Symptom Trajectory in Hematopoietic Stem Cell Transplantation Recipients Who Survive Critical Illness

Background

Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of ICU admission. Data are sparse about long-term patient-reported outcomes in patients who survive the ICU. The Edmonton Symptom Assessment System (ESAS) score is a validated method for measuring symptoms across nine domains (pain, tiredness, lack of appetite, shortness of breath, nausea, drowsiness, depression, anxiety, and poor well-being) and has been collected systematically for patients with cancer in Ontario, Canada.

Research Question

What is the association between ICU admission and subsequent symptom trajectory among HSCT recipients?

Study Design and Methods

This was a population-based cohort study of HSCT recipients in the province of Ontario between 2006 and 2017. The main exposure was being discharged alive from the ICU; these patients were matched on baseline characteristics to patients who survived hospitalization (without the ICU). The primary outcome was the rate of moderate to severe symptoms within 1 year of hospital discharge, measured by ESAS total distress score. Secondary outcomes included each individual domain of ESAS. We performed Poisson regression analysis and reported incidence rate ratios (IRRs) with 95% CIs.

Results

During the study period, 5,844 adult patients received HSCT in Ontario, of whom 1,580 (27.0%) were admitted to the ICU and 552 (34.9%) died in the hospital. Compared with patients who survived hospitalization, patients who survived the ICU showed a higher rate of moderate to severe symptoms within 1 year as measured by the total distress score (IRR, 1.29; 95% CI, 1.05-1.59) and for domains of pain (IRR, 1.22; 95% CI, 1.00-1.50), shortness of breath (IRR, 1.58; 95% CI, 1.25-1.99), drowsiness (IRR, 1.26; 95% CI, 1.03-1.54), depression (1.41; 95% CI, 1.09-1.82), anxiety (IRR, 1.40; 95% CI, 1.10-1.78), and poor well-being (IRR, 1.27; 95% CI, 1.08-1.50).

Interpretation

HSCT recipients who survive critical illness show an increased rate of moderate to severe symptoms during follow-up when compared with patients who survive hospitalization.