Dataset Information

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis.

ABSTRACT:

Introduction

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. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations.

Methods

We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent ICU care in Ontario, Canada from 1 January 1992 to 31 March 2002. The primary endpoint was mortality at 1 year.

Results

A total of 2,653 patients received bone marrow transplantation; 504 of which received ICU care during a subsequent hospitalization. Patients receiving any major procedure during their ICU stay had higher 1-year mortality than those patients who received no ICU procedure (87% versus 44%, P < 0.0001). Death rates at 1 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 1 year were mechanical ventilation (odds ratio, 7.4; 95% confidence interval, 4.8 to 11.4) and hemodialysis (odds ratio, 8.7; 95% confidence interval, 2.1 to 36.7), yet no combination of procedures uniformly predicted 100% mortality.

Conclusion

The prognosis of bone marrow transplant recipients receiving ICU care during subsequent hospitalizations is very poor but should not be considered futile.

SUBMITTER: Scales DC

PROVIDER: S-EPMC2481474 | biostudies-literature | 2008

REPOSITORIES: biostudies-literature

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Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis.

Scales Damon C DC Thiruchelvam Deva D Kiss Alexander A Sibbald William J WJ Redelmeier Donald A DA

Critical care (London, England) 20080611 3

<h4>Introduction</h4>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. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations.<h4>Methods</h4>We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received ...[more]

PMID: 18547422

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Project description:BackgroundEarly hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs.ObjectiveTo determine risk factors and outcomes associated with EHRs (ie, hospitalization within 30 days of discharge from transplant hospitalization) in kidney transplant recipients.DesignPopulation-based cohort study using linked, administrative health care databases.SettingOntario, Canada.PatientsWe included 5437 kidney transplant recipients from 2002 to 2015.MeasurementsRisk factors and outcomes associated with EHRs. We assessed donor, recipient, and transplant risk factors. We also assessed the following outcomes: total graft failure, death-censored graft failure, death with a functioning graft, mortality, and late hospital readmission.MethodsWe used multivariable logistic regression to examine the association of each risk factor and the odds of EHR. To examine the relationship between EHR status (yes vs no [reference]) and the outcomes associated with EHR (eg, total graft failure), we used a multivariable Cox proportional hazards model.ResultsIn all, 1128 kidney transplant recipients (20.7%) experienced an EHR. We found the following risk factors were associated with an increased risk of EHR: older recipient age, lower income quintile, several comorbidities, longer hospitalization for initial kidney transplant, and older donor age. After adjusting for clinical characteristics, compared to recipients without an EHR, recipients with an EHR had an increased risk of total graft failure (adjusted hazard ratio [aHR]: 1.46, 95% CI: 1.29, 1.65), death-censored graft failure (aHR: 1.62, 95% CI: 1.36, 1.94), death with graft function (aHR: 1.34, 95% CI: 1.13, 1.59), mortality (aHR: 1.41, 95% CI: 1.22, 1.63), and late hospital readmission in the first 0.5 years of follow-up (eg, 0 to <0.25 years: aHR: 2.11, 95% CI: 1.85, 2.40).LimitationsWe were not able to identify which readmissions could have been preventable and there is a potential for residual confounding.ConclusionsResults can be used to identify kidney transplant recipients at risk of EHR and emphasize the need for interventions to reduce the risk of EHRs.Trial registrationThis is not applicable as this is a population-based cohort study and not a clinical trial.

Project description:ObjectivesDevelopmental coordination disorder (DCD) is related to poorer educational outcomes among children and adolescents. Evidence on this association into adulthood is lacking. Therefore, we aimed to investigate whether probable DCD (pDCD) in childhood affected educational outcomes among adults, and whether this was affected by sex or a co-occurring attention deficit in childhood.DesignRegister-based longitudinal cohort study.SettingNeonatal intensive care (NIC) recipients born at Uppsala University Children's Hospital, Uppsala, Sweden, from 1986 to 1989 until they reached the age of 28.Participants185 NIC recipients.Primary and secondary outcome measuresAt the age of 6.5, 46 (24.6%) of the NIC recipients were diagnosed with pDCD. Using register-based longitudinal data, we compared participants with and without pDCD in terms of: (1) age at Upper Secondary School (USS) graduation, and (2) highest level of education achieved by age 28.ResultsThe median age at USS graduation was 19 years, with similar graduation ages and ranges between those with or without pDCD. However, a higher proportion of participants without pDCD had graduated from USS at ages 19 and 24. By age 29, most participants had completed USS. At age 28, 33% of participants had attained a bachelor's or master's degree. Although there was no significant difference between the groups, the proportion that had attained a degree was higher among those without pDCD and women without pDCD had achieved the highest level of education. Educational outcomes remained similar for those with pDCD, regardless of childhood attention deficit.ConclusionspDCD during childhood may have a lasting impact on educational outcomes, particularly among women. Raising awareness of DCD among parents, health and educational professionals is vital for early identification and the provision of appropriate support and interventions in schools, mitigating the potential negative consequences associated with DCD and promoting positive educational outcomes.

Dataset Information

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis.

Introduction

Methods

Results

Conclusion

Publications

Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis.

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