Antiphospholipid Antibodies and Multiple Organ Failure in Critically Ill Cancer Patients

Abstract

OBJECTIVES: To describe the clinical outcomes and thrombotic events in a series of critically ill cancer patients positive for antiphospholipid (aPL) antibodies. DESIGN: Retrospective case series study. SETTING: Medical-surgical oncologic intensive care unit (ICU). Patients and Participants: Eighteen patients with SIRS/sepsis and multiple organ failure (MOF) and positive for aPL antibodies, included over a 10-month period. INTERVENTIONS: None MEASUREMENTS AND RESULTS: aPL antibodies and coagulation parameters were measured up to 48 hours after the occurrence of acrocyanosis or arterial/venous thrombotic events. When current criteria for the diagnosis of aPL syndrome were applied, 16 patients met the criteria for “probable” and two patients had a definite diagnosis of APL syndrome in its catastrophic form (CAPS). Acrocyanosis, arterial events and venous thrombosis were present in eighteen, nine and five patients, respectively. Sepsis, cancer and major surgery were the main precipitating factors. All patients developed MOF during the ICU stay, with a hospital mortality rate of 72% (13/18). Five patients were discharged from the hospital. There were three survivors at 90 days of follow-up. New measurements of lupus anticoagulant (LAC) antibodies were performed in these three survivors and one patient still tested positive for these antibodies. CONCLUSIONS: In this small series of patients, we observed a high frequency of auto-antibodies and micro- and macro-vascular thrombotic events in critically ill cancer patients. The coexistence of sepsis or SIRS and aPL antibodies was often associated with MOF and death. More studies are necessary to determine the pathophysiological significance of antiphospholipid antibodies in severely ill cancer patients.

Anticardiolipin Autoantibodies as Useful Biomarkers for the Prediction of Mortality in Septic Patients

“…Our results illustrated some aspects of these complex changes in sepsis, and we hypothesized that aPL might have the potential for predicting future organ failure and could be used as an indicator to predict in-hospital mortality in intensive care unit (ICU). Our findings are supported by previous studies which reported the occurrence of aPL as pathogenic in different diseases such as in cancer [ 23 , 24 ], acute respiratory distress syndrome (ARDS) [ 25 ], human immunodeficiency virus (HIV) [ 26 ], acute kidney injury (AKI) [ 27 ], and more recently in COVID-19 [ 11 , 28 – 30 ]. In our study, we measured aCL IgM, IgG, IgA and aPS IgM, IgG, and IgA autoantibodies in septic patients, without a clinical history of auto-immune disease, at different time points during their hospitalization in ICU.…”

Acrocyanosis: The Flying Dutchman

“…32,153 Multiple reports describe an association between acrocyano sis and cold agglutinins, cryoglubulins, or cryofibrino gen. 28,33,[154][155][156] Almost a third of all patients with positive antiphospholipid antibodies have acrocyanosis. 30,40,157,158 Anticardiolipin antibodies have been reported in 25% of patients with acrocyanosis. In this report, the term 'essential acrocyanosis' may not be justifiable, given that a quarter of the patients developed digital necrosis.…”

Antiphospholipid antibodies in critically ill patients

“…It was observed that the ICU and hospital stay and 90 day mortality were 61%, 72% and 83%, respectively, a higher rate than reported in the contemporaneous literature for critically ill patients with cancer. ( 16 )…”