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Inicio Medicina Clínica (English Edition) Impact of previous admission to an intensive care unit on stem cell transplantat...
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Vol. 155. Issue 9.
Pages 382-387 (November 2020)
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Vol. 155. Issue 9.
Pages 382-387 (November 2020)
Original article
DOI: 10.1016/j.medcle.2020.01.013
Impact of previous admission to an intensive care unit on stem cell transplantation outcome
Impacto de un ingreso previo en una unidad de medicina intensiva sobre los resultados del trasplante hematopoyético
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Edurne Sarratea, Maria-José Jiméneza, Mireia Morgadesa, Pilar Marcosb, Pilar Ricartb, Susana Vivesa, Blanca Xicoya, Anna Torrenta, María-Teresa Misisb, Maria-Luisa Bordejeb, Montserrat Batllea, Miriam Morenoa, Juan-Manuel Sanchoa, Josep-Maria Riberaa, Christelle Ferraa,
Corresponding author
cferra@iconcologia.net

Corresponding author.
a Department of Hematology, ICO-Badalona, Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
b Intensive Care Department, Hospital Universitari Germans Trias I Pujol, Universitat Autónoma de Barcelona, Badalona, Spain
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Tables (3)
Table 1. Baseline characteristics of ICU and NO-ICU patients.
Table 2. Infectious agents detected in the ICU and NO-ICU groups during the stem cell transplant procedure.
Table 3. Probability of OS, RI and NRM in the autologous and allogeneic groups.
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Abstract
Introduction

The impact of an admission to ICU before stem cell transplantation (SCT) on post-SCT outcome is not well established.

Patients and methods

We reviewed the medical records of patients who had received a first SCT between 2000 and 2016 in our institution. The outcome of 22 patients who required ICU admission during chemotherapy prior to SCT (ICU group) was compared with 44 matched patients (1:2) who did not need it (NO-ICU group).

Results

There were no differences in transplant complications, in time to neutrophil and platelet recovery or in the length of hospital stay during SCT between the ICU and NO-ICU groups. However, microbiologically documented infections were more common in the ICU group (16/20) than in the NO-ICU group (18/39) (p=.027). The 5-yr overall survival probability (CI 95%) was 49% (28–70%) in the ICU vs. 45% (29–61%) in the NO-ICU group (p=.353), while the 5-yr incidence of non-relapse mortality was 32% (14–52%) and 24% (12–38%) (p=.333), respectively. Six patients (27%) in the ICU group and 8 (18%) in the NO-ICU group required admission to the ICU during or after the SCT procedure (p=.293). Twelve (54%) patients in the ICU and 22 (50%) in the NO-ICU group died, the causes of death were similar in both groups.

Conclusion

Our results show that admission to the ICU prior to SCT does not have a negative impact on patient outcomes following SCT and should not be considered as an exclusion criterion for SCT.

Keywords:
Stem cell transplantation
Intensive care unit
Prognosis
Survival
Resumen
Introducción

No se conoce con exactitud el impacto de la necesidad de ingreso previo en una unidad de cuidados intensivos (UCI) en la supervivencia postrasplante de progenitores hematopoyéticos (TPH).

Pacientes y métodos

Se revisaron los archivos de pacientes que habían recibido un TPH entre el 2000 y 2016 en una única institución. El resultado del TPH en 22 pacientes que habían precisado de ingreso en una UCI durante las quimioterapias administradas previas al TPH (grupo UCI) se comparó con el de 44 pacientes controles (1:2) trasplantados que no habían precisado ingreso previo en UCI (grupo NO-UCI).

Resultados

No hallamos diferencias en las complicaciones post-TPH, en el tiempo de injerto de neutrófilos o de plaquetas, ni tampoco en la duración del ingreso hospitalario entre el grupo UCI y el grupo NO-UCI (p=0,353). Sin embargo, la incidencia de infecciones documentadas microbiológicamente fue mayor en el grupo UCI (16/20) que en el NO-UCI. La probabilidad de supervivencia a 5 años (IC95%) fue del 49% (28-70%) para el grupo UCI vs. el 45% (29-61%) para el grupo NO-UCI (p=0,353), mientras que la mortalidad relacionada con el TPH a los 5 años fue del 32% (14-52%) y 24% (12-38%) (p=0,333), respectivamente. Seis pacientes (27%) en el grupo UCI y 8 (18%) en el grupo NO-UCI precisaron ingreso en UCI durante o después del proceso de TPH (p=0,293). Doce pacientes (54%) en el grupo UCI y 22 (50%) en el NO-UCI fallecieron, y las causas de muerte fueron similares en ambos grupos.

Conclusión

El ingreso en UCI no tiene necesariamente un impacto negativo en los resultados de un TPH posterior en pacientes hematológicos y no debería ser criterio de exclusión para dicho procedimiento.

Palabras clave:
Trasplante de progenitores hematopoyéticos
Unidad de cuidados intensivos
Pronóstico
Supervivencia

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