Hematopoietic colony-stimulating factors for neutropenic patients in the ICU

Bouchama, Abderrezak; Khan, Bashir Ahmad; Djazmati, W; Shukri, Khalid

doi:10.1007/s001340050996

Cited by 16 publications

(5 citation statements)

References 9 publications

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“…Conversely, use of G-CSF in patients with already overt infections (curative G-CSF) was found to have a limited benefit in neutropenic patients [ 58 , 59 ]. Data regarding interest of prophylactic or curative use of G-CSF are limited to studies with high risk of bias and suggest a limited efficacy in this setting [ 60 – 62 ]. In addition, G-CSF remains associated with potential side effects, including risk of worsening respiratory status during neutropenia recovery [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data

et al. 2018

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BackgroundThe study objective was to assess the influence of neutropenia on outcome of critically ill cancer patients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on outcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission, need for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)).MethodsData sources were PubMed and the Cochrane database. Study selection included articles focusing on critically ill cancer patients published in English and studies in humans from May 2005 to May 2015. For study selection, the study eligibility was assessed by two investigators. Individual data from selected studies were obtained from corresponding authors.ResultsOverall, 114 studies were identified and authors of 30 studies (26.3% of selected studies) agreed to participate in this study. Of the 7515 included patients, three were excluded due to a missing major variable (neutropenia or mortality) leading to analysis of 7512 patients, including 1702 neutropenic patients (22.6%). After adjustment for confounders, and taking study effect into account, neutropenia was independently associated with mortality (OR 1.41; 95% CI 1.23–1.62; P = 0.03). When analyzed separately, neither admission period, underlying malignancy nor need for mechanical ventilation modified the prognostic influence of neutropenia on outcome. However, among patients for whom data on G-CSF administration were available (n = 1949; 25.9%), neutropenia was no longer associated with outcome in patients receiving G-CSF (OR 1.03; 95% CI 0.70–1.51; P = 0.90).ConclusionAmong 7512 critically ill cancer patients included in this systematic review, neutropenia was independently associated with poor outcome despite a meaningful survival. Neutropenia was no longer significantly associated with outcome in patients treated by G-CSF, which may suggest a beneficial effect of G-CSF in neutropenic critically ill cancer patients.Systematic review registrationPROSPERO CRD42015026347. Date of registration: Sept 18 2015Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2076-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data

et al. 2018

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“…We found that 30-day mortality was 58% in our 102 CICPs, of whom 91 (89.2%) received MV, 67 (65.7%) vasopressor agents, and 28 (27.4%) dialysis. Few studies have been specifically designed to identify predictors of death in neutropenic CICPs [19,20,24]. Blot at al.…”

Section: Discussionmentioning

confidence: 99%

“…In two studies that used univariate analysis, G-CSF therapy had no effect on in-ICU neutropenia duration in CICPs [19,20]. The statistical methods used in these studies failed to take into account the time-dependency of NR.…”

Section: Discussionmentioning

confidence: 99%

“…Univariate analysis of data from two recent studies suggested that treatment with granulocyte colony-stimulating factor (G-CSF), an agent capable of shortening neutropenia duration in cancer patients [18], may be ineffective in the ICU [19,20]. However, these studies failed to consider that NR can occur at any time during the ICU stay and that, consequently, NR cannot be included in the prognostic model at the same level as patient characteristics available at ICU admission.…”

Section: Introductionmentioning

confidence: 99%

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Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients

Darmon

Azoulay

Alberti

et al. 2002

Intensive Care Medicine

110

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“…In meta-analyses performed in patients with non-Hodgkin’s lymphoma or solid tumors, use of G-CSF was associated with a decrease in both overall mortality and infection-related mortality [ 135 – 137 ]. Little data on this topic in the ICU are available, suggesting limited efficacy in this setting [ 72 , 138 ], and it was obtained from studies with low-level evidence. Thus, despite uncertainties and while additional studies are needed, it seems reasonable to recommend using prophylactic G-CSF when available or deemed necessary by an oncologist or hematologist.…”

Section: Hematological Managementmentioning

confidence: 99%

Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF)

Schnell

Azoulay

Benoît

et al. 2016

Ann. Intensive Care

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Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0189-6) contains supplementary material, which is available to authorized users.

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Hematopoietic colony-stimulating factors for neutropenic patients in the ICU

Abstract: H-CSF for treatment of neutropenia in patients admitted to the ICU did not accelerate neutrophil recovery or improve survival.

Cited by 16 publications

References 9 publications

Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data

Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data

Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients

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