Worsening of respiratory status during neutropenia recovery in noncritically ill hematological patients: results of a prospective multicenter study.
BACKGROUND
Neutropenia recovery (NR) has been associated with worsening preexisting lung injury in up to 50% of critically ill cancer patients. However, only limited relevant data exist in the general population of hematological patients.


OBJECTIVE
To assess the incidence of acute respiratory deterioration during NR in patients with hematological malignancies.


METHODS
Adult patients with neutropenia expected to last more than 7 days were included. Worsening of respiratory status (WRS) was defined as a decrease in oxygen saturation of ≥5%, the need for oxygen therapy for ≥24 h, an increase in oxygen flow of ≥50% in patients previously treated with oxygen, or the need for mechanical ventilation. NR was defined as the 3 days preceding or following a neutrophil count of >0.5 × 109/l.


RESULTS
A total of 16 of 50 patients included in this pilot study experienced WRS during NR (32%), and 13 patients had WRS during neutropenia (26%). The incidence density of WRS was 0.53 (±0.79) episodes per 10 days during NR and 0.20 (±0.39) episodes per 10 days during neutropenia (p = 0.004). Sepsis, stem cell transplantation, preexisting pneumonia, or the use of granulocyte colony-stimulating factor were not associated with WRS during NR.


CONCLUSIONS
Up to one third of noncritically ill hematological patients with expected neutropenia of more than 7 days experience WRS during NR. Clinical consequences and risk factors for WRS during NR remain to be evaluated.
Department of Hematology, Lucien Neuwirth Oncology Institute, Saint-Priest-en-Jarrez,France.
Marie
M
Balsat
Alienor
A
Xhaard
Etienne
E
Lengline
Emmanuelle
E
Tavernier
Jérôme
J
Cornillon
Denis
D
Guyotat
Michael
M
Darmon
D055371:Acute Lung Injury / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000503:physiopathology*; D016017:Odds Ratio; D010865:Pilot Projects; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
D016179:Granulocyte Colony-Stimulating Factor