MSc. Nurse, Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo (SP), Brazil.
MD, PhD. Physician and ICU coordinator, Professor. A.C. Camargo Cancer Center, São Paulo (SP), Brazil. Professor, Discipline of Pulmonology, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2022 Aug 1;141(2):107-113. doi: 10.1590/1516-3180.2021.0986.R1.11052022. eCollection 2022.
Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients.
To describe the characteristics of HSCT recipients admitted to the ICU shortly after transplantation and assess differences in 1-year mortality between autologous and allogeneic HSCT recipients.
A single-center retrospective cohort study in a cancer center in Brazil.
We included all consecutive patients who underwent HSCT less than a year before ICU admission between 2009 and 2018. We collected clinical and demographic data and assessed the 1-year mortality of all patients. The effect of allogeneic HSCT compared with autologous HSCT on 1-year mortality risk was evaluated in an unadjusted model and an adjusted Cox proportional hazard model for age and Sequential Organ Failure Assessment (SOFA) at admission.
Of the 942 patients who underwent HSCT during the study period, 83 (8.8%) were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT = 26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%) patients who underwent autologous and allogeneic HSCT, respectively, had died. Allogeneic HSCT was associated with increased 1-year mortality (unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%, 1.48-5.26]; adjusted HR = 2.62 [CI 95%, 1.29-5.31]).
Allogeneic HSCT recipients admitted to the ICU had higher short- and long-term mortality rates than autologous HSCT recipients, even after adjusting for age and severity at ICU admission.
造血干细胞移植（HSCT）受者在移植后早期需要入住重症监护病房（ICU），其预后较差。然而，许多研究仅关注异基因 HSCT 受者。
描述移植后早期入住 ICU 的 HSCT 受者的特征，并评估自体和异基因 HSCT 受者在 1 年死亡率方面的差异。
巴西一家癌症中心的单中心回顾性队列研究。
我们纳入了 2009 年至 2018 年间 ICU 入住前 1 年内接受 HSCT 的所有连续患者。我们收集了临床和人口统计学数据，并评估了所有患者的 1 年死亡率。在未调整模型和调整年龄和入院时序贯器官衰竭评估（SOFA）的校正 Cox 比例风险模型中，评估异基因 HSCT 与自体 HSCT 对 1 年死亡率风险的影响。
在研究期间接受 HSCT 的 942 例患者中，有 83 例（8.8%）纳入本研究（自体 HSCT=57 例[68.7%]，异基因 HSCT=26 例[31.3%]）。在 ICU 入住后 1 年时，分别有 21 例（36.8%）和 18 例（69.2%）接受自体和异基因 HSCT 的患者死亡。异基因 HSCT 与 1 年死亡率增加相关（未调整的危险比，HR=2.79[95%可信区间，CI，1.48-5.26]；调整后的 HR=2.62[CI 95%，1.29-5.31]）。
与自体 HSCT 受者相比，即使在校正 ICU 入院时的年龄和严重程度后，入住 ICU 的异基因 HSCT 受者的短期和长期死亡率仍较高。
