Acute respiratory failure in immunocompromised patients: outcome and clinical features according to neutropenia status

Massimo Antonelli, Mokart 1 Djamel, Darmon 2 Michael, Schellongowski 3 Peter, Pickkers 4 Peter, Soares 5 Marcio, Rello 6 7 8 Jordi, R Bauer 9 Philippe, van de Louw 10 Andry, Lemiale 2 Virginie, Silvio Taccone 11 Fabio, Martin-Loeches 12 13 Ignacio, Salluh 5 Jorge, Rusinova 14 Katerina, Mehta 15 Sangeeta, Kouatchet 17 Achille, Barratt-Due 18 Andreas, Valkonen 19 Miia, Pearl Landburg 20 Precious, Brandt Bukan 21 RaminPène 22 Frédéric, Metaxa 23 Victoria, Burghi 24 Gaston, Saillard 25 Colombe, B Nielsen 26 27 Lene, Canet 28 Emmanuel, Bisbal 25 Magali, Azoulay 2 Elie

Research output: Contribution to journalMeeting Abstract

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.
Original languageEnglish
Pages (from-to)---
JournalAnnals of Intensive Care
Publication statusPublished - 2020

Keywords

  • Acute respiratory failure, immunocompromised

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