Skip to main content
Top
Published in:

03-01-2024 | Stem Cell Transplantation | Original Article

Temporal trends in critical care utilization and outcomes in allogeneic hematopoietic stem cell transplant recipients

Authors: Kiyan Heybati, Domenic Ochal, William Hogan, Hassan Al-Khateeb, David Sklar, Svetlana Herasevich, Mark Litzow, Mithun Shah, Mehrdad Hefazi Torghabeh, Urshila Durani, Philippe Bauer, Ognjen Gajic, Hemang Yadav

Published in: Annals of Hematology | Issue 3/2024

Login to get access

Abstract

Historically, the prognosis of allogeneic hematopoietic stem cell transplant (allo-HCT) recipients who require intensive care unit (ICU) admission has been poor. We aimed to describe the epidemiological trends of ICU utilization and outcomes in allo-HCT patients. We conducted a retrospective cohort study including adults (≥ 18) undergoing allo-HCT between 01/01/2005 and 31/12/2020 at Mayo Clinic, Rochester. Temporal trends in outcomes were assessed by robust linear regression modelling. Risk factors for hospital mortality were chosen a priori and assessed with multivariable logistic regression modelling. Of 1,249 subjects, there were 486 ICU admissions among 287 individuals. Although older patients underwent allo-HCT (1.64 [95% CI: 1.11 to 2.45] years per year; P = 0.025), there was no change in ICU utilization over time (P = 0.91). The ICU and hospital mortality rates were 19.2% (55/287) and 28.2% (81/287), respectively. There was a decline in ICU mortality (-0.38% [95% CI: -0.70 to -0.06%] per year; P = 0.035). The 1-year post-HCT mortality for those requiring ICU admission was 56.1% (161/287), with no significant difference over time, versus 15.8% (141/891, 71 missing) among those who did not. The frequency and duration of invasive mechanical ventilation (IMV) declined. In multivariable analyses, higher serum lactate, higher sequential organ failure assessment (SOFA) scores, acute respiratory distress (ARDS), and need for IMV were associated with greater odds of hospital mortality. Over time, rates of ICU utilization have remained stable, despite increasing patient age. Several trends suggest improvement in outcomes, notably lower ICU mortality and frequency of IMV. However, long-term survival remains unchanged. Further work is needed to improve long-term outcomes in this population.
Appendix
Available only for authorised users
Literature
19.
go back to reference Hoaglin DC, Mosteller F, Tukey JW (2011) Exploring data tables, trends, and shapes. John Wiley & Sons Hoaglin DC, Mosteller F, Tukey JW (2011) Exploring data tables, trends, and shapes. John Wiley & Sons
27.
30.
33.
Metadata
Title
Temporal trends in critical care utilization and outcomes in allogeneic hematopoietic stem cell transplant recipients
Authors
Kiyan Heybati
Domenic Ochal
William Hogan
Hassan Al-Khateeb
David Sklar
Svetlana Herasevich
Mark Litzow
Mithun Shah
Mehrdad Hefazi Torghabeh
Urshila Durani
Philippe Bauer
Ognjen Gajic
Hemang Yadav
Publication date
03-01-2024
Publisher
Springer Berlin Heidelberg
Published in
Annals of Hematology / Issue 3/2024
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-023-05612-9

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more