Bone Marrow Transplantation (2018) 53:1233–1241 https://doi.org/10.1038/s41409-018-0181-x REVIEW ARTICLE Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality Colombe Saillard 1 ● Michael Darmon 2,3 ● Magali Bisbal 3,4 ● Antoine Sannini 4 ● Laurent Chow-Chine 4 ● Marion Faucher 4 ● Etienne Lengline 3,5 ● Norbert Vey 1,6 ● Didier Blaise 1,6 ● Elie Azoulay 3,7,8 ● Djamel Mokart 3,4 on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH) Received: 31 January 2018 / Revised: 8 March 2018 / Accepted: 25 March 2018 / Published online: 27 April 2018 © Macmillan Publishers Limited, part of Springer Nature 2018 Abstract Outcome of patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) has improved. To investigate if this improvement can be transposed to the ICU setting, we conducted a systematic review and meta-analysis to assess short-term mortality of critically ill allo-HSCT patients admitted to the ICU and to identify prognostic factors of mortality. Public-domain electronic databases, including Medline via PubMed and the Cochrane Library were searched. All full-text articles written-English studies published from 2006 to 2016, including allo-HSCT adults transferred to the ICU were included. Eighteen studies were selected, including 2342 patients. Overall estimated ICU mortality was 51.7%. Prognostic factors associated with an increased ICU mortality were mechanical ventilation (OR = 12.2, 95% CI = 6.2–23.7), vasopressors (OR = 6.3, 95% CI = 3.6–11.1), renal replacement therapy (OR = 4.2, 95% CI = 2.8–6.2), ICU admission for acute respiratory failure (OR = 2.2, 95% CI = 1.1–4.4), acute kidney injury (OR = 2.2, 95% CI = 1.3–4), and acute graft- versus-host disease (OR = 1.6, 95% CI = 1.1–2.3). Factors associated with an increased ICU survival were a single-organ failure (OR = 0.2, 95% CI = 0.1–0.4), neurological failure (OR = 0.4, 95% CI = 0.2–0.8), and reduced-intensity conditioning regimens (OR = 0.7, 95% CI = 0.5–0.9). Septic shock, underlying malignancy, disease status, donor, and graft source did not impact prognosis. Outcome has improved, supporting the usefulness of ICU management. Organ failures at ICU admission, organ support requirement, and GVHD are the main prognostic factors. Introduction Major advances have been made in the care of patients undergoing allogenic hematopoietic stem cell transplanta- tion (allo-HSCT) [1–5], including advances in hematology, transplant procedures, and development of reduced- intensity conditioning (RIC) regimens [6, 7], resulting in improved outcome [8]. Decrease in overall mortality, non- relapse mortality, relapse, severe graft-versus-host disease Registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO/, number 42016047307). * Colombe Saillard saillardc@ipc.unicancer.fr 1 Department of Hematology, Institut Paoli Calmettes, Marseille, France 2 Medical-Surgical ICU, Hôpital Nord, Saint-Etienne, France 3 GRRR-OH—Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie, Paris, France 4 Department of Anesthesiology and Critical Care Institut Paoli Calmettes, Polyvalent Intensive Care Unit, Marseille, France 5 Department of Hematology, Saint-Louis University Hospital, Paris, France 6 Aix Marseille University, Marseille, France 7 Medical ICU, Saint-Louis University Hospital, Paris, France 8 Paris-Diderot University, Sorbonne-Paris-Cité, Paris, France Electronic supplementary material The online version of this article (https://doi.org/10.1038/s41409-018-0181-x) contains supplementary material, which is available to authorized users. 1234567890();,: 1234567890();,: