A Prognostic Index for Survival among Mechanically Ventilated Hematopoietic Cell Transplant Recipients

Melhem Solh, Sanjay Oommen, Rachel Isaksson Vogel, Ryan Shanley, Navneet S. Majhail, Linda J. Burns

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

The prognosis of recipients of allogeneic hematopoietic cell transplantation (HCT) who require mechanical ventilation (MV) has historically been poor. Of 883 adults undergoing allogeneic HCT at the University of Minnesota between 1998 and 2009, 179 (20%) required MV before day 100 posttransplantation. We evaluated the outcomes of these patients to develop a prognostic index to predict the 100-day post-MV overall survival (OS) based on factors present at the time of MV. The 179 patients were divided at random into a training set (n = 119) and a validation set (n = 60). The 100-day postventilation OS was 17% for the total population. Multivariate Cox regression on the training set identified creatinine <2 mg/dL and platelet count >20 × 109/L as significant predictors of better OS. Recursive partitioning classified patients with these good prognostic criteria into class A (n = 76); all other patients were classified as class B (n = 103). Among class A patients, 100-day OS was 29% in the training set and 30% in the validation set. Corresponding OS in class B patients was 5% and 15%, respectively. This prognostic index should help guide physicians in counseling HCT patients and their families regarding the use of MV and potential outcomes.

Original languageEnglish (US)
Pages (from-to)1378-1384
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number9
DOIs
StatePublished - Sep 2012

Bibliographical note

Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.

Keywords

  • Allogeneic transplantation
  • Mechanical ventilation
  • Prognosis

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