title: Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies.
abstract: BACKGROUND
  Neutropenia 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Compared 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).
  
  
  CONCLUSIONS
  Patients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seocho-Gu, Seoul 137-701, Korea. chinkook@catholic.ac.kr
authors.forename: Chin Kook
authors.initials: CK
authors.lastname: Rhee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kang
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Kim
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyung Kyu
authors.initials: HK
authors.lastname: Yoon
authors.forename: Seok Chan
authors.initials: SC
authors.lastname: Kim
authors.forename: Soon Suk
authors.initials: SS
authors.lastname: Kwon
authors.forename: Young Kyoon
authors.initials: YK
authors.lastname: Kim
authors.forename: Kwan Hyung
authors.initials: KH
authors.lastname: Kim
authors.forename: Hwa Sik
authors.initials: HS
authors.lastname: Moon
authors.forename: Sung Hak
authors.initials: SH
authors.lastname: Park
authors.forename: Hee Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.forename: Jeong Sup
authors.initials: JS
authors.lastname: Song
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000209:etiology* / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome