%). Forty-five patients (53%) underwent allogeneic HSCT, and 40 patients (47%) underwent autologous HSCT. Fifty-one patients (60%) required mechanical ventilation (MV). Fifty-two patients (61%) survived their MICU stay, and 35 patients (41%) were discharged alive from the hospital. The long-term survival rate (ie, > 6 months) in this cohort was 28%. Nineteen mechanically ventilated patients (37%) survived their MICU stay, and 33 patients (97%) survived who did not require MV (p < 0.01). The independent predictors of poor outcome during the MICU stay were elevated serum lactate level on admission to the MICU, the need for MV, and the presence of more than two organ systems that failed.

Conclusions: The study showed short-term and long-term survival rates among adult HSCT recipients who had been admitted to MICU that were higher than those previously reported. While there were no absolute predictors of mortality, patients with higher MICU admission serum lactate levels, those requiring MV, or those developing more than two organ system failures had poor MICU outcomes.

Key Words: bone marrow transplantation • complications • hematopoietic stem cell transplantation • mechanical ventilation • medical ICU • multiorgan system failure • outcome • prognosis






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