Acute graft-versus-host disease (aGVHD) is a major cause of morbidity mortality in critically ill hematopoietic stem cell transplantation recipients. We assessed aGVHD trajectories in 191 allogeneic-HSCT recipients (age 42 (27–46)) admitted to our ICU between 2005 and 2015. aGVHD affected 130 (68%) patients (including 90% who underwent steroid therapy at a dose of 2 (2–2) mg/kg) and was graded 3 or 4 in 31% of the patients. Trajectories of aGVHD were clustered in four groups: (1) no aGVHD, (2) controlled aGVHD, (3) uncontrolled aGVHD (active, stable, or worsening), and (4) newly diagnosed and untreated aGVHD. Patients with controlled aGVHD and those admitted at the onset of aGVHD had similar survival than patients who never experienced aGVHD. By multivariable analysis, the dynamic assessment of aGVHD was independently associated with 90-day mortality, in addition to the admission to the ICU for acute respiratory failure, acute kidney injury or acute liver failure, and sepsis-related organ failure assessment score at admission. In conclusion, these findings suggest that GVHD cannot be assessed as a binary variable and at a single time point. Patients in whom GVHD is not uncontrolled with corticosteroids should have the same goals of ICU care than patients without GVHD.

急性移植物抗宿主病（aGVHD）是重症造血干细胞移植受者发病死亡的主要原因。我们评估了2005年至2015年间接受ICU治疗的191名同种异体HSCT接受者（42岁（27-46岁））的aGVHD轨迹。aGVHD影响了130（68％）例患者（包括90％接受2剂量类固醇治疗的患者（ 2–2）mg / kg），在31％的患者中分为3或4级。aGVHD的轨迹分为四组：（1）无aGVHD，（2）受控制的aGVHD，（3）无控制的aGVHD（活动，稳定或恶化），以及（4）新诊断和未治疗的aGVHD。患有aGVHD的患者和开始接受aGVHD的患者与从未经历过aGVHD的患者具有相似的生存率。通过多变量分析，除急性呼吸衰竭，急性肾损伤或急性肝衰竭的ICU入院以及入院时败血症相关器官衰竭的评估分数外，aGVHD的动态评估与90天死亡率独立相关。总之，这些发现表明，不能将GVHD评估为二进制变量并且不能在单个时间点进行评估。并非使用皮质类固醇控制GVHD的患者应与未使用GVHD的患者具有相同的ICU护理目标。