TY - JOUR
T1 - Intensive care outcomes in adult hematopoietic stem cell transplantation patients
AU - Bayraktar, Ulas D.
AU - Nates, Joseph L.
N1 - Publisher Copyright:
© 2016 Baishideng Publishing Group Inc. All rights reserved.
PY - 2016/2/10
Y1 - 2016/2/10
N2 - Although outcomes of intensive care for patients undergoing hematopoietic stem cell transplantation (HSCT) have improved in the last two decades, the short-term mortality still remains above 50% among allogeneic HSCT patients. Better selection of HSCT patients for intensive care, and consequently reduction of nonbeneficial care, may reduce financial costs and alleviate patient suffering. We reviewed the studies on intensive care outcomes of patients undergoing HSCT published since 2000. The risk factors for intensive care unit (ICU) admission identified in this report were primarily patient and transplant related: HSCT type (autologous vs allogeneic), conditioning intensity, HLA mismatch, and graft-versus-host disease (GVHD). At the same time, most of the factors associated with ICU outcomes reported were related to the patients' functional status upon development of critical illness and interventions in ICU. Among the many possible interventions, the initiation of mechanical ventilation was the most consistently reported factor affecting ICU survival. As a consequence, our current ability to assess the benefit or futility of intensive care is limited. Until better ICU or hospital mortality prediction models are available, based on the available evidence, we recommend practitioners to base their ICU admission decisions on: Patient pretransplant comorbidities, underlying disease status, GVHD diagnosis/grade, and patients' functional status at the time of critical illness.
AB - Although outcomes of intensive care for patients undergoing hematopoietic stem cell transplantation (HSCT) have improved in the last two decades, the short-term mortality still remains above 50% among allogeneic HSCT patients. Better selection of HSCT patients for intensive care, and consequently reduction of nonbeneficial care, may reduce financial costs and alleviate patient suffering. We reviewed the studies on intensive care outcomes of patients undergoing HSCT published since 2000. The risk factors for intensive care unit (ICU) admission identified in this report were primarily patient and transplant related: HSCT type (autologous vs allogeneic), conditioning intensity, HLA mismatch, and graft-versus-host disease (GVHD). At the same time, most of the factors associated with ICU outcomes reported were related to the patients' functional status upon development of critical illness and interventions in ICU. Among the many possible interventions, the initiation of mechanical ventilation was the most consistently reported factor affecting ICU survival. As a consequence, our current ability to assess the benefit or futility of intensive care is limited. Until better ICU or hospital mortality prediction models are available, based on the available evidence, we recommend practitioners to base their ICU admission decisions on: Patient pretransplant comorbidities, underlying disease status, GVHD diagnosis/grade, and patients' functional status at the time of critical illness.
KW - Comorbidity
KW - Intensive care
KW - Mechanical ventilation
KW - Outcome prediction
KW - Stem cell transplantation
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U2 - 10.5306/wjco.v7.i1.98
DO - 10.5306/wjco.v7.i1.98
M3 - Review article
C2 - 26862493
AN - SCOPUS:84956647289
SN - 2218-4333
VL - 7
SP - 98
EP - 105
JO - World Journal of Clinical Oncology
JF - World Journal of Clinical Oncology
IS - 1
ER -