Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies

Abstract

IntroductionNeutropenia recovery may be associated with deterioration in oxygenation and exacerbation of pre-existing pulmonary disease. However, risk factors for acute respiratory distress syndrome (ARDS) during neutropenia recovery in patients with hematologic malignancies have not been studied.MethodsWe studied critically ill patients with hematologic malignancies with the dual objectives of describing patients with ARDS during neutropenia recovery and identifying risk factors for ARDS during neutropenia recovery. A cohort of consecutive neutropenic patients with hematologic malignancies who were admitted to the intensive care unit (ICU) was studied. During a 6-year period, 71 patients recovered from neutropenia, of whom 38 (53.5%) developed ARDS during recovery.ResultsCompared with non-ARDS patients, patients who experienced ARDS during neutropenia recovery were more likely to have pneumonia, be admitted to the ICU for respiratory failure, and receive mechanical ventilator therapy. The in-ICU mortality was significantly different between the two groups (86.8% versus 51.5%, respectively, for patients who developed ARDS during neutropenia recovery versus those who did not during neutropenia recovery). In multivariate analysis, only occurrence of pneumonia during the neutropenic episode was associated with a marked increase in the risk of ARDS (odds ratio, 4.76).ConclusionsPatients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery.

Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study

“…Since that time, others have reported similar findings [9,10,12,13,14], including several studies that have assessed risk of WRS in critically ill patients [9,12,14]. For example, up to half of critically ill cancer patients with NR experience WRS [1,12]. Information about noncritically ill patients is scarce, however, and relies mainly on small case series [8,10,13].…”

“…These include longer neutropenia duration [9], preexisting respiratory failure or infection [8,12,13,15], the need for mechanical ventilation [12], and G-CSF use [11,13,16]. Nevertheless, the pathophysiology of WRS remains debated.…”

“…In addition, the use of granulocyte colony-stimulating factor (G-CSF) has been associated with a deterioration of respiratory status [3,4,5,6,7]. Neutropenia recovery (NR) is a risk factor for the deterioration of respiratory status or exacerbation of preexisting lung injury [8,9,10], and this deterioration usually occurs during the 3 days flanking NR [2,9,11,12]. Preexisting pulmonary infection [9], prolonged aplasia [9], and rapid NR [10] have been reported as risk factors for the deterioration of respiratory status during NR.…”

“…Preexisting pulmonary infection [9], prolonged aplasia [9], and rapid NR [10] have been reported as risk factors for the deterioration of respiratory status during NR. Up to 50% of critically ill patients experience a deterioration of their respiratory status during NR [9,11,12], but little information is available for less severe hematological patients (i.e. neutropenic patients who did not require ICU admission) [8,10,13].…”

Divergent Effects of Neutrophils on Fas-Induced Pulmonary Inflammation, Apoptosis, and Lung Damage

“…Interestingly, ALI/ARDS may also occur during neutropenia [99,160], but it should be noted that the disease tends to progress rapidly once PMN counts are restored [15]. In contrast, in clinical studies septic patients received granulocytemacrophage colony stimulating factor (GM-CSF) without an increased incidence of ALI [137].…”