Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignancies.
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.
Rhee
Chin Kook
CK
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
Kang
Ji Young
JY
Kim
Yong Hyun
YH
Kim
Jin Woo
JW
Yoon
Hyung Kyu
HK
Kim
Seok Chan
SC
Kwon
Soon Suk
SS
Kim
Young Kyoon
YK
Kim
Kwan Hyung
KH
Moon
Hwa Sik
HS
Park
Sung Hak
SH
Kim
Hee Je
HJ
Lee
Seok
S
Song
Jeong Sup
JS
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