An indicator of endothelial dysfunction predicts the need for ICU transfer in patients with bone marrow transplantation

  • The Endothelial Stress and Activation Index, calculated through routine biomarkers, reveals the endothelium activation status.
  • The hematology team, from IDIBELL and ICO, has published an article in the journal Blood Advances that proposes this index as a tool to identify patients with higher risk to be transferred to the Intensive Care Unit (ICU) after hematopoietic stem cell transplant.
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Bone marrow transplantation can be a curative therapy for those patients with malignant and non-malignant hematological diseases. However, such treatment may cause life-threatening complications and have a direct impact on the quality of life. Pretransplant assessment of individual risk is essential to select those patients who could benefit most from the procedure.

The endothelium, the cell monolayer that covers blood vessels, plays a key role in infectious and non-infectious complications of a bone marrow transplant. A study coordinated by the hematopoietic and lymphoid tumors research group from IDIBELL and ICO, published in the journal Blood Advances, has described the ability of an endothelial activation indicator, calculated before the procedure, to predict the probability of transfer to ICU. This index, called the EASIX for its acronym Endothelial Activation and Stress Index, uses only three parameters available in routine blood tests (LDH, creatinine, and platelets) to calculate the degree of endothelium activation.

The study led by Dr. Anna Sureda, group leader at IDIBELL and head of the ICO’s clinical hematology service, shows that patients with a high pre-transplant EASIX index have a higher incidence of ICU admission. Furthermore, the study confirms the potential of this index to predict transplant-related mortality and overall survival in these patients.

The researchers propose the use of the EASIX index as a prognostic tool to identify patients with a higher risk of suffering serious complications, and therefore in need of intensive care. “Identifying the individual risk of developing serious complications that require transfer to the ICU could help us to implement early personalized interventions and manage health resources” indicates Dr. Marta Peña, first author of the work.



The Bellvitge Biomedical Research Institute (IDIBELL) is a biomedical research center created in 2004. It is participated by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L’Hospitalet de Llobregat.

IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the “HR Excellence in Research” program of the European Union and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).

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