EurRespir J. 2011 Dec 1. [Epubahead of print]
Prognosis of acute respiratory distress syndrome (ARDS) in neutropenic cancer patients.
Mokart D, van Craenenbroeck T, Lambert J, Textoris J, Brun JP, Sannini A, Chow-Chine L, Hamouda S, Fouché L, Ettori F, Faucher M, Blache JL.
Paoli-CalmetteInstitute, Marseille, France.
Up today, no study has been specifically designed to identify determinants of death neutropeniccancerpatients presenting ARDS. The aim of this study was to identify early predictive factors of 28-day mortality in these patients. Factors associated with 28-day mortality during ICU stay were also described.Seventy consecutive cancerpatients with ARDSand neutropeniawere prospectively analysedover a 6-year period.Mortality at 28-day was 63%. Factors independently associated with good prognosiswere: lobar ARDS(odds ratio 0.10, 95% CI: 0.02-0.48), use of initial antibiotic treatment active on difficult to treat bacteria (ticarcillin-resistantPseudomonasaeruginosa, Stenotrophomonasmaltophilia, or ESBL-producingstrains) (OR=0.08, 95% CI: 0.02-0.33) and first line chemotherapy (OR=0.08, 95% CI: 0.02-0.37). During the ICU stay, mortality was associated with the markers of organ dysfunctions, the absence of neutropeniarecovery and the use of vasopressors. During the first three weeks, the conditional probability of discharge alive from ICU did not decrease.At ICU admission, first line chemotherapy, lobar ARDSand antibiotic treatment active on DTTbacteria were associated with survival. During ICU stay, mortality was associated with organ dysfunctionsand use of vasopressors. Most survivors have an ICU stay longer than three weeks.