title: Prognosis of neutropenic patients admitted to the intensive care unit.
abstract: OBJECTIVE
  The prognosis of critically ill cancer patients has improved recently. Controversies remain as regard to the specific prognosis impact of neutropenia in critically ill cancer patients. The primary objective of this study was to assess hospital outcome of critically ill neutropenic cancer patients admitted into the ICU. The secondary objective was to assess risk factors for unfavorable outcome in this population of patients and specific impact of neutropenia.
  
  
  METHODS
  We performed a post hoc analysis of a prospectively collected database. The study was carried out in 17 university or university-affiliated centers in France and Belgium. Neutropenia was defined as a neutrophil count lower than 500/mm(3).
  
  
  RESULTS
  Among the 1,011 patients admitted into the ICU during the study period 289 were neutropenic at the time of admission. Overall, 131 patients died during their hospital stay (hospital mortality 45.3 %). Four variables were associated with a poor outcome, namely allogeneic transplantation (OR 3.83; 95 % CI 1.75-8.35), need for mechanical ventilation (MV) (OR 6.57; 95 % CI 3.51-12.32), microbiological documentation (OR 2.33; CI 1.27-4.26), and need for renal replacement therapy (OR 2.77; 95 % CI 1.34-5.74). Two variables were associated with hospital survival, namely age younger than 70 (OR 0.22; 95 % CI 0.1-0.52) and neutropenic enterocolitis (OR 0.37; 95 % CI 0.15-0.9). A case-control analysis was also performed with patients of the initial database; after adjustment, neutropenia was not associated with hospital mortality (OR 1.27; 95 % CI 0.86-1.89).
  
  
  CONCLUSIONS
  Hospital survival was closely associated with younger age and neutropenic enterocolitis. Conversely, need for conventional MV, for renal replacement therapy, and allogeneic hematopoietic stem cell transplantation (HSCT) were associated with poor outcome.
authors.affiliation: Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille Cedex 09, France, mokartd@ipc.unicancer.fr.
authors.forename: D
authors.initials: D
authors.lastname: Mokart
authors.forename: M
authors.initials: M
authors.lastname: Darmon
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authors.initials: M
authors.lastname: Resche-Rigon
authors.forename: V
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authors.lastname: Lemiale
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authors.lastname: Pène
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authors.lastname: Mayaux
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authors.lastname: Vincent
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authors.lastname: Nyunga
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authors.lastname: Bruneel
authors.forename: C
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authors.lastname: Lebert
authors.forename: P
authors.initials: P
authors.lastname: Perez
authors.forename: A
authors.initials: A
authors.lastname: Renault
authors.forename: R
authors.initials: R
authors.lastname: Hamidfar
authors.forename: M
authors.initials: M
authors.lastname: Jourdain
authors.forename: A-P
authors.initials: AP
authors.lastname: Meert
authors.forename: D
authors.initials: D
authors.lastname: Benoit
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authors.lastname: Chevret
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authors.lastname: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000150:complications / Q000196:embryology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors