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

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Abstract

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.

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Abbreviations

ALL:

Acute lymphoblastic leukemia

AML:

Acute myeloid leukemia

APACHE II:

Acute physiology and chronic health evaluation II

ARDS:

Acute respiratory distress syndrome

ARF:

Acute respiratory failure

CLL:

Chronic lymphatic leukemia

CML:

Chronic myeloid leukemia

COD:

Concomitant organ dysfunction

EBMT:

European Society for Blood and Marrow Transplantation

GvHD:

Graft-versus-host disease

HSCT:

Hematopoetic stem cell transplantation

ICU:

Intensive care unit

ID:

Initial diagnosis

IQR:

Interquartile range

IMV:

Invasive mechanical ventilation

LOD:

Leading organ dysfunction

LST:

Life-sustaining therapies

MDS:

Myelodysplastic syndrome

MODS:

Multiple organ dysfunction syndrome

MPN:

Myeloproliferative neoplasm

NIV:

Non-invasive ventilations

PBSC:

Peripheral blood stem cells

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Author information

Authors and Affiliations

  1. Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany

    Catherina Lueck, Michael Stadler, Christian Koenecke, Elke Dammann, Arnold Ganser, Matthias Eder & Gernot Beutel

  2. Interdisciplinary Internal Intensive Care Unit, Department for Respiratory Diseases and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany

    Marius M. Hoeper

  3. Interdisciplinary Internal Intensive Care Unit, Department for Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany

    Andrea Schneider

  4. Interdisciplinary Internal Intensive Care Unit, Department for Nephrology and Hypertension, Hannover Medical School, Braunschweig, Germany

    Jan T. Kielstein

  5. Intensive Care in Hematologic and Oncologic Patients (iCHOP), Hannover, Germany

    Catherina Lueck & Gernot Beutel

Authors
  1. Catherina Lueck
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  2. Michael Stadler
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  3. Christian Koenecke
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  4. Marius M. Hoeper
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  5. Elke Dammann
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  6. Andrea Schneider
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  7. Jan T. Kielstein
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  8. Arnold Ganser
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  9. Matthias Eder
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  10. Gernot Beutel
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Corresponding author

Correspondence to Gernot Beutel.

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Informed consent and ethical approval

Informed consent for data collection was obtained from all individual participants (according to EBMT Registry forms) and approved by the local ethics committee. Our study was performed in accordance with the 1964 Declaration of Helsinki and its later amendments.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Lueck, C., Stadler, M., Koenecke, C. et al. Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients. Intensive Care Med 44, 1483–1492 (2018). https://doi.org/10.1007/s00134-018-5347-x

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