Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Hematol Oncol Stem Cell Ther. 2024 Mar 22;17(2):110-119. doi: 10.56875/2589-0646.1114.
Prognostic factors reliably predicting outcomes for critically ill adolescent and young adult (AYA) patients undergoing allogeneic hematopoietic cell transplantation (allo-HSCT) are lacking. We assessed transplant and intensive care unit (ICU)-related factors impacting patient outcomes.
AYA patients who underwent allo-HSCT and required ICU admission at a Tertiary care Centre, during the period of 2003-2013, were included in this retrospective review. This was a non-interventional study. Only outcomes after the first allo-HSCT and index ICU admissions were analyzed. Disease-, transplant-, and ICU-related variables were analyzed to identify risk factors predictive of survival.
Overall, 152 patients were included (males, 60.5%); median age at transplantation was 24 years (interquartile range [IQR] 18-32.5); median age at admission to the ICU was 25.8 years (IQR 19-34). Eighty-four percent underwent transplantation for a hematological malignancy; 129 (85%) received myeloablative conditioning. Seventy-one percent of ICU admissions occurred within the first year after allo-HSCT. ICU admission was primarily due to respiratory failure (47.3%) and sepsis (43.4%). One hundred and three patients (68%) died within 28 days of ICU admission. The 1- and 5-year overall survival rates were 19% and 17%, respectively. Main causes for ICU-related death were refractory septic shock with multiorgan failure (n = 49, 32%) and acute respiratory distress syndrome (ARDS) (n = 39, 26%). Univariate analysis showed that ICU mortality was associated with an Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, a sequential organ failure assessment (SOFA score) > 12, a high lactate level, anemia, thrombocytopenia, leukopenia, hyperbilirubinemia, a high international normalized ratio (INR) and acute graft-versus-host disease (GVHD). Multivariate analysis identified thrombocytopenia, high INR, and acute GVHD as independent predictors of mortality.
In AYA allo-HSCT patients admitted to the ICU, mortality remains high. Higher SOFA and APACHE scores, the need for organ support, thrombocytopenia, coagulopathy, and acute GVHD predict poor outcomes.
目前缺乏能够可靠预测危重症青少年和青年（AYA）患者接受异基因造血细胞移植（allo-HSCT）后结局的预后因素。本研究评估了影响患者结局的移植和重症监护病房（ICU）相关因素。
纳入 2003 年至 2013 年期间在一家三级医疗中心接受 allo-HSCT 并需要入住 ICU 的 AYA 患者，进行回顾性研究。这是一项非干预性研究。仅分析首次 allo-HSCT 和指数 ICU 入院后的结局。分析疾病、移植和 ICU 相关变量，以确定预测生存的危险因素。
共有 152 例患者（男性占 60.5%）纳入研究；移植时的中位年龄为 24 岁（四分位距[IQR] 18-32.5 岁）；入住 ICU 时的中位年龄为 25.8 岁（IQR 19-34 岁）。84%的患者因血液系统恶性肿瘤接受移植；129 例（85%）接受了清髓性预处理。71%的 ICU 入院发生在 allo-HSCT 后 1 年内。ICU 入院的主要原因是呼吸衰竭（47.3%）和败血症（43.4%）。103 例（68%）患者在 ICU 入院后 28 天内死亡。1 年和 5 年总生存率分别为 19%和 17%。ICU 相关死亡的主要原因是难治性感染性休克伴多器官功能衰竭（n=49，32%）和急性呼吸窘迫综合征（ARDS）（n=39，26%）。单因素分析显示，ICU 死亡率与急性生理学和慢性健康评估（APACHE）Ⅱ评分>20、序贯器官衰竭评估（SOFA）评分>12、高乳酸水平、贫血、血小板减少、白细胞减少、高胆红素血症、高国际标准化比值（INR）和急性移植物抗宿主病（GVHD）有关。多因素分析确定血小板减少、高 INR 和急性 GVHD 是死亡的独立预测因素。
在接受 allo-HSCT 并入住 ICU 的 AYA 患者中，死亡率仍然很高。较高的 SOFA 和 APACHE 评分、器官支持的需求、血小板减少、凝血障碍和急性 GVHD 预示着不良结局。
