Abstract
Up today, no study has been specifically designed to identify determinants of death neutropenic cancer patients 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 cancer patients with ARDS and neutropenia were prospectively analysed over a 6-year period.
Mortality at 28-day was 63%. Factors independently associated with good prognosis were: lobar ARDS (odds ratio 0.10, 95% CI: 0.02–0.48), use of initial antibiotic treatment active on difficult to treat bacteria (ticarcillin-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or ESBL-producing strains) (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 neutropenia recovery 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 ARDS and antibiotic treatment active on DTT bacteria were associated with survival. During ICU stay, mortality was associated with organ dysfunctions and use of vasopressors. Most survivors have an ICU stay longer than three weeks.
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