title: Outcomes in adult critically ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH).
abstract: OBJECTIVE
  Whether neutropenia has an impact on the mortality of critically ill cancer patients remains controversial, yet it is widely used as an admission criterion and prognostic factor.
  
  
  METHODS
  Systematic review and meta-analysis. Studies on adult cancer patients and intensive care units were searched on PubMed and Cochrane databases (2005-2015). Summary estimates of mortality risk differences were calculated using the random-effects model.
  
  
  RESULTS
  Among the 1,528 citations identified, 38 studies reporting on 6,054 patients (2,097 neutropenic patients) were included. Median mortality across the studies was 54% [45-64], with unadjusted mortality in neutropenic and non-neutropenic critically ill patients of 60% [53-74] and 47% [41-68], respectively. Overall, neutropenia was associated with a 10% increased mortality risk (6%-14%; I² = 50%). The admission period was not associated with how neutropenia affected mortality. Mortality significantly dropped throughout the study decade [-11% (-13.5 to -8.4)]. This mortality drop was observed in non-neutropenic patients [-12.1% (-15.2 to -9.0)] but not in neutropenic patients [-3.8% (-8.1 to +5.6)].Sensitivity analyses disclosed no differences in underlying malignancy, mechanical ventilation use, or Granulocyte-colony stimulating factor use. Seven studies allowed the adjustment of severity results (1,350 patients). Although pooled risk difference estimates were similar to non-adjusted results, there was no significant impact of neutropenia on mortality (risk difference of mortality, 9%; 95% CI, -15 to +33).
  
  
  CONCLUSIONS
  Although the unadjusted mortality of neutropenic patients was 11% higher, this effect disappeared when adjusted for severity. Therefore, when cancer patients become critically ill, neutropenia cannot be considered as a decision-making criterion.
authors.affiliation: Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bouteloup
authors.affiliation: Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Perinel
authors.affiliation: Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bourmaud
authors.affiliation: Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France.|Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Anesthesiology and Intensive Care Unit, Institut Paoli Calmette, Marseille Cedex 9, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mokart
authors.affiliation: Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France.|Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Saint-Etienne, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D009503:Neutropenia / Q000401:mortality* / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor
keywords: hematologic; intensive care units; neoplasms; outcomes; prognosis