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Impact of pre-transplant individual comorbidities on risk of ICU admission and survival outcomes following allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 58, pages 311–316 (2023)Cite this article

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Abstract

Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-hsct) can require intensive care unit (ICU) admission in the post-transplant period. Whereas outcomes of ICU admission are poor, little is known about the pre-transplant risk factors leading to them. We conducted a retrospective analysis to investigate the impact of pre-transplant individual comorbidities on acute inpatient complications, focusing on ICU admission, ventilator support and multi-system organ failure, following allo-hsct. During the initial hospitalization, 33 (11%) patients required ICU admission, 29 (10%) required ventilator support and 33 (11%) developed multi-system organ failure. Risk factors for ICU admission and ventilator support included pre-transplant infection, pre-transplant diabetes, time to neutrophil engraftment, donor type and older transplant decade (2008-2010). Risk factors for multi-system organ failure included pre-transplant diabetes, time to neutrophil engraftment and older transplant decade (2008–2010). For ICU patients, the 60-day and 6-month mortality was 58% and 67%, respectively and the median overall survival was 1.4 months. Patients with diabetes and infection at the time of HSCT and longer time to neutrophil engraftment during transplant are at an increased risk for ICU admission, ventilator support and multi-system organ failure. Patients admitted to the ICU are also at a high risk for mortality leading to poor survival.

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Fig. 1: ICU Survival Outcomes.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Authors and Affiliations

  1. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Omer Jamy, John Dasher, Donna Salzman & Ravi Bhatia

  2. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA

    Alice Chen & Smita Bhatia

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  1. Omer Jamy
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Contributions

OJ, RB, and SB contributed towards the conception of the presented study. OJ and AC contributed towards data collection. OJ, AC and SB contributed towards data analysis. OJ, JD, AC, DS, RB and SB contributed towards drafting, revising and approving the manuscript.

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Correspondence to Omer Jamy.

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Jamy, O., Dasher, J., Chen, A. et al. Impact of pre-transplant individual comorbidities on risk of ICU admission and survival outcomes following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 58, 311–316 (2023). https://doi.org/10.1038/s41409-022-01897-y

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