Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. The objective of this study was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations.
The authors conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from January 1, 1992 to March 31, 2002. The primary endpoint was mortality at one year.
A total of 2,653 patients received bone marrow transplantation; of which 504 received ICU care during a subsequent hospitalization. Patients receiving any major procedure during ICU had higher one-year mortality than those who received no ICU procedure (87% versus 44%, p<0.0001). Death rates at one year were highest for those receiving mechanical ventilation (87%), pulmonary artery catheterization (91%), or hemodialysis (94%). In combination, the strongest independent predictors of death at one year were mechanical ventilation (OR 7.4; 95% confidence interval 4.8 to 11.4) and hemodialysis (OR 8.7; 95% confidence interval 2.1 to 36.7), yet no combination of procedures uniformly predicted 100% mortality.
The prognosis of bone marrow transplant recipients receiving ICU care during subsequent hospitalizations is very poor but should not be considered futile.