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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2013 October;79(10):1156-63
Acute respiratory failure in neutropenic patients is associated with a high post-ICU mortality
Mokart D. 1, Azoulay E. 2, Schnell D. 2, Bourmaud A. 3, Kouatchet A. 4, Pène F. 5, Lemiale V. 2, Lambert J. 6, Bruneel F. 7, Vincent F. 8, Legrand M. 9, Rabbat A. 10, Darmon M. 11 ✉
1 Medical-Surgical ICU, Paoli-Calmettes Institute, Marseille, France;
2 Medical ICU, University Hospital St Louis, Paris, France;
3 Public Health and Biostatistics Department, Lucien Neuwirth Institute, Saint-Priest en Jarrez, France;
4 Medical ICU, Angers University Hospital, Angers, France;
5 Medical ICU, Cochin University Hospital, Paris, France;
6 Biostatistics Department, Saint-Louis University Hospital, Paris, France;
7 Medical-Surgical ICU, Versailles Hospital, Versailles, France;
8 Medical-Surgical ICU, Avicenne University Hospital, Bobigny, France;
9 Surgical ICU, Lariboisière University Hospital, Paris, France;
10 Medical ICU, Hôtel Dieu University Hospital, Paris, France;
11 Medical-Surgical ICU, Saint-Etienne University Hospital, Avenue Albert Raymond, Saint-Priest en Jarez, France
Background: Few studies have evaluated outcomes of neutropenic patients admitted to the ICU at the onset of acute respiratory failure (ARF). The main objective of this study was to describe outcomes and to identify early predictors of hospital mortality in critically ill cancer patients with ARF during chemotherapy-induced neutropenia.
Methods: Retrospective analysis of prospectively collected data extracted from two recent prospective multicentre studies. We included neutropenic adults admitted to the ICU for ARF.
Results: Of the 123 study patients, 107 patients (87%) had haematological malignancies; 78 (64%) were male, median age was 57 years (44-62), and median LOD score at ICU admission was 6 (4-9). ICU and hospital mortality rates were 42% and 77%, respectively. Endotracheal mechanical ventilation was an independent risk factor for hospital mortality (odds ratio [OR], 7.73; 95% confidence interval [95%CI], 2.52-23.69); two factors independently protected from hospital mortality, namely, ICU admission for ARF during neutropenia recovery (OR, 0.23; 95%CI, 0.07-0.73) and steroid therapy before ICU admission (OR, 0.35; 95%CI, 0.11-0.95).
Conclusion: Our study demonstrates a meaningful ICU survival in the studied population and identified factors associated with ICU and hospital mortality. Further work is needed to address the reasons for the high post-ICU mortality rate after ARF.