Ana Vujaklija Brajkovic, Iva Kosuta, Lucija Batur, Sara Sundalic, Marijana Medic, Andro Vujevic, Luka Bielen, Jaksa Babel
{"title":"实体器官或骨髓移植后入住重症监护病房的患者：回顾性队列研究。","authors":"Ana Vujaklija Brajkovic, Iva Kosuta, Lucija Batur, Sara Sundalic, Marijana Medic, Andro Vujevic, Luka Bielen, Jaksa Babel","doi":"10.5500/wjt.v15.i1.98975","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) revolutionized the survival and quality of life of patients with malignant diseases, various immunologic, and metabolic disorders or those associated with a significant impairment in a patient's quality of life.</p><p><strong>Aim: </strong>To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit (ICU).</p><p><strong>Methods: </strong>We conducted a single-center, retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb, Croatia covering the period from January 1, 2018 to December 31, 2023.</p><p><strong>Results: </strong>The study included 91 patients with either SOT [28 patients (30.8%)] or HSCT [63 patients (69.2%)]. The median age was 56 (43.2-64.7) years, and 60.4% of the patients were male. Patients with SOT had more comorbidities than patients after HSCT [<i>χ²</i> (5, <i>n</i> = 141) = 18.513, <i>P</i> < 0.001]. Sepsis and septic shock were the most frequent reasons for admission, followed by acute respiratory insufficiency in patients following HSCT. Survival rate significantly differed between SOT and HSCT [<i>χ²</i> (1, <i>n</i> = 91) = 21.767, <i>P</i> < 0.001]. ICU survival was 57% in the SOT and 12.7 % in the HSCT group. The need for mechanical ventilation [<i>χ²</i> (1, <i>n</i> = 91) = 17.081, <i>P</i> < 0.001] and vasopressor therapy [<i>χ²</i> (1, <i>n</i> = 91) = 36.803, <i>P</i> < 0.001] was associated with survival. The necessity for acute renal replacement therapy did not influence patients' survival [<i>χ²</i> (1, <i>n</i> = 91) = 0.376, <i>P</i> = 0.54]. In the subgroup of patients with infection, 90% had septic shock, and the majority had positive microbiological samples, mostly Gram-negative bacteria. The ICU survival of patients with sepsis/septic shock cumulatively was 15%. The survival of SOT patients with sepsis/shock was 45%.</p><p><strong>Conclusion: </strong>Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock. Despite advancements in critical care, the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high. Early recognition and timely ICU admittance might improve the outcome of patients, especially after HSCT.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"15 1","pages":"98975"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612888/pdf/","citationCount":"0","resultStr":"{\"title\":\"Patients admitted in the intensive care unit after solid organ or bone marrow transplantation: Retrospective cohort study.\",\"authors\":\"Ana Vujaklija Brajkovic, Iva Kosuta, Lucija Batur, Sara Sundalic, Marijana Medic, Andro Vujevic, Luka Bielen, Jaksa Babel\",\"doi\":\"10.5500/wjt.v15.i1.98975\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) revolutionized the survival and quality of life of patients with malignant diseases, various immunologic, and metabolic disorders or those associated with a significant impairment in a patient's quality of life.</p><p><strong>Aim: </strong>To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit (ICU).</p><p><strong>Methods: </strong>We conducted a single-center, retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb, Croatia covering the period from January 1, 2018 to December 31, 2023.</p><p><strong>Results: </strong>The study included 91 patients with either SOT [28 patients (30.8%)] or HSCT [63 patients (69.2%)]. The median age was 56 (43.2-64.7) years, and 60.4% of the patients were male. Patients with SOT had more comorbidities than patients after HSCT [<i>χ²</i> (5, <i>n</i> = 141) = 18.513, <i>P</i> < 0.001]. Sepsis and septic shock were the most frequent reasons for admission, followed by acute respiratory insufficiency in patients following HSCT. Survival rate significantly differed between SOT and HSCT [<i>χ²</i> (1, <i>n</i> = 91) = 21.767, <i>P</i> < 0.001]. ICU survival was 57% in the SOT and 12.7 % in the HSCT group. The need for mechanical ventilation [<i>χ²</i> (1, <i>n</i> = 91) = 17.081, <i>P</i> < 0.001] and vasopressor therapy [<i>χ²</i> (1, <i>n</i> = 91) = 36.803, <i>P</i> < 0.001] was associated with survival. The necessity for acute renal replacement therapy did not influence patients' survival [<i>χ²</i> (1, <i>n</i> = 91) = 0.376, <i>P</i> = 0.54]. In the subgroup of patients with infection, 90% had septic shock, and the majority had positive microbiological samples, mostly Gram-negative bacteria. The ICU survival of patients with sepsis/septic shock cumulatively was 15%. The survival of SOT patients with sepsis/shock was 45%.</p><p><strong>Conclusion: </strong>Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock. Despite advancements in critical care, the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high. Early recognition and timely ICU admittance might improve the outcome of patients, especially after HSCT.</p>\",\"PeriodicalId\":65557,\"journal\":{\"name\":\"世界移植杂志\",\"volume\":\"15 1\",\"pages\":\"98975\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612888/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"世界移植杂志\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5500/wjt.v15.i1.98975\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"世界移植杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5500/wjt.v15.i1.98975","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：实体器官移植（SOT）和造血干细胞移植（HSCT）彻底改变了恶性疾病、各种免疫和代谢紊乱或与患者生活质量显著损害相关的患者的生存和生活质量。目的：探讨重症监护病房（ICU） SOT或HSCT患者入院原因及治疗结果。方法：2018年1月1日至2023年12月31日，在克罗地亚萨格勒布大学医院中心内科ICU进行单中心回顾性流行病学研究。结果：该研究包括91例SOT患者[28例（30.8%）]或HSCT患者[63例（69.2%）]。中位年龄56岁（43.2 ~ 64.7）岁，男性占60.4%。SOT患者的合并症多于HSCT患者[χ 2 (5, n = 141) = 18.513, P < 0.001]。脓毒症和脓毒性休克是最常见的入院原因，其次是急性呼吸功能不全。SOT与HSCT的生存率差异有统计学意义[χ 2 (1, n = 91) = 21.767, P < 0.001]。SOT组ICU生存率为57%，HSCT组为12.7%。机械通气[χ²(1,n = 91) = 17.081, P < 0.001]和血管加压治疗[χ²(1,n = 91) = 36.803, P < 0.001]与生存率相关。急性肾替代治疗的必要性对患者的生存无影响[χ 2 (1, n = 91) = 0.376, P = 0.54]。在感染患者亚组中，90%为感染性休克，多数微生物标本呈阳性，以革兰氏阴性菌为主。脓毒症/感染性休克患者的ICU累计生存率为15%。脓毒症/休克的SOT患者生存率为45%。结论：SOT或HSCT患者因脓毒症和感染性休克而入住ICU的病例较多。尽管在重症监护方面取得了进步，但难治性感染性休克和多器官衰竭患者的死亡率在这一患者群体中非常高。早期识别并及时进入ICU可改善患者的预后，尤其是移植后。
Patients admitted in the intensive care unit after solid organ or bone marrow transplantation: Retrospective cohort study.
Background: Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) revolutionized the survival and quality of life of patients with malignant diseases, various immunologic, and metabolic disorders or those associated with a significant impairment in a patient's quality of life.
Aim: To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit (ICU).
Methods: We conducted a single-center, retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb, Croatia covering the period from January 1, 2018 to December 31, 2023.
Results: The study included 91 patients with either SOT [28 patients (30.8%)] or HSCT [63 patients (69.2%)]. The median age was 56 (43.2-64.7) years, and 60.4% of the patients were male. Patients with SOT had more comorbidities than patients after HSCT [χ² (5, n = 141) = 18.513, P < 0.001]. Sepsis and septic shock were the most frequent reasons for admission, followed by acute respiratory insufficiency in patients following HSCT. Survival rate significantly differed between SOT and HSCT [χ² (1, n = 91) = 21.767, P < 0.001]. ICU survival was 57% in the SOT and 12.7 % in the HSCT group. The need for mechanical ventilation [χ² (1, n = 91) = 17.081, P < 0.001] and vasopressor therapy [χ² (1, n = 91) = 36.803, P < 0.001] was associated with survival. The necessity for acute renal replacement therapy did not influence patients' survival [χ² (1, n = 91) = 0.376, P = 0.54]. In the subgroup of patients with infection, 90% had septic shock, and the majority had positive microbiological samples, mostly Gram-negative bacteria. The ICU survival of patients with sepsis/septic shock cumulatively was 15%. The survival of SOT patients with sepsis/shock was 45%.
Conclusion: Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock. Despite advancements in critical care, the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high. Early recognition and timely ICU admittance might improve the outcome of patients, especially after HSCT.
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