Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (Grrr-OH) study - 08/01/26
, Virginie Lemiale 1 , Matthieu Resche-Rigon 2 , Djamel Mokart 3, 17 , Frédéric Pène 4 , Achille Kouatchet 5 , Julien Mayaux 6 , François Vincent 7 , Martine Nyunga 8 , Fabrice Bruneel 9 , Antoine Rabbat 4 , Pierre Perez 10 , Anne-Pascale Meert 11 , Dominique Benoit 12 , Rebecca Hamidfar 13 , Michael Darmon 14 , Mercé Jourdain 15 , Anne Renault 16 , Benoît Schlemmer 1 , Elie Azoulay 1, 17
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Abstract |
Background |
Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology.
Methods |
This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders.
Results |
This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06–21.62); p < 0.005), use of invasive mechanical ventilation (OR 1.65 (95% CI 1.07–2.55); p = 0.02), a SOFA score > 7 (OR 3.32 (95% CI 2.15–5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71–5.07); p < 0.005).
Conclusions |
In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted.
ClinicalTrials.Gov NCT01172132
Le texte complet de cet article est disponible en PDF.Keywords : Acute respiratory failure, Hematological malignancies, Outcome, Etiologies, Bronchoalveolar lavage, Diagnostic strategy
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Vol 6 - N° 1
Article 102- 2016 Retour au numéro
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