Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

Abstract

SCT indications and procedures are increasing worldwide. We sought to estimate the prevalence of acute respiratory failure (ARF) of any cause in hospitalized SCT patients, and assess the impact of invasive mechanical ventilation (IMV) on outcomes. We hypothesize that duration of IMV in such patients is an independent predictor of higher mortality. We performed a retrospective analysis of the largest all-payer hospitalization data set in the United States, Nationwide In-patient Sample for years [2004][2005][2006][2007][2008][2009][2010]. Of the 101 462 SCT hospitalizations, 6074 (6%) developed ARF and were the final cohort. Type of SCT with ARF included autologous 1987 (32.7%), allogeneic 3467 (57.1%) and cord blood 655 (10.8%). Duration of IMV included o96 h (17.1%) and ⩾ 96 h (41.1%). Overall in-hospital mortality (IHM) was 50.6% (3075). Predictors of IHM were IMV o96 h (odds ratio = 3.42 (2.44-4.79), P o0.0001) or IMV ⩾ 96 h (OR = 4.61 (3.17-6.70), P o 0.0001). Type of SCT, comorbid burden, gender, hospital-teaching status/bed size or insurance did not influence IHM. IMV ⩾ 96 h was associated with higher hospital charges (mean $762 515, 95% estimate 0.3991 (0.3123-0.4859), increase of $304 474, P o 0.0001) and higher length of stay (mean 61.5 days, 95% estimate 0.2198 (0.1531-0.2866), increase of 13 days, P o 0.0001). In conclusion, ARF in hospitalized SCT patients is not an uncommon occurrence and is associated with 50% mortality. Duration of IMV (⩾96 h) was an independent predictor of higher mortality rates. Hospital resource utilization was significant.

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…67,70,71 The need for ventilatory support ranges from 28 to 76% in recent studies, 13,16,21,24,25,[27][28][29][30][31][32][33][34][35] and ICU mortality varies from 63 to 85% (Table 3). These results are far worse than the respective 70% and 62% ICU and hospital survival rates reported in a large observational study of unselected ICU patients requiring MV.…”

Prevalence, predictors and outcomes of cardiopulmonary resuscitation in hospitalized adult stem cell transplant recipients in the United States: not just opening the black box but exploring an opportunity to optimize!

“…3,9,10 The retrospective design of our study precludes us from drawing a true cause and effect relationship, nevertheless, the associations we found appear to have merits. Our study identified only those patients who had an IHCA and received CPR, it did not identify the population who had IHCA but did not receive CPR due to DNAR status or deemed futile.…”

“…8,9 It is imperative to identify and evaluate the risk factors associated with IHCA requiring CPR in this cohort so as to inform the patients, surrogates or providers involved in care and to optimize outcomes.…”

A golden opportunity

“…In a previous issue of the journal, Allareddy et al 1 report on the prevalence of acute respiratory failure from any cause in hospitalized SCT patients and the associated hospital costs. The authors utilized the Nationwide Inpatient Sample (NIS), which is the largest all-payer inpatient database in the United States, approximating 97% of all hospital discharges annually.…”

“…Prior to recent advances, respiratory failure requiring mechanical ventilation following SCT had mortality rates between 85-90%. 2 Allareddy et al 1 found an overall mortality rate between 60.6 and 66.5% for SCT patients requiring mechanical ventilation. These numbers, although significantly improved compared with older studies, are still well above the o 30% mortality reported for those requiring mechanical ventilation for respiratory failure in the general population.…”