Evolution of organ failures in allogeneic hematopoietic cell transplantation recipients admitted to the intensive care unit

The prognosis of allogeneic hematopoietic cell transplantation (HCT) recipients admitted to the intensive care unit (ICU) has been historically poor and a time-limited ICU trial may be considered in these patients with uncertain outcomes. How the evolution of organ failures over the first few days of ICU may inform on prognosis is however unclear. Here, we conducted a retrospective, monocentric study to evaluate the evolution of organ failures, assessed by organ support and Sequential Organ Failure Assessment (SOFA), during ICU stay in 161 allogeneic HCT recipients admitted to the ICU. In patients with a length of stay of 3 days or more ( n = 110), there were significant associations between SOFA on day 3, delta SOFA (defined by the difference between SOFA on days 1 and 3 following ICU admission), and new organ support requirement between days 1 and 3 with ICU mortality. While the prediction accuracy was overall limited, SOFA at day 3 and change in organ support requirement better predicted ICU mortality than SOFA on day 1 and delta-SOFA. Together, organ failure (and the need for organ support) is the main driver of outcome in allogeneic HCT recipients while integrating the trajectory of organ failures had limited prognostic value to help in decision making.