Rates and Outcomes of Cardiovascular Complications in Critically Ill Blood or Marrow Transplant Patients: A...

Blood or marrow transplant (BMT) is an increasingly utilized treatment for hematologic disease, with approximately 20,000 procedures performed in the United States each year; up to a third of these patients will require intensive care unit (ICU) admission. Although BMT is associated with both acute and long-term cardiac toxicity, cardiovascular complications among critically ill BMT patients in the era of modern transplant techniques have not yet been fully characterized. to determine the incidence of cardiovascular complications, compare cardiovascular complication risks by selected patient characteristics and evaluate whether cardiovascular complications are associated with poorer outcomes among critically ill patients post BMT. We conducted a retrospective cohort study of 206 patients admitted to the Oncology ICU after BMT. We collected medical record data regarding incidence of cardiovascular complications, defined as arrythmia requiring treatment, cardiac tamponade, myocardial infarction, cardiac arrest, coronary angiography, newly decreased left ventricular ejection fraction, and elevated troponin, as well as diagnostic testing including echocardiography and electrocardiography. The primary outcome was the occurrence of a cardiovascular complication amongst critically ill patients following BMT. Secondary outcomes included abnormal cardiac biomarkers (troponin-I, BNP), abnormal echocardiograms, and abnormal ECGs. Poisson regression with robust standard errors was used to compare cardiovascular complication incidence between subgroups. We used unadjusted and multivariable logistic regression to evaluate the association of cardiovascular complications with mortality. About 206 patients were included in the analysis. About 118 (58%) experienced at least 1 cardiovascular complication. The most common cardiac complication was arrythmia requiring treatment (30.6%) followed by elevated troponin (>5x upper limit of normal; 27%), newly decreased left ventricular ejection fraction (21%), cardiogenic shock (11%), myocardial infarction (6%) and pericardial tamponade (6%). Prior cardiac history (rate ratio [RR] = 1.34; 95% CI: 1.07, 1.69) and presence of a bloodstream infection (RR = 1.41; 95% CI: 1.13, 1.77) were associated with higher rates of cardiovascular complications. As a whole, cardiovascular complications were associated with higher odds of hospital mortality (OR 2.37; 95% CI: 1.26, 4.43). When analyzed according to specific cardiovascular complications, higher odds of hospital mortality were seen in patients with a troponin >5x ULN (OR 2.52, 95% CI: 1.23, 5.18), cardiogenic shock (OR 6.17, 95% CI: 1.82, 20.90) and tamponade (OR 4.32, 95% CI: 1.16, 16.11). Cardiovascular complications occurred in nearly 60% of critically ill BMT patients. A prior history of cardiac conditions and bloodstream infection were associated with an increased rate of complications and patients with these characteristics should be monitored more closely for cardiac dysfunction. Cardiogenic shock, pericardial tamponade, and significantly elevated troponin levels were associated with increased odds of hospital mortality. These represent potentially treatable complications, and early identification and multi-disciplinary management may help improve outcomes.