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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data

Authors: Quentin Georges, Elie Azoulay, Djamel Mokart, Marcio Soares, Kyeongman Jeon, Sandra Oeyen, Chin Kook Rhee, Pascale Gruber, Marlies Ostermann, Quentin A. Hill, Pieter Depuydt, Christelle Ferra, Anne-Claire Toffart, Peter Schellongowski, Alice Müller, Virginie Lemiale, Fabien Tinquaut, Aurélie Bourmaud, Michaël Darmon

Published in: Critical Care | Issue 1/2018

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Abstract

Background

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)).

Methods

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.

Results

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).

Conclusion

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.

Systematic review registration

PROSPERO CRD42015026347. Date of registration: Sept 18 2015
Appendix
Available only for authorised users
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Metadata
Title
Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data
Authors
Quentin Georges
Elie Azoulay
Djamel Mokart
Marcio Soares
Kyeongman Jeon
Sandra Oeyen
Chin Kook Rhee
Pascale Gruber
Marlies Ostermann
Quentin A. Hill
Pieter Depuydt
Christelle Ferra
Anne-Claire Toffart
Peter Schellongowski
Alice Müller
Virginie Lemiale
Fabien Tinquaut
Aurélie Bourmaud
Michaël Darmon
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2076-z

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