Intensive care outcomes in adult hematopoietic stem cell transplantation patients

作     者：Ulas D Bayraktar Joseph L Nates 

作者机构：Department of Stem Cell TransplantationUniversity of Texas MD Anderson Cancer Center Department of Critical Care University of Texas MD Anderson Cancer Center 

出 版 物：《World Journal of Clinical Oncology》 (世界临床肿瘤学杂志（英文版）)

年 卷 期：2016年第7卷第1期

页      面：98-105页

学科分类：1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 100215[医学-康复医学与理疗学] 10[医学] 

主　　题：Stem cell transplantation Intensive care Mechanical ventilation Comorbidity Outcome prediction 

摘      要：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.