Contribution to diagnosis and treatment of bone marrow aspirate results in critically ill patients undergoing bone marrow aspiration: a retrospective study of 193 consecutive patients

Calvet, Laure; Pereira, Bruno; Sapin, Anne‐Françoise; Mareynat, Gabrielle; Lautrette, Alexandre; Souweine, Bertrand

doi:10.1186/s40560-017-0263-7

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…Persistent fever that is refractory to antibiotics, pancytopenia, major hyperferritinemia, or unexplained liver enzyme elevation should lead practitioners to screen patients for HLH (35)(36)(37). Although variable and non-specific, bonemarrow hemophagocytosis is still a hallmark HLH criterion (38)(39)(40) and was associated with a higher ICU mortality rate in our study. Among biological factors, non-regenerative profound anemia and hypofibrinogenemia have been reported to be independent predictors of a poor outcome (31)(32)(33)41).…”

Section: Discussionmentioning

confidence: 57%

High Mortality of HLH in ICU Regardless Etiology or Treatment

et al. 2021

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Background: Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult HLH in the ICU (ICU-HLH). We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population.Methods: This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (≥ 4/8) and/or had an HScore ≥ 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH.Results: Two hundred and sixty patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% (n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16–1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21–1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28–1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11–24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09–1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04–1.41], p = 0.02).Conclusions: In this large retrospective cohort study of critically ill patients, ICU-HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology or specific treatment. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.

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Section: Discussionmentioning

confidence: 57%

High Mortality of HLH in ICU Regardless Etiology or Treatment

et al. 2021

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“…Persistent fever that is refractory to antibiotics, pancytopenia, major hyperferritinemia, or unexplained chemical hepatitis should lead practitioners to screen patients for HLH [31][32][33]. Although variable and non-speci c, bone-marrow hemophagocytosis is still a hallmark HLH criterion [34][35][36] and was associated with a higher ICU mortality rate in our study. Among biological factors, non regenerative profound anemia and hypo brinogenemia have been reported to be independent predictors of a poor outcome [27][28][29]37].…”

Section: Discussionmentioning

confidence: 58%

Features of hemophagocytic lymphohistiocytosis in the intensive care unit (ICU) : a 260-patient retrospective analysis

Bichon¹,

Bourenne²,

Allardet-Servent³

et al. 2021

Preprint

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Background Adult hemophagocytic lymphohistiocytosis (HLH) is highly lethal in the ICU. The diagnostic and therapeutic emergency that HLH represents is compounded by its unknown pathophysiological mechanisms. Here, we report on a large cohort of adult-acquired HLH in the ICU. We analyzed prognostic factors associated with mortality to define the diagnostic and therapeutic challenges in this specific population, Methods This retrospective study included adult patients diagnosed with HLH in four ICUs in Marseille, France between 2010 and 2020. Patients who fulfilled the HLH-2004 criteria (> 4/8) and/or had an HScore > 169 were diagnosed with HLH. HLH was categorized into four groups according to etiology: sepsis-associated HLH, intracellular infection-associated HLH, malignancy-associated HLH, and idiopathic HLH. Results 260 patients were included: 121 sepsis-associated HLH (47%), 84 intracellular infection-associated HLH (32%), 28 malignancy-associated HLH (11%), and 27 idiopathic HLH (10%). The ICU mortality rate reached 57% (n = 147/260) without a statistical difference between etiological groups. Independent factors associated with mortality in multivariate analysis included age (OR (5 years) = 1.31 [1.16–1.48], p < 0.0001), SOFA score at ICU admission (OR = 1.37 [1.21–1.56], p < 0.0001), degradation of the SOFA score between ICU arrival and HLH diagnosis (Delta SOFA) (OR = 1.47 [1.28–1.70], p < 0.0001), the presence of bone-marrow hemophagocytosis (OR = 5.27 [1.11–24.97], p = 0.04), highly severe anemia (OR = 1.44 [1.09–1.91], p = 0.01), and hypofibrinogenemia (OR = 1.21 [1.04–1.41], p = 0.02). Conclusions In this large retrospective cohort study of critically ill patients, ICU-acquired HLH in adults was associated with a 57% mortality rate, regardless of HLH etiology. Factors independently associated with prognosis included age, presence of hemophagocytosis in bone-marrow aspirates, organ failure at admission, and worsening organ failure during the ICU stay. Whether a rapid diagnosis and the efficacy of specific therapy improve outcome is yet to be prospectively investigated.

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“…As a result, the authors concluded that BMA could significantly contribute to diagnosis and treatment in patients with or without any hematological malignancy during admission to the intensive care unit. 7 In our study, the BMA evaluation directly contributed to the diagnosis and treatment of 200 (40%) patients, including 186 (37.2%) with malignant hematological diseases and 14 (2.8%) with benign hematological diseases. In a study by Gilotara et al in 100 cases, when the results of BMA and BMB assessment were compared, there was a 72.4% agreement.…”

Section: A H E a D O F P R I N Tmentioning

confidence: 78%

Diagnostic importance of bone marrow aspiration evaluation: A single-center study

Doğan¹,

Demi̇rci̇oğlu²

2022

Pak J Med Sci

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Background &Objective: Early diagnosis can be made based on the morphological examination of bone marrow aspiration (BMA) until the bone marrow biopsy (BMB) result is reported. This allows for treatment to be started immediately, especially in hematological malignancies for which urgent treatment is indicated. This study aimed to determine the sensitivity and importance of bone marrow aspiration in the diagnosis of hematological malignancies. Methods: In this study, the data of patients who underwent bone marrow aspiration and bone marrow biopsy in Van Yuzuncu Yil University hospital between 2017 and 2019 were retrospectively analyzed. A total of 500 patients who simultaneously underwent BMA and BMB were included in the study. Data were obtained from electronic medical records. Results: Indication for bone marrow evaluation was abnormalities in complete blood count in 270 (54%) of patients. The diagnosis was made based on the evaluation of BMA in 475 (95%). In 456 (96%) of the 475 patients diagnosed with BMA, the diagnosis was consistent with that of BMB. Agreement of BMB with BMA was 100% in acute and chronic leukemias, while BMA was not sufficient for the diagnosis of lymphoma and solid organ metastasis. Conclusion: Our study showed that the evaluation of BMA was highly sensitive in the diagnosis of hematological malignancies, such as acute leukemias, chronic leukemias, and multiple myeloma. doi: https://doi.org/10.12669/pjms.38.4.4797 How to cite this:Dogan A, Demircioglu S. Diagnostic importance of bone marrow aspiration evaluation: A single-center study. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.4797 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Contribution to diagnosis and treatment of bone marrow aspirate results in critically ill patients undergoing bone marrow aspiration: a retrospective study of 193 consecutive patients

Cited by 10 publications

References 27 publications

High Mortality of HLH in ICU Regardless Etiology or Treatment

High Mortality of HLH in ICU Regardless Etiology or Treatment

Features of hemophagocytic lymphohistiocytosis in the intensive care unit (ICU) : a 260-patient retrospective analysis

Diagnostic importance of bone marrow aspiration evaluation: A single-center study

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