Influence of neutropenia on mortality of critically ill cancer patients : results of a meta-analysis on individual data
Georges, Quentin (Jean Monnet University, France)
Azoulay, Elie (Paris-Diderot University)
Mokart, Djamel (Institut Paoli Calmette)
Soares, Marcio (D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine, Rio de Janeiro)
Jeon, Kyeongman (Sungkyunkwan University School of Medicine, South Korea)
Oeyen, Sandra (Ghent University Hospital, Belgium)
Rhee, Chin Kook (The Catholic University of Korea)
Gruber, Pascale (Royal Marsden Hospital (Regne Unit))
Ostermann, Marlies (Guy's and St Thomas' NHS Foundation Trust (Regne Unit))
Hill, Quentin A. (Leeds Teaching Hospitals, Leeds, UK)
Depuydt, Pieter (Ghent University Hospital, Belgium)
Ferrá, Christelle (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Toffart, Anne-Claire (Grenoble Alpes University Hospital, Grenoble, France)
Schellongowski, Peter (Medical University of Vienna)
Müller, Alice (Universidade Federal do Rio Grande do Sul)
Lemiale, Virginie (Saint-Louis University Hospital, Paris, France)
Tinquaut, Fabien (Hygée Centre and Public Health Department, Lucien Neuwirth Cancerology Institute, Saint-Priest-en-Jarez, France)
Bourmaud, Aurélie (Hygée Centre and Public Health Department, Lucien Neuwirth Cancerology Institute, Saint-Priest-en-Jarez, France)
Darmon, Michaël (Saint-Etienne University Hospital, France)

Data:	2018
Resum:	The study objective was to assess the influence of neutropenia on outcome of critically ill cancer patients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on outcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission, need for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)). Data sources were PubMed and the Cochrane database. Study selection included articles focusing on critically ill cancer patients published in English and studies in humans from May 2005 to May 2015. For study selection, the study eligibility was assessed by two investigators. Individual data from selected studies were obtained from corresponding authors. Overall, 114 studies were identified and authors of 30 studies (26. 3% of selected studies) agreed to participate in this study. Of the 7515 included patients, three were excluded due to a missing major variable (neutropenia or mortality) leading to analysis of 7512 patients, including 1702 neutropenic patients (22. 6%). After adjustment for confounders, and taking study effect into account, neutropenia was independently associated with mortality (OR 1. 41; 95% CI 1. 23-1. 62; P = 0. 03). When analyzed separately, neither admission period, underlying malignancy nor need for mechanical ventilation modified the prognostic influence of neutropenia on outcome. However, among patients for whom data on G-CSF administration were available (n = 1949; 25. 9%), neutropenia was no longer associated with outcome in patients receiving G-CSF (OR 1. 03; 95% CI 0. 70-1. 51; P = 0. 90). Among 7512 critically ill cancer patients included in this systematic review, neutropenia was independently associated with poor outcome despite a meaningful survival. Neutropenia was no longer significantly associated with outcome in patients treated by G-CSF, which may suggest a beneficial effect of G-CSF in neutropenic critically ill cancer patients.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Prognosis ; Outcomes ; Hematologic ; Neoplasms ; Intensive care units ; Mechanical ventilation ; Neutropenia
Publicat a:	Critical Care, Vol. 22 (december 2018) , ISSN 1466-609X

DOI: 10.1186/s13054-018-2076-z
PMID: 30514339

10 p, 918.9 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP) > Institut de Recerca contra la Leucèmia Josep Carreras
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