title: Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors.
abstract: Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5-y period. We sought to identify prognostic factors of long-term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13-2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13-2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52-3.31) were associated with long-term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42-0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42-0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X-ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome.
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Lagier
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Platon
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Chow-Chine
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Sannini
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Bisbal
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Brun
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Blache
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Faucher
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Mokart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: ARDS: long-term outcome; ARDS: predictive factors; ARDS: severity; haematological malignancy