Prognosis of acute respiratory distress syndrome in neutropenic cancer patients

Abstract

To date, no study has been specifically designed to identify determinants of death in neutropenic cancer patients presenting with acute respiratory distress syndrome (ARDS). The aim of this study was to identify early predictive factors of 28-day mortality in these patients. Factors associated with 28-day mortality during intensive care unit (ICU) stay were also described.70 consecutive cancer patients with ARDS and neutropenia were prospectively analysed over a 6-yr period.Mortality at 28 days was 63%. Factors independently associated with good prognosis were: lobar ARDS (OR 0.10, 95% CI 0.02-0.48), use of initial antibiotic treatment active on difficult to treat bacteria (ticarcillin-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia or extended-spectrum b-lactamase-producing strains) (OR 0.08, 95% CI 0.02-0.33) and first-line chemotherapy (OR 0.08, 95% CI 0.02-0.37). During the ICU stay, mortality was associated with the markers of organ dysfunctions, the absence of neutropenia recovery and the use of vasopressors. During the first 3 weeks, the conditional probability of discharge alive from ICU did not decrease.At ICU admission, first-line chemotherapy, lobar ARDS and antibiotic treatment active on difficult-to-treat bacteria were associated with survival. During ICU stay, mortality was associated with organ dysfunctions and use of vasopressors. Most survivors have an ICU stay of .3 weeks.

Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (Grrr-OH) study

“…IMV is a well-known risk factor for death among hematology patients with ARF [18, 32, 46, 47]. Invasive fungal infections such as pulmonary aspergillosis have also been associated with high-case fatality rates in this population [18, 48].…”

Outcomes in adult critically Ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

“…Despite being a transient and expected immune dysfunction, the duration of which is influenced by factors such as sepsis, lung injury, response to chemotherapy, underlying malignancy, and tumor progression or stage. Neutropenia is associated with complications that include severe sepsis [5], acute respiratory failure [50] and specific conditions such as neutropenic enterocolitis [51]. Although immune defects associated with neutropenia are likely to influence the outcome of critically ill patients, the results of studies in this field remain controversial.…”

Mouse Models of Acute Respiratory Distress Syndrome

“…While many researchers view neutrophilic infiltrates and subsequent tissue injury as one of the main inciting features of ARDS (X. Zhou, Dai, and Huang 2012;Williams and Chambers 2014), the syndrome also develops in neutropenic patients or those who have recently undergone full-body bone marrow irradiation (Mokart et al 2012;Azoulay and Darmon 2010;Ognibene et al 1986;Laufe et al 1986). This divergence is most likely due to the vast variety of stimuli that can incite the development of ARDS.…”