title: Acute respiratory distress syndrome in patients with malignancies.
abstract: OBJECTIVE
  Little attention has been given to ARDS in cancer patients, despite their high risk for pulmonary complications. We sought to describe outcomes in cancer patients with ARDS meeting the Berlin definition.
  
  
  METHODS
  Data from a cohort of patients admitted to 14 ICUs between 1990 and 2011 were used for a multivariable analysis of risk factors for hospital mortality.
  
  
  RESULTS
  Of 1,004 included patients (86 % with hematological malignancies and 14 % with solid tumors), 444 (44.2 %) had neutropenia. Admission SOFA score was 12 (10-13). Etiological categories were primary infection-related ARDS (n = 662, 65.9 %; 385 bacterial infections, 213 invasive aspergillosis, 64 Pneumocystis pneumonia); extrapulmonary septic shock-related ARDS (n = 225, 22.4 %; 33 % candidemia); noninfectious ARDS (n = 76, 7.6 %); and undetermined cause (n = 41, 4.1 %). Of 387 (38.6 %) patients given noninvasive ventilation (NIV), 276 (71 %) subsequently required endotracheal ventilation. Hospital mortality was 64 % overall. According to the Berlin definition, 252 (25.1 %) patients had mild, 426 (42.4 %) moderate and 326 (32.5 %) severe ARDS; mortality was 59, 63 and 68.5 %, respectively (p = 0.06). Mortality dropped from 89 % in 1990-1995 to 52 % in 2006-2011 (p < 0.0001). Solid tumors, primary ARDS, and later admission period were associated with lower mortality. Risk factors for higher mortality were allogeneic bone-marrow transplantation, modified SOFA, NIV failure, severe ARDS, and invasive fungal infection.
  
  
  CONCLUSIONS
  In cancer patients, 90 % of ARDS cases are infection-related, including one-third due to invasive fungal infections. Mortality has decreased over time. NIV failure is associated with increased mortality. The high mortality associated with invasive fungal infections warrants specific studies of early treatment strategies.
authors.affiliation: Intensive Care Unit of the Saint-Louis University Hospital, Paris, France, elieazoulay.icm@sls.aphp.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.forename: Pierre
authors.initials: P
authors.lastname: Perez
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.forename: Dominique
authors.initials: D
authors.lastname: Benoit
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.forename: Martine
authors.initials: M
authors.lastname: Nyunga
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
mesh_terms: D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007938:Leukemia / Q000150:complications; D008171:Lung Diseases / Q000150:complications; D008223:Lymphoma / Q000150:complications; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors