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Prognosis of neutropenic patients admitted to the intensive care unit

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Abstract

Purpose

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/mm3.

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).

Conclusion

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.

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Conflicts of interest

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Author information

Authors and Affiliations

  1. Saint-Louis Hospital, Paris, France

    M. Resche-Rigon, V. Lemiale, S. Chevret & E. Azoulay

  2. Cochin Hospital, Paris, France

    F. Pène

  3. Pitié-Salpétrière Hospital, Paris, France

    J. Mayaux

  4. Hôtel Dieu Hospital, Paris, France

    A. Rabbat

  5. Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille Cedex 09, France

    D. Mokart

  6. Centre Hospitalier Universitaire Hospital, Angers, France

    A. Kouatchet

  7. Avicenne Hospital, Bobigny, France

    F. Vincent

  8. Victor Provo Hospital, Roubaix, France

    M. Nyunga

  9. Mignot Hospital, Versailles, France

    F. Bruneel

  10. Montaigu Hospital, La Roche Sur Yon, France

    C. Lebert

  11. Brabois Hospital, Nancy, France

    P. Perez

  12. Brest Hospital, Brest, France

    A. Renault

  13. Albert Michallon Hospital, Grenoble, France

    R. Hamidfar

  14. Salengro Hospital, Lille, France

    M. Jourdain

  15. Nord Hospital, Saint-Etienne, France

    M. Darmon

  16. Institut Jules Bordet, Brussels, Belgium

    A.-P. Meert

  17. Ghent University Hospital, Ghent, Belgium

    D. Benoit

Authors
  1. D. Mokart
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  2. M. Darmon
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  18. D. Benoit
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  19. S. Chevret
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  20. E. Azoulay
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Corresponding author

Correspondence to D. Mokart.

Additional information

A study from the Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GRRROH), Paris, France (http://www.grrroh.com).

Take-home message: Hospital survival is closely associated with younger age and with neutropenic enterocolitis. Need for conventional MV, for renal replacement therapy, and allogeneic HSCT were associated with poor outcome.

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Mokart, D., Darmon, M., Resche-Rigon, M. et al. Prognosis of neutropenic patients admitted to the intensive care unit. Intensive Care Med 41, 296–303 (2015). https://doi.org/10.1007/s00134-014-3615-y

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  • DOI: https://doi.org/10.1007/s00134-014-3615-y

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