Septic Shock After Allogeneic Hematopoietic Stem Cell Transplantation: Outcomes and Prognostic Factors in a Multicenter ICU Cohort
Authors' conclusion
Our results show that septic shock after allo-HSCT carries a high mortality (63% at 90 days), largely driven by host-related factors and initial illness severity.
Study context
- Population
- Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) admitted to the ICU with septic shock, 2015–2020of 1,164 ICU admissions
- Participants
- 444 recipients
- Outcome
- Outcomes (mortality) and independent prognostic factors
- Follow-up
- 90 days
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Mortality
Mortality at 90 days
63%
n = 280
Observational data: associations, not effects.
Further findings
Factors associated with 90-day survival (extended Cox model)
| HR (95% CI) | P value | ||
|---|---|---|---|
| Fungal documentation | 1.78 (1.19–2.67) | P = 0.005 | |
| SOFA score | 1.07 (1.02–1.13) | P = 0.007 | |
| Neutropenia | 3.94 (1.18–13.1) | P = 0.026 | |
| 0.050.21520Hazard ratio (log scale) |
Early aminoglycoside use and 90-day survival (48-hour landmark analysis)
| HR (95% CI) | P value | ||
|---|---|---|---|
| Early aminoglycoside use | 0.46 (0.33–0.64) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Factors not associated with 90-day survival
| HR (95% CI) | ||
|---|---|---|
| Age ≥ 56 years | 1.36 (0.99–1.87) | |
| Early bacterial documentation | 0.90 (0.64–1.26) | |
| 0.512Hazard ratio (log scale) |
- Factors associated with 90-day survival (extended Cox model): associated independently with 90-day survival
- Early aminoglycoside use and 90-day survival (48-hour landmark analysis): time-varying analyses indicated a nonconstant association over time
Mortality · 3 years
- Mortality at 3 years
- 81% (n = 350)
Factors not associated with 90-day survival
- Graft-versus-host disease type not associated with 90-day survival
Illness severity and course
- Median Sequential Organ Failure Assessment (SOFA) score (IQR)
- 8 (6-11)
- Microbiological documentation
- 62% (n = 261)
- Fungal pathogens
- 17% (n = 74)
- Respiratory tract infection source
- 43%; n = 180
- Invasive mechanical ventilation
- 64% (n = 284)
- RRT
- 32% (n = 143)
Original publication
Septic Shock After Allogeneic Hematopoietic Stem Cell Transplantation: Outcomes and Prognostic Factors in a Multicenter ICU Cohort. Chest. Published 29 August 2026. doi:10.
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