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Outcomes in adult critically Ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH)
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Abstract
Marie Bouteloup1,*, Sophie Perinel1,*, Aurélie Bourmaud2, Elie Azoulay3,4, Djamel Mokart5 and Michael Darmon1,6,7
1 Medical-Surgical ICU, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France
2 Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institut, Saint Priest en Jarez, France
3 Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
4 Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France
5 Anesthesiology and Intensive Care Unit, Institut Paoli Calmette, Marseille Cedex 9, France
6 Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Saint-Etienne, France
7 pour le Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH)
* These authors have contributed equally to this work
Correspondence to:
Michael DARMON, email:
Keywords: prognosis; outcomes; hematologic; neoplasms; intensive care units
Received: April 28, 2016 Accepted: September 14, 2016 Published: September 21, 2016
Abstract
PURPOSE: Whether neutropenia has an impact on the mortality of critically ill cancer patients remains controversial, yet it is widely used as an admission criterion and prognostic factor.
METHODS: Systematic review and meta-analysis. Studies on adult cancer patients and intensive care units were searched on PubMed and Cochrane databases (2005-2015). Summary estimates of mortality risk differences were calculated using the random-effects model.
RESULTS: Among the 1,528 citations identified, 38 studies reporting on 6,054 patients (2,097 neutropenic patients) were included. Median mortality across the studies was 54% [45-64], with unadjusted mortality in neutropenic and non-neutropenic critically ill patients of 60% [53-74] and 47% [41-68], respectively. Overall, neutropenia was associated with a 10% increased mortality risk (6%-14%; I² = 50%). The admission period was not associated with how neutropenia affected mortality. Mortality significantly dropped throughout the study decade [-11% (-13.5 to -8.4)]. This mortality drop was observed in non-neutropenic patients [-12.1% (-15.2 to -9.0)] but not in neutropenic patients [-3.8% (-8.1 to +5.6)].
Sensitivity analyses disclosed no differences in underlying malignancy, mechanical ventilation use, or Granulocyte-colony stimulating factor use. Seven studies allowed the adjustment of severity results (1,350 patients). Although pooled risk difference estimates were similar to non-adjusted results, there was no significant impact of neutropenia on mortality (risk difference of mortality, 9%; 95% CI, −15 to +33)
CONCLUSION: Although the unadjusted mortality of neutropenic patients was 11% higher, this effect disappeared when adjusted for severity. Therefore, when cancer patients become critically ill, neutropenia cannot be considered as a decision-making criterion.
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