Evaluation of prognostic factors associated with intensive care unit mortality in patients with hematopoietic stem cell transplantation

Abstract

Background & objective: Although the outcome of patients admitted to ICUs have considerably improved in recent years, hematopoietic stem cell transplantation (HSCT) continues to be significantly associated with mortality.

We studied the  prognostic factors associated with ICU mortality after HSCT. The Acute Physiological and Chronic Health Evaluation II (APACHE II) was used as a prognostic scoring system.

Methods: Within the scope of the research, the clinical and laboratory data of 52 patients who were admitted to the ICU after undergoing HSCT between 2013 and 2019 were analyzed retrospectively.

Results: Mortality risk was found to be 4.22 times higher in patients who received mechanical ventilation (MV) within the first 24 h (P = 0.047), 18.37 times higher in patients who received total parenteral nutrition (TPN) support (P = 0.007), and 158.17 times higher in recipients of vasopressor drug support compared to those who did not (P < 0.001). It was found that a one unit increase in GCS score decreased mortality risk by 0.58 fold (P = 0.015). Additionally, a one unit increase in heart rate was found to increase mortality risk by 1.03 fold (P = 0.010). Whereas, one unit increases in systolic blood pressure or diastolic blood pressure decreased the mortality risk by 0.91 and 0.92 fold, respectively (P = 0.001 and P = 0.002). Mortality was not associated with APACHE II or graft-versus-host disease.

Conclusion: Receiving MV, TPN or vasopressor treatment, and having lower GCS, higher heart rate, lower systolic and diastolic blood pressure were associated with an increase in the risk of ICU mortality in HSCT recipients admitted to the ICU.

Abbreviations: HSCT - hematopoietic stem cell transplantation; TPN - total parenteral nutrition; APACHE II - Acute Physiological and Chronic Health Evaluation II: GVHT - graft-versus-host disease; ICU - intensive care unit; GCS – Glasgow Coma Scale; MODS - Multiple organ dysfunction syndrome 

Key words: Hematopoietic stem cell transplantation; Intensive care; Mortality; Mechanical ventilation, parenteral nutrition; MV- mechanical ventilation;

Citation: Tunay B, Sadri S. Evaluation of prognostic factors associated with intensive care unit mortality in patients with hematopoietic stem cell transplantation. Anaesth. pain intensive care 2022;26(4):480-487 ; DOI: 10.35975/apic.v26i4.1951

Received: Nov 12, 2021; Reviewed: May 11, 2022; Accepted: July 08, 2022