Yazarlar : Agarwal S, O'Donoghue S, Gowardman J, Kennedy G, Bandeshe H, Boots R.

Yayın : Intern Med J.

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/21627739

Konu : Enfeksiyon

Literatür İçeriği :

Abstract

Background:  Previous research at our institution (1988-98) established an intensive care unit (ICU) and hospital mortality between 70-80% in hematopoietic stem cell transplant (HSCT) patients requiring ICU admission. Aims:  This study explored mortality in a more contemporary cohort while comparing outcomes to published literature and our previous experience. Methods:  Retrospective chart review of HSCT patients admitted to ICU between December 1998 and June 2008. Results:  Of 146 admissions, 53% were male, with a mean age of 44 years, an APACHE II score of 28 and SOFA score of 11. Fifty-six percent had GVHD, with respiratory failure (67%) being the most common admission diagnosis. All but one received mechanical ventilation. The ICU and hospital mortality were 42% (72% 1988-1998 cohort) and 64% (82% 1998-1998 cohort) respectively. The 6 and 12 month survival were 29% and 24% respectively for the 1998-2008 cohort. Dying in ICU was independently predicted by fungal infection (P = 0.02) and early onset of organ failure (P < 0.001), while GVHD (P = 0.04) predicted survival. Mortality at 12 months was independently predicted by the acute physiology score (P = 0.002), increasing number of organ failures (P = 0.001), and CMV positive serology (P = 0.005), while blood stream infection (P = 0.003), an antibiotic change on admission to the ICU (P = 0.007) and a diagnosis of non-Hodgkin's lymphoma (P = 0.02) predicted survival. Conclusion:  Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long-term survival.

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