PROGNOSTIC INDICATORS FOR BLOOD AND MARROW TRANSPLANT PATIENTS ADMITTED TO AN INTENSIVE-CARE UNIT

Although hematopoietic stem cell transplantation (HSCT) can be curativ e in patients with certain malignancies, survival is poor if the recip ient becomes critically ill. This prospective study examined the outco mes of 115 consecutive HSCT patients admitted to the medical intensive care unit (MICU) of a tertiary cancer center and identified variables associated with survival. The need for endotracheal intubation and me chanical ventilation (''intubation'') had a profound adverse effect on survival. Overall, 9 of 48 (18.8%) intubated patients survived compar ed with a survival rate of 44 of 67 (65.7%) among patients not intubat ed (p < 0.001). This pattern persisted for nearly all patient subgroup s. Among intubated patients, those receiving peripheral blood stem cel l transplant (PBSCT) had significantly better survival than bone marro w transplant (BMT) patients (8 of 26, 31% versus 1 of 22, 4%; p = 0.02 8). Multiple logistic regression analyses indicated that the probabili ty a patient admitted to the MICU survived decreased significantly if the patient was intubated, had an allogeneic rather than autologous tr ansplant, had an infection or gastrointestinal bleeding, and also decr eased with higher respiratory rate, higher heart rate, longer time fro m transplant to MICU admission or higher bilirubin. These results may be of value in deciding which critically ill patients will benefit fro m intubation following major complications after HSCT transplantation.