Outcomes in AML Patients Admitted to the ICU Following Allogeneic Stem Cell Transplantation
Notice bibliographique
Résumé
Background: Patients with acute myeloid leukemia (AML) who undergo an allogeneic stem cell transplant (allo-SCT) frequently require admission to the intensive care unit (ICU) within the first 100 days post-transplant, which is often associated with a poor prognosis. This retrospective study aims to evaluate the clinical outcomes and infection epidemiology among patients who require ICU admission during this critical period. Methods: We screened 438 AML patients who underwent allo-SCT between 2012 and 2023, including adult patients ≥ 18 years old, within 100 days of their index transplantation who required ICU admission for more than 72 hours. 65 patients met these criteria. Patients were divided into sepsis (N=46) and non-sepsis (N=19) groups, and baseline characteristics, treatment regimens, and outcomes were compared. Univariable Cox regression was used to assess factors associated with 90-day mortality after ICU admission. Results: The median age was 56.8 years in the sepsis group and 63.9 years in the non-sepsis group, with males comprising 43.5% and 57.9%, respectively. The median time from transplant to ICU admission was 20 days. Graft-versus-host disease (GVHD) was more prevalent in the sepsis group (34.8% vs. 26.3%, p=0.5072), with 64.3% of GVHD patients receiving methylprednisolone. Both groups received comparable GVHD and antimicrobial prophylaxis. Patients with sepsis had a significantly higher rates of mechanical ventilation (67.4% vs. 15.8%, p<0.001), longer ventilator duration (7.0 days vs. 2.0 days, p=0.03), vasopressor requirement (69.6% vs. 15.8%, p=<0.001), and extended ICU stays (median 9.5 days vs. 3.0 days, p<0.001). Among septic patients, survivors (N=8) had fewer comorbidities and higher rates of GVHD (50% vs. 31.6%, p=0.421) compared to those who died (N=38). We found no significant differences in comorbidities, neutropenia, lymphocyte count, GVHD prophylaxis, or antimicrobial prophylaxis between survivors and non-survivors. Sepsis before engraftment was more common in survivors (71.4% vs. 61.8%), with no significant differences in lactate levels (3.3 vs. 2.7). Overall, 52 patients (80%) died within 90 days of ICU admission. Univariable analyses revealed that sepsis (hazard ratio [HR] 3.34, 95% confidence interval [CI] 1.47-7.57; p=0.004), renal replacement therapy (HR 2.35, 95% CI 1.23-4.48; p=0.010), and mechanical ventilation (HR 3.14, 95% CI 1.61-6.12; p<0.001) were associated with increased 90-day mortality, while GVHD was not significantly associated (HR 1.25, 95% CI 0.65-2.39; p=0.506). Lastly, there were no significant differences in infection types or antimicrobial usage between the sepsis and non-sepsis groups. The most identified organisms were Klebsiella, Enterococcus, and Pseudomonas, with no significant differences between survivors and non-survivors. Conclusion: Sepsis significantly worsens clinical outcomes in AML patients undergoing allo-SCT, leading to higher rates of mechanical ventilation, prolonged ICU stays, and increased 90-day mortality. Early identification and aggressive management of sepsis are essential for improving mortality outcomes in this high-risk population.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».