ICU, A.C. Camargo Cancer Center, São Paulo, Brazil.
ICU, A.C. Camargo Cancer Center, São Paulo, Brazil.
J Crit Care. 2022 Oct;71:154077. doi: 10.1016/j.jcrc.2022.154077. Epub 2022 May 27.
Studies of critically ill hematopoietic stem cell transplantation (HSCT) recipients have mainly been single-center and focused on allogenic HSCT recipients. We aimed to describe a cohort of autologous HSCT with an unplanned intensive care unit (ICU) admission.
This study is a retrospective cohort study of autologous HSCT performed as a treatment for a hematological malignancy, during their first unplanned ICU admission in 50 hospitals in Brazil. We assessed the hospital mortality and the association between mechanical ventilation, vasopressors, and renal replacement therapy and hospital mortality in autologous HSCT recipients, adjusted for potential confounders.
We included 301 patients. Multiple myeloma was the most common malignancy driving to HSCT. ICU and hospital mortality were 22.9% and 37.5%, respectively. After adjustment for potential confounders, mechanical ventilation (OR = 9.10; CI 95%, 4.82-17.15) was associated with hospital mortality, but vasopressors (OR = 1.43; CI 95%, 0.77-2.64) and renal replacement therapy (OR = 1.30; CI 95%, 0.63-2.66) were not.
In this large cohort of critically ill autologous HSCT recipients, mechanical ventilation was the only organ support-therapy associated with increased mortality in autologous HSCT recipients.
危重症造血干细胞移植（HSCT）受者的研究主要为单中心研究，且集中于异基因 HSCT 受者。我们旨在描述一组计划外重症监护病房（ICU）收治的自体 HSCT 患者。
本研究是一项回顾性队列研究，纳入了巴西 50 家医院中因血液系统恶性肿瘤行自体 HSCT 治疗且首次计划外 ICU 收治的患者。我们评估了机械通气、血管加压素和肾脏替代治疗与自体 HSCT 受者院内死亡率之间的相关性，并对潜在混杂因素进行了校正。
共纳入 301 例患者。多发性骨髓瘤是导致 HSCT 的最常见恶性肿瘤。ICU 和院内死亡率分别为 22.9%和 37.5%。在校正潜在混杂因素后，机械通气（OR=9.10；95%CI：4.82-17.15）与院内死亡率相关，而血管加压素（OR=1.43；95%CI：0.77-2.64）和肾脏替代治疗（OR=1.30；95%CI：0.63-2.66）与院内死亡率无关。
在本大规模危重症自体 HSCT 受者队列中，机械通气是唯一与自体 HSCT 受者死亡率增加相关的器官支持治疗。
