Overall Survival Rate in Allogeneic Stem Cell Transplanted Patients Requiring Intensive Care Can Be Predicted by the Prognostic Index for Critically Ill Allogeneic Transplantation Patients (PICAT) and the Sequential Organ Failure Assessment (SOFA) Scores

SIMPLE SUMMARY: Intensive care admission is a common complication of allogeneic hematopoietic stem cell transplantation. Mortality remains very high, and among several prognosis tools, data about power of discrimination showed contradictory results. The aim of our retrospective study was to evaluate the efficacy of a new score, the Prognostic Index for Critically Ill Allogeneic Transplantation (PICAT) Patients, for this specific setting in a cohort of 111 patients. We confirmed the ability of this score to discriminate three groups of patients with different outcomes. Moreover, we evaluated a classic intensive score, the Sequential Organ Failure Assessment (SOFA), and we showed that the SOFA outperformed the PICAT to predict outcomes in our cohort. ABSTRACT: Background. Allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients requiring intensive care unit (ICU) have high mortality rates. Methods. In the current study, we retrospectively assessed whether the Prognostic Index for Critically Ill Allogeneic Transplantation patients (PICAT) score predicted overall survival in a cohort of 111 consecutive allo-HCT recipients requiring ICU. Results. Survival rates at 30 days and 1 year after ICU admission were 57.7% and 31.5%, respectively, and were significantly associated with PICAT scores (p = 0.036). Specifically, survival at 30-day for low, intermediate, and high PICAT scores was 64.1%, 58.1%, and 31.3%, respectively. At one-year, the figures were 37.5%, 29%, and 12.5%, respectively. In multivariate analyses, high PICAT score (HR = 2.23, p = 0.008) and relapse prior to ICU admission (HR = 2.98, p = 0.0001) predicted higher mortality. We next compared the ability of the PICAT and the Sequential Organ Failure Assessment (SOFA) scores to predict mortality in our patients using c-statistics. C statistics for the PICAT and the SOFA scores were 0.5687 and 0.6777, respectively. Conclusions. This study shows that while the PICAT score is associated with early and late mortality in allo-HCT recipients requiring ICU, it is outperformed by the SOFA score to predict their risk of mortality.