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Predictors of short-term and long-term mortality in critically ill patients admitted to the intensive care unit following allogeneic stem cell transplantation

Bone Marrow Transplantation volume 54, pages 418–424 (2019)Cite this article

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Abstract

Historically, the mortality of patients admitted to the ICU after allogeneic stem cell transplantation (alloSCT) is high. Advancements in transplantation procedures, infectious monitoring and supportive care may have improved the outcome. This study aimed to determine short-term and long-term mortality after ICU admission of patients after alloSCT and to identify prognostic clinical and transplantation-related determinants present at ICU admission for long-term outcome. A multicenter cohort study was performed to determine 30-day and 1-year mortality within 2 years following alloSCT. A total of 251 patients were included. The 30-day and 1-year mortality was 55% and 80%, respectively. Platelet count <25 × 109/L (OR: 2.26, CI: 1.02–5.01) and serum bilirubin >19 μmol/L (OR: 2.47 CI: 1.08–5.65) at admission, other donor than a HLA-matched-related or HLA-matched-unrelated donor (OR: 4.59, CI: 1.49–14.1) and vasoactive medication within 24 h (OR: 2.35, CI: 1.28–4.31) were associated with increased 30-day mortality. Other donor than a HLA-matched-related or HLA-matched-unrelated donor (OR: 1.9, CI: 1.13–3.19), serum bilirubin >77 (OR: 2.05, CI: 1.28–3.30) and vasoactive medication within 24 h (OR: 1.65, CI: 1.12–2.43) were associated with increased 1-year mortality. Neutropenia was associated with decreased 30-day and 1-year mortality (OR: 0.29, CI: 0.14–0.59 and OR: 0.70, CI: 0.48–0.98). Myeloablative conditioning and T cell-depleted transplantation were not associated with increased mortality.

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Members of the HEMA-ICU Study Group

Bart J. Biemond13, Marcella C.A. Müller14, Alexander J. Vlaar14, Pieter R. Tuinman15, Angelique M. Spoelstra16, M. Sesmu Arbous17, Pim L.J. van der Heiden18, David J. van Westerloo17, Maarten van Vliet19, Nicole M.A. Blijlevens19, Murielle Hilkens20, Walter M. van den Bergh21, Hanneke C. Kluin22, Walther N.K.A. van Mook23, Astrid MP24, Nuray Kusadasi25.

Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands

    P. L. J. van der Heiden, M. S. Arbous & D. J. van Westerloo

  2. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

    M. S. Arbous & S. le Cessie

  3. Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands

    E. J. van Beers

  4. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    W. M. van den Bergh

  5. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

    S. le Cessie

  6. Department of Hematology, Maastricht University Medical Center+, Maastricht, The Netherlands

    A. M. P. Demandt

  7. Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

    M. Eefting & W. A. F. Marijt

  8. Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands

    C. Hess, M. van Vliet & N. M. A. Blijlevens

  9. Departement of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

    N. Kusadasi

  10. Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands

    W. N. K. A. van Mook

  11. Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands

    M. C. A. Müller

  12. Department of Intensive Care Medicine, VU university Medical Center, Amsterdam, The Netherlands

    P. R. Tuinman

  13. Department of Haematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Bart J Biemond

  14. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Marcella C.A. Müller & Alexander J. Vlaar

  15. Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

    Pieter R. Tuinman

  16. Department of Haematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

    Angelique M. Spoelstra

  17. Department of Intensive Care Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands

    M. Sesmu Arbous & David J. van Westerloo

  18. Department of Haematology and Intensive Care Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands

    Pim L.J. van der Heiden

  19. Department of Haematology, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands

    Maarten van Vliet & Nicole M.A. Blijlevens

  20. Department of Intensive Care Medicine, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands

    Murielle Hilkens

  21. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Walter M. van den Bergh

  22. Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Hanneke C. Kluin

  23. Department of Intensive Care Medicine, Maastricht University Medical Center, University of Maastricht, Maastricht, The Netherlands

    Walther N.K.A. van Mook

  24. Department of Haematology, Maastricht University Medical Center, University of Maastricht, Maastricht, The Netherlands

    Astrid M.P. Demandt

  25. Department of Intensive Care Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands

    Nuray Kusadasi

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  1. P. L. J. van der Heiden
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  2. M. S. Arbous
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  5. S. le Cessie
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  6. A. M. P. Demandt
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  7. M. Eefting
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  8. C. Hess
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  9. N. Kusadasi
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  10. W. A. F. Marijt
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  11. W. N. K. A. van Mook
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  13. P. R. Tuinman
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  14. M. van Vliet
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  15. D. J. van Westerloo
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  16. N. M. A. Blijlevens
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Consortia

on behalf of the HEMA-ICU Study Group

  • Bart J Biemond
  • , Marcella C.A. Müller
  • , Alexander J. Vlaar
  • , Pieter R. Tuinman
  • , Angelique M. Spoelstra
  • , M. Sesmu Arbous
  • , David J. van Westerloo
  • , Pim L.J. van der Heiden
  • , Maarten van Vliet
  • , Nicole M.A. Blijlevens
  • , Murielle Hilkens
  • , Walter M. van den Bergh
  • , Hanneke C. Kluin
  • , Walther N.K.A. van Mook
  • , Astrid M.P. Demandt
  •  & Nuray Kusadasi

Corresponding author

Correspondence to P. L. J. van der Heiden.

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The authors declare that they have no conflict of interest.

Additional information

Members of the HEMA-ICU Study Group are listed at the end of the paper.

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van der Heiden, P.L.J., Arbous, M.S., van Beers, E.J. et al. Predictors of short-term and long-term mortality in critically ill patients admitted to the intensive care unit following allogeneic stem cell transplantation. Bone Marrow Transplant 54, 418–424 (2019). https://doi.org/10.1038/s41409-018-0277-3

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  • DOI: https://doi.org/10.1038/s41409-018-0277-3

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