ADMISSION OF BONE-MARROW TRANSPLANT RECIPIENTS TO THE INTENSIVE-CARE UNIT - OUTCOME, SURVIVAL AND PROGNOSTIC FACTORS

The role of ICU support in BRIT patients is controversial, In an era o f constrained resources, the use of prognostic factors predicting outc ome may be helpful in identifying patients who are most likely (or unl ikely) to benefit from this intervention, We attempted to define the s urvival of patients admitted to ICU following autologous or allogeneic BRIT and to identify those factors important in determining patient o utcome, A retrospective study of all adult BRIT recipients admitted to intensive care over a 6 year study period was performed to determine overall and prognostic indicators of poor outcome, Pre-treatment, pre- ICU admission and ICU admission data were analyzed to identify factors predicting long-term survival, 116 patients mere admitted to ICU on 1 35 separate occasions with the primary reasons for admission being res piratory failure (66%), sepsis associated with hypotension (10%), and cardiorespiratory failure (8%). No pre-ICU characteristics were predic tive of survival, Univariate analysis identified the number of support measures required, the need for ventilation or hemodynamic support, t he APACHE II score, the gear of ICU admission and the serum bilirubin as significant predictors of post-discharge survival, On multivariate analysis the year of ICU admission, the need for hemodynamic support a nd the serum bilirubin remained significant, The APACHE II score signi ficantly underestimated survival in the 46% of patients with scores le ss than 35, and could only be used to predict 100% mortality when it e xceeded 35, Twenty-three percent of all BRIT patients admitted to the ICU and 17% of ventilated patients survived to hospital discharge, Of the 27 patients surviving to leave hospital, 16 remain alive with a me dian follow-up of 4.2 years and a mean Karnofsky performance status of 90, Although mortality in BRIT recipients admitted to ICU is high our results indicate that intensive care support can be lifesaving and th at the outcome in patients requiring ventilation and ICU support may n ot be as poor as has been previously reported, No single variable was identified which could be used to predict futility but patients requir ing both hemodynamic support and mechanical ventilation, and those wit h an APACHE II score greater than 45 have a very poor prognosis and ar e unlikely to benefit from lengthy ICU support.