1. Allogeneic stem cell transplantation recipients requiring intensive care: time is of the essence
- Author
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Aline Tanguy-Schmidt, Sylvie François, Sylvain Thepot, Corentin Orvain, Mathilde Hunault-Berger, Pierre Asfar, Mélanie Mercier, Norbert Ifrah, Jean-François Hamel, François Beloncle, Jonathan Farhi, Aurélien Sutra Del Galy, Alain Mercat, Achille Kouatchet, Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Service des maladies du sang [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Fédérations hospitalo-universitaires Grand Ouest Acute Leukemia [Angers] (FHU GOAL), Réanimation Médicale [CHU Angers], Centre de Recherche Clinique (CRC Angers), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), Bernardo, Elizabeth, Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Innate immunity and Immunotherapy ( CRCINA - Département INCIT - Equipe 7 ), Centre de recherche de Cancérologie et d'Immunologie / Nantes - Angers ( CRCINA ), Université d'Angers ( UA ) -Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche en Santé de l'Université de Nantes ( IRS-UN ) -Centre hospitalier universitaire de Nantes ( CHU Nantes ) -Université d'Angers ( UA ) -Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche en Santé de l'Université de Nantes ( IRS-UN ) -Centre hospitalier universitaire de Nantes ( CHU Nantes ), CHU Angers, Fédérations hospitalo-universitaires Grand Ouest Acute Leukemia [Angers] ( FHU GOAL ), Centre hospitalier universitaire d'Angers ( CHU Angers ), Centre de Recherche Clinique ( CRC Angers ), and Université d'Angers ( UA ) -CHU Angers
- Subjects
Adult ,Male ,Intensive care unit (ICU) ,medicine.medical_specialty ,Time Factors ,Critical Care ,Graft vs Host Disease ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Early admission ,[ SDV.CAN ] Life Sciences [q-bio]/Cancer ,law.invention ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Refractory ,law ,Risk Factors ,Intensive care ,medicine ,Humans ,Transplantation, Homologous ,Hospital Mortality ,Retrospective Studies ,business.industry ,Mortality rate ,Hematopoietic Stem Cell Transplantation ,Retrospective cohort study ,Hematology ,General Medicine ,Middle Aged ,Intensive care unit ,Lymphoproliferative Disorders ,3. Good health ,Transplantation ,Hospitalization ,Intensive Care Units ,030220 oncology & carcinogenesis ,Hematologic Neoplasms ,Emergency medicine ,Allogeneic stem cell transplantation (SCT) ,Female ,Stem cell ,business ,030215 immunology - Abstract
International audience; The benefit of early admission of allogeneic stem cell transplantation (SCT) recipients to the intensive care unit (ICU) as soon as they develop organ injury is unknown. We performed a retrospective study on 92 patients admitted to the ICU to determine the impact of time from organ injury to ICU admission on outcome. The number of organ injuries prior to ICU admission was associated with an increased in-hospital mortality (OR 1.7, 95% CI 1–2.7, p = 0.04). Time between first organ injury and ICU admission was also associated with an increased in-hospital survival (OR 1.4, 95% CI 1.1–1.8, p = 0.02). A score combining these two covariates—the number of organ injuries/day (sum of days spent with each individual organ injury)—further improved the prediction of hospital survival. Patients with more organ injuries/day had significantly higher in-hospital mortality rate even after adjustment for refractory acute GVHD and the SOFA (OR 1.3, 95% CI 1–1.7, p = 0.02). Early ICU admission of allogeneic SCT recipients to the ICU as soon as they develop organ injury is associated with decreased in-hospital mortality.
- Published
- 2018