Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients.


OBJECTIVE:Hematopoietic stem cell transplant (HSCT) recipients admitted to the intensive care unit (ICU) have high mortality. The prognostic importance of peripheral blood stem cell source in critically ill HSCT recipients and the performance of Acute Physiology and Chronic Health Evaluation (APACHE) III have not been well studied. In a previous study, the hospital mortality rate of HSCT recipients admitted to our ICU was 77%. The objectives of this study were to describe the clinical course of HSCT recipients admitted to the ICU and to determine the performance of APACHE III in predicting their mortality. DESIGN:Retrospective cohort study. SETTING:Academic medical center. PATIENTS:HSCT recipients admitted to the ICU. MEASUREMENTS:Demographics, transplant type, stem cell source, APACHE II and III predicted mortality, development of sepsis and organ failure, use of mechanical ventilation, duration of hospital stay, and mortality. RESULTS:Ninety-four percent of the 112 HSCT recipients were white and 64% male. The mean APACHE II and III scores were 25 and 44, respectively. The APACHE II and III hospital predicted mortality rates were 44% and 42%, respectively. Mechanical ventilation was provided to 63%. Organ failure developed in 94% and sepsis in 62%. The ICU, hospital, and 30-day mortality rates were 33%, 46%, and 52%, respectively. Allogeneic transplant and higher APACHE III scores, but not bone marrow stem cell source, were associated with increased mortality. Invasive mechanical ventilation, vasoactive medication use, sepsis, and organ failure during patients' ICU course were also associated with increased mortality. The area under the receiver operating characteristic curve for APACHE III hospital mortality prediction was 0.704 (95% confidence interval, 0.610-0.786). For APACHE III hospital mortality prediction, the value of the Hosmer-Lemeshow statistic showed good model fit. CONCLUSIONS:Current mortality figures of HSCT recipients admitted to the ICU are better than previously reported. The APACHE III prognostic model has moderate discrimination and good calibration in predicting hospital mortality in these patients.


Crit Care Med


Critical care medicine


Afessa B,Tefferi A,Dunn WF,Litzow MR,Peters SG




Has Abstract


2003-06-01 00:00:00












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    abstract:OBJECTIVES:We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance. DESIGN:We compared the time periods before (baseline) and after (intervention) the implementation of...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lu C,Liu Q,Yuan H,Wang L

    更新日期:2019-01-01 00:00:00

  • Automatic Classification of Sedation Levels in ICU Patients Using Heart Rate Variability.

    abstract:OBJECTIVE:To explore the potential value of heart rate variability features for automated monitoring of sedation levels in mechanically ventilated ICU patients. DESIGN:Multicenter, pilot study. SETTING:Several ICUs at Massachusetts General Hospital, Boston, MA. PATIENTS:Electrocardiogram recordings from 40 mechanica...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Nagaraj SB,McClain LM,Zhou DW,Biswal S,Rosenthal ES,Purdon PL,Westover MB

    更新日期:2016-09-01 00:00:00

  • Mild hypothermia attenuates circulatory and pulmonary dysfunction during experimental endotoxemia.

    abstract:OBJECTIVE:We tested whether mild hypothermia impacts on circulatory and respiratory dysfunction during experimental endotoxemia. DESIGN:Randomized controlled prospective experimental study. SETTING:Large animal facility, Medical University of Graz, Austria. SUBJECTS:Thirteen anesthetized and mechanically ventilated ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schwarzl M,Seiler S,Wallner M,von Lewinski D,Huber S,Maechler H,Steendijk P,Zelzer S,Truschnig-Wilders M,Obermayer-Pietsch B,Lueger A,Pieske BM,Post H

    更新日期:2013-12-01 00:00:00

  • Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis.

    abstract:OBJECTIVES:A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure ...

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    pub_type: 杂志文章


    authors: Meyer N,Harhay MO,Small DS,Prescott HC,Bowles KH,Gaieski DF,Mikkelsen ME

    更新日期:2018-03-01 00:00:00

  • Epidemiology of Chronic Critical Illness in Japan: A Nationwide Inpatient Database Study.

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Ohbe H,Matsui H,Fushimi K,Yasunaga H

    更新日期:2021-01-01 00:00:00

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    abstract:OBJECTIVES:With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. DES...

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    pub_type: 杂志文章


    authors: Pastores SM,Halpern NA,Oropello JM,Kostelecky N,Kvetan V

    更新日期:2015-10-01 00:00:00

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    pub_type: 杂志文章


    authors: Burns SM,Ryan B,Burns JE

    更新日期:2000-07-01 00:00:00

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    authors: Shoskes A,Migdady I,Rice C,Hassett C,Deshpande A,Price C,Hernandez AV,Cho SM

    更新日期:2020-12-01 00:00:00

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    pub_type: 杂志文章


    authors: Wang P,Ba ZF,Cioffi WG,Bland KI,Chaudry IH

    更新日期:1999-05-01 00:00:00

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    更新日期:2005-09-01 00:00:00

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    authors: Cribbs SK,Tse C,Andrews J,Shenvi N,Martin GS

    更新日期:2015-08-01 00:00:00

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    authors: Leone M,Boutière B,Camoin-Jau L,Albanèse J,Horschowsky N,Mège JL,Martin C,Dignat-George F

    更新日期:2002-04-01 00:00:00

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    authors: Orford NR,Saunders K,Merriman E,Henry M,Pasco J,Stow P,Kotowicz M

    更新日期:2011-06-01 00:00:00

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    authors: Testelmans D,Maes K,Wouters P,Gosselin N,Deruisseau K,Powers S,Sciot R,Decramer M,Gayan-Ramirez G

    更新日期:2006-12-01 00:00:00

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    更新日期:1998-10-01 00:00:00

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    pub_type: 临床试验,杂志文章,随机对照试验


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    更新日期:2008-01-01 00:00:00

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    pub_type: 杂志文章


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    更新日期:1994-12-01 00:00:00

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    更新日期:2001-04-01 00:00:00

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    更新日期:2010-02-01 00:00:00

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    pub_type: 杂志文章


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    更新日期:1990-09-01 00:00:00

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    authors: Koo DJ,Jackman D,Chaudry IH,Wang P

    更新日期:2001-03-01 00:00:00

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Zhang LM,Castresana MR,Shaker IJ,Dalton ML,Leeper-Woodford SK,Newman WH

    更新日期:1997-11-01 00:00:00