Kew Andrea K, Couban Stephen, Patrick Ward, Thompson Kara, White Darrell
Department of Medicine, Dalhousie University, and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Biol Blood Marrow Transplant. 2006 Mar;12(3):301-5. doi: 10.1016/j.bbmt.2005.10.020.
Stem cell transplantation (SCT) is associated with complications that may necessitate intensive care unit (ICU) admission. The outcome for SCT patients requiring ICU admission has been reported to be poor. We describe the outcome of consecutive SCT patients admitted to the ICU at a single center. The study was a retrospective review of all patients at the Queen Elizabeth II Health Sciences Center who received an SCT between 1992 and 2001 and were subsequently admitted to the ICU. The primary outcome was overall survival at 12 months after ICU admission. There were 440 SCTs in the study period; 38 of these patients were admitted to the ICU on 42 separate occasions. The primary indication for ICU admission was respiratory failure. The probability of survival at 12 months was 21.6% (95% CI, 8.4%-34.9%). On multivariate analysis, the only statistically significant variable associated with decreased 12-month survival was vasopressor use. The probability of survival for patients receiving vasopressor support was 5% (95% CI, 0%-14.5%) at 30 days and 0% at 12 months, whereas the probability of survival for patients not receiving vasopressor support was 76.5% (95% CI, 56.3%-96.6%) at 30 days and 45.8% (95% CI, 21.5%-69.9%) at 12 months. In this 10-year review of consecutive SCT recipients requiring ICU admission, we found that the outcome of SCT patients requiring ICU admission may not be as poor as previously reported. However, SCT recipients requiring vasopressor support had very poor outcomes. These findings will be important in deciding which SCT patients may benefit from ICU admission and care.
干细胞移植（SCT）会伴有一些并发症，可能需要入住重症监护病房（ICU）。据报道，需要入住ICU的SCT患者预后较差。我们描述了在单一中心入住ICU的连续性SCT患者的预后情况。本研究是对1992年至2001年间在伊丽莎白二世健康科学中心接受SCT并随后入住ICU的所有患者进行的回顾性研究。主要结局是入住ICU后12个月的总生存率。研究期间共进行了440例SCT；其中38例患者在42个不同时间点入住ICU。入住ICU的主要指征是呼吸衰竭。12个月时的生存概率为21.6%（95%可信区间，8.4%-34.9%）。多因素分析显示，与12个月生存率降低相关的唯一具有统计学意义的变量是血管升压药的使用。接受血管升压药支持的患者在30天时的生存概率为5%（95%可信区间，0%-14.5%），在12个月时为0%；而未接受血管升压药支持的患者在30天时的生存概率为76.5%（95%可信区间，56.3%-96.6%），在12个月时为45.8%（95%可信区间，21.5%-69.9%）。在这项对需要入住ICU的连续性SCT受者进行的10年回顾中，我们发现需要入住ICU的SCT患者的预后可能并不像之前报道的那么差。然而，需要血管升压药支持的SCT受者预后非常差。这些发现对于决定哪些SCT患者可能从入住ICU及接受治疗中获益具有重要意义。
