Acute respiratory failure in immunocompromised patients : outcome and clinical features according to neutropenia status

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Efraim Investigators Nine , Mokart , D , Darmon , M , Schellongowski , P , Valkonen , M & Azoulay , E 2020 , ' Acute respiratory failure in immunocompromised patients : outcome and clinical features according to neutropenia status ' , Annals of intensive care , vol. 10 , no. 1 , 146 . https://doi.org/10.1186/s13613-020-00764-7

Title: Acute respiratory failure in immunocompromised patients : outcome and clinical features according to neutropenia status
Author: Efraim Investigators Nine; Mokart, Djamel; Darmon, Michael; Schellongowski, Peter; Valkonen, Miia; Azoulay, Elie
Contributor: University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
Date: 2020-10-22
Language: eng
Number of pages: 9
Belongs to series: Annals of intensive care
ISSN: 2110-5820
URI: http://hdl.handle.net/10138/321163
Abstract: Background The impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia. Methods We performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort. Results Overall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%;p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93-2.11). Similar results were observed after matching (52% vs 46%, respectively;p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63-1.72). Conclusion Neutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections.
Subject: DISTRESS-SYNDROME
CANCER-PATIENTS
DIAGNOSTIC STRATEGY
INCREASED MORTALITY
SEVERE SEPSIS
SURVIVAL
HEMATOLOGY
PROGNOSIS
ADMISSION
SEVERITY
3126 Surgery, anesthesiology, intensive care, radiology
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