title: Acute respiratory failure in neutropenic patients is associated with a high post-ICU mortality.
abstract: BACKGROUND
  Few studies have evaluated outcomes of neutropenic patients admitted to the ICU at the onset of acute respiratory failure (ARF). The main objective of this study was to describe outcomes and to identify early predictors of hospital mortality in critically ill cancer patients with ARF during chemotherapy-induced neutropenia.
  
  
  METHODS
  Retrospective analysis of prospectively collected data extracted from two recent prospective multicentre studies. We included neutropenic adults admitted to the ICU for ARF.
  
  
  RESULTS
  Of the 123 study patients, 107 patients (87%) had haematological malignancies; 78 (64%) were male, median age was 57 years (44-62), and median LOD score at ICU admission was 6 (4-9). ICU and hospital mortality rates were 42% and 77%, respectively. Endotracheal mechanical ventilation was an independent risk factor for hospital mortality (odds ratio [OR], 7.73; 95% confidence interval [95%CI], 2.52-23.69); two factors independently protected from hospital mortality, namely, ICU admission for ARF during neutropenia recovery (OR, 0.23; 95%CI, 0.07-0.73) and steroid therapy before ICU admission (OR, 0.35; 95%CI, 0.11-0.95).
  
  
  CONCLUSIONS
  Our study demonstrates a meaningful ICU survival in the studied population and identified factors associated with ICU and hospital mortality. Further work is needed to address the reasons for the high post-ICU mortality rate after ARF.
authors.affiliation: Medical-Surgical ICU, Paoli-Calmettes Institute, Marseille, France - mokartd@ipc.unicancer.fr.
authors.forename: D
authors.initials: D
authors.lastname: Mokart
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
authors.forename: D
authors.initials: D
authors.lastname: Schnell
authors.forename: A
authors.initials: A
authors.lastname: Bourmaud
authors.forename: A
authors.initials: A
authors.lastname: Kouatchet
authors.forename: F
authors.initials: F
authors.lastname: Pène
authors.forename: V
authors.initials: V
authors.lastname: Lemiale
authors.forename: J
authors.initials: J
authors.lastname: Lambert
authors.forename: F
authors.initials: F
authors.lastname: Bruneel
authors.forename: F
authors.initials: F
authors.lastname: Vincent
authors.forename: M
authors.initials: M
authors.lastname: Legrand
authors.forename: A
authors.initials: A
authors.lastname: Rabbat
authors.forename: M
authors.initials: M
authors.lastname: Darmon
mesh_terms: D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008126:Lod Score; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000401:mortality*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000150:complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D013256:Steroids