title: Antiphospholipid antibodies in critically ill patients with cancer: a prospective cohort study.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the prevalence and the prognostic impact of antiphospholipid antibodies (aPL) in critically ill cancer patients.
  
  
  METHODS
  This is a prospective cohort study in adult patients admitted to the intensive care unit for more than 48 hours at a cancer center. Clinical and laboratory data including coagulation parameters were obtained. Cox proportional hazard models were used to identify predictors of 6-month mortality.
  
  
  RESULTS
  Ninety-five (solid tumor, 79%; hematologic malignancies, 21%) patients were included, and aPL were identified in 74% of them. Median Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment scores were 51 (37-65) and 5 (2-8) points, respectively. The most frequent aPL were lupus anticoagulant (61%) and anti-β2 glicoprotein I (32%). Vascular complications occurred in 18% of patients and were comparable between aPL+ and aPL- patients. Sepsis and need for renal replacement therapy were more frequent in aPL+ patients. Hospital and 6-month mortality rates were 44% and 56%, respectively. Higher Sequential Organ Failure Assessment scores (each point) (hazard ratios [HR]=2.83 [95% confidence interval, 1.59-5.00]), medical admissions (HR=2.66 [1.34-5.27]), and d-dimer more than 500 ng/dL (HR=1.89 (1.04-3.44]) were independently associated with mortality. After adjusting for these covariates, aPL status was not associated with outcomes (HR=1.22 [0.60-2.47]).
  
  
  CONCLUSIONS
  Lupus anticoagulants were frequent in critically ill cancer patients. However, they were not associated with medium-term survival in these patients.
authors.affiliation: Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Vassalo
authors.affiliation: Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Spector
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Ernesto
authors.initials: E
authors.lastname: de Meis
authors.affiliation: Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Lígia S C F
authors.initials: LS
authors.lastname: Rabello
authors.affiliation: Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Maíra M
authors.initials: MM
authors.lastname: Rosolem
authors.affiliation: D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Pedro E A A
authors.initials: PE
authors.lastname: do Brasil
authors.affiliation: Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.affiliation: Postgraduate Program, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: marciosoaresms@gmail.com.
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
mesh_terms: D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000097:blood; D053482:beta 2-Glycoprotein I / Q000097:blood
chemical_list: D017152:Antibodies, Antiphospholipid; D005338:Fibrin Fibrinogen Degradation Products; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I; C036309:fibrin fragment D
keywords: Antiphospholipid antibodies; Cancer; Intensive care unit; Prognosis