Feasibility of Acute Physiology and Chronic Health Evaluation (APACHE) II and III score-based screening in patients receiving allogeneic hematopoietic stem-cell transplantation

Sung Won Kim, Masahiro Kami, Norinaga Urahama, Rie Yamamoto, Akiko Hori, Osamu Imataki, Yoshinobu Kanda, Ryuji Tanosaki, Shin Mineishi, Yoichi Takaue, Osamu Honda

Research output: Contribution to journalArticle

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Abstract

Patients who require management in the intensive care unit (ICU) for complications after allogeneic hematopoietic stem-cell transplantation (HSCT) generally have a poor outcome. We retrospectively studied whether the risk-prediction stratification systems commonly used for patients admitted to the ICU, that is, the Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III systems, could be useful for identifying patients who should receive intensive care earlier. We reviewed the medical records of 210 patients who underwent allogeneic HSCT and found that 18 (8.6%) had been admitted to the ICU for acute respiratory failure (n=9), acute renal failure (n=7), and septic shock (n=2). The median APACHE II and III scores were, respectively, 16 (10-27) and 55 (22-87) at the onset of complications and 26 (15-43) and 101 (65-157) upon admission to the ICU. Thus, both the APACHE II and APACHE III scores at ICU admission were higher than those at the onset of complications (P<0.0001). Seventeen patients (94%) subsequently died, with a median ICU stay of 7.5 days (1-51 days), as a result of multiorgan failure (n=14), respiratory failure (n=2), and septic shock (n=1). The APACHE II and III scores of the sole surviving patient were, respectively, 21 and 71 at the onset and 24 and 86 upon transfer to the ICU. Thus, the APACHE scores in this study were lower than those reported for other surgical or medical patients treated in the ICU, despite their uniform poor prognosis. Although nine patients had developed grade III to IV acute graft-versus-host disease, which is the most common cause of morbidity and mortality after allogeneic HSCT, this was not fully evaluated in the current scoring systems. Application of these systems to HSCT will require adequate modification, with particular attention to organ dysfunction secondary to graft-versus-host disease.

Original languageEnglish (US)
Pages (from-to)566-570
Number of pages5
JournalTransplantation
Volume75
Issue number4
DOIs
StatePublished - Feb 27 2003

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APACHE
Hematopoietic Stem Cell Transplantation
Intensive Care Units
Graft vs Host Disease
Septic Shock
Respiratory Insufficiency
Critical Care
Acute Kidney Injury
Medical Records
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Kim, Sung Won ; Kami, Masahiro ; Urahama, Norinaga ; Yamamoto, Rie ; Hori, Akiko ; Imataki, Osamu ; Kanda, Yoshinobu ; Tanosaki, Ryuji ; Mineishi, Shin ; Takaue, Yoichi ; Honda, Osamu. / Feasibility of Acute Physiology and Chronic Health Evaluation (APACHE) II and III score-based screening in patients receiving allogeneic hematopoietic stem-cell transplantation. In: Transplantation. 2003 ; Vol. 75, No. 4. pp. 566-570.
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abstract = "Patients who require management in the intensive care unit (ICU) for complications after allogeneic hematopoietic stem-cell transplantation (HSCT) generally have a poor outcome. We retrospectively studied whether the risk-prediction stratification systems commonly used for patients admitted to the ICU, that is, the Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III systems, could be useful for identifying patients who should receive intensive care earlier. We reviewed the medical records of 210 patients who underwent allogeneic HSCT and found that 18 (8.6{\%}) had been admitted to the ICU for acute respiratory failure (n=9), acute renal failure (n=7), and septic shock (n=2). The median APACHE II and III scores were, respectively, 16 (10-27) and 55 (22-87) at the onset of complications and 26 (15-43) and 101 (65-157) upon admission to the ICU. Thus, both the APACHE II and APACHE III scores at ICU admission were higher than those at the onset of complications (P<0.0001). Seventeen patients (94{\%}) subsequently died, with a median ICU stay of 7.5 days (1-51 days), as a result of multiorgan failure (n=14), respiratory failure (n=2), and septic shock (n=1). The APACHE II and III scores of the sole surviving patient were, respectively, 21 and 71 at the onset and 24 and 86 upon transfer to the ICU. Thus, the APACHE scores in this study were lower than those reported for other surgical or medical patients treated in the ICU, despite their uniform poor prognosis. Although nine patients had developed grade III to IV acute graft-versus-host disease, which is the most common cause of morbidity and mortality after allogeneic HSCT, this was not fully evaluated in the current scoring systems. Application of these systems to HSCT will require adequate modification, with particular attention to organ dysfunction secondary to graft-versus-host disease.",
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Feasibility of Acute Physiology and Chronic Health Evaluation (APACHE) II and III score-based screening in patients receiving allogeneic hematopoietic stem-cell transplantation. / Kim, Sung Won; Kami, Masahiro; Urahama, Norinaga; Yamamoto, Rie; Hori, Akiko; Imataki, Osamu; Kanda, Yoshinobu; Tanosaki, Ryuji; Mineishi, Shin; Takaue, Yoichi; Honda, Osamu.

In: Transplantation, Vol. 75, No. 4, 27.02.2003, p. 566-570.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Feasibility of Acute Physiology and Chronic Health Evaluation (APACHE) II and III score-based screening in patients receiving allogeneic hematopoietic stem-cell transplantation

AU - Kim, Sung Won

AU - Kami, Masahiro

AU - Urahama, Norinaga

AU - Yamamoto, Rie

AU - Hori, Akiko

AU - Imataki, Osamu

AU - Kanda, Yoshinobu

AU - Tanosaki, Ryuji

AU - Mineishi, Shin

AU - Takaue, Yoichi

AU - Honda, Osamu

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