Acute respiratory failure in immunocompromised patients: outcome and clinical features according to neutropenia status - 08/01/26
, Michael Darmon 2, Peter Schellongowski 3, Peter Pickkers 4, Marcio Soares 5, Jordi Rello 6, 7, 8, Philippe R. Bauer 9, Andry van de Louw 10, Virginie Lemiale 2, Fabio Silvio Taccone 11, Ignacio Martin-Loeches 12, 13, Jorge Salluh 5, Katerina Rusinova 14, Sangeeta Mehta 15, Massimo Antonelli 16, Achille Kouatchet 17, Andreas Barratt-Due 18, Miia Valkonen 19, Precious Pearl Landburg 20, Ramin Brandt Bukan 21, Frédéric Pène 22, Victoria Metaxa 23, Gaston Burghi 24, Colombe Saillard 1, Lene B. Nielsen 25, 26, Emmanuel Canet 27, Magali Bisbal 1, Elie Azoulay 2for the Efraim investigators and the Nine-I study group
for the Efraim investigators and the Nine-I study group
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Abstract |
Background |
The impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia.
Methods |
We performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort.
Results |
Overall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%; p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93–2.11). Similar results were observed after matching (52% vs 46%, respectively; p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63–1.72).
Conclusion |
Neutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections.
Le texte complet de cet article est disponible en PDF.Keywords : Medical and Health Sciences, Clinical Sciences
Plan
Vol 10 - N° 1
Article 146- 2020 Retour au numéro
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