Skip to main content
Top
Published in: Supportive Care in Cancer 4/2003

01-04-2003 | Original Article

Leucopenia is an independent predictor in cancer patients requiring invasive mechanical ventilation: a prognostic factor analysis in a series of 168 patients

Authors: F. Vallot, M. Paesmans, T. Berghmans, J. P. Sculier

Published in: Supportive Care in Cancer | Issue 4/2003

Login to get access

Abstract

Objective

To determine prognostic factors predicting success of invasive mechanical ventilation in medical cancer patients admitted to ICU for a complication, in terms of extubation and ICU and hospital discharges.

Design

Retrospective study

Setting

Medical ICU of an European cancer hospital.

Subjects

A total of 168 consecutive cancer patients who were admitted to ICU for an acute medical complication requiring immediate mechanical ventilation or who later needed mechanical ventilation.

Measurements

Variables related to the demographic, cancer, scores and complication characteristics. Extubation rates, ICU and hospital mortalities and duration of survival were measured.

Results

Respectively, 26%, 22% and 17% of the patients were extubated, discharged from the ICU and discharged from hospital. For weaning from mechanical ventilation, a higher APACHE II score and leucopenia were poor prognostic factors in univariate analysis, but leucopenia remained the only significant one in multivariate analysis. For ICU mortality, no significant prognostic feature was identified. For hospital mortality, leucopenia was the only significant factor in univariate as well as in multivariate analyses.

Conclusion

Leucopenia appeared to be the only independent poor prognostic factor for both extubation and hospital discharge. None of the variables related to the cancer disease process was shown to be a predictor of success.
Literature
1.
go back to reference Sculier JP (1995) Intensive care and oncology. Support Care Cancer 3:93–105PubMed Sculier JP (1995) Intensive care and oncology. Support Care Cancer 3:93–105PubMed
2.
go back to reference Sculier JP, Berghmans T, Lemaitre F, Vallot F (2001) La ventilation artificielle chez les patients atteints de cancer. Rev Mal Respir 18:137–154PubMed Sculier JP, Berghmans T, Lemaitre F, Vallot F (2001) La ventilation artificielle chez les patients atteints de cancer. Rev Mal Respir 18:137–154PubMed
3.
go back to reference Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand J P, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401PubMed Azoulay E, Recher C, Alberti C, Soufir L, Leleu G, Le Gall JR, Fermand J P, Schlemmer B (1999) Changing use of intensive care for hematological patients: the example of multiple myeloma. Intensive Care Med 25:1395–1401PubMed
4.
go back to reference Sculier JP, Paesmans M, Markiewicz E, Berghmans T (2000) Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 28:2786–2792 Sculier JP, Paesmans M, Markiewicz E, Berghmans T (2000) Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 28:2786–2792
5.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed
6.
go back to reference Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMed Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMed
7.
go back to reference Haines IE, Zalcberg J, Buchanan JD (1990) Not-for-resuscitation orders in cancer patients—principles of decision-making. Med J Aust 153:225–229PubMed Haines IE, Zalcberg J, Buchanan JD (1990) Not-for-resuscitation orders in cancer patients—principles of decision-making. Med J Aust 153:225–229PubMed
8.
go back to reference Kaplan E, Meier P (1978) Non-parametric estimation for incomplete observations. Am Stat Assoc J 53:457–481 Kaplan E, Meier P (1978) Non-parametric estimation for incomplete observations. Am Stat Assoc J 53:457–481
9.
go back to reference Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York
10.
go back to reference Cox DR, Oakes D (1984) Analysis of survival data. Chapman and Hall, London Cox DR, Oakes D (1984) Analysis of survival data. Chapman and Hall, London
11.
go back to reference Snow RM, Miller WC, Rice DL, Ali MK (1979) Respiratory failure in cancer patients. JAMA 241:2039–2042PubMed Snow RM, Miller WC, Rice DL, Ali MK (1979) Respiratory failure in cancer patients. JAMA 241:2039–2042PubMed
12.
go back to reference Dees A, Ligthart JL, van Putten WL, Planting AS, Stoter G (1990) Mechanical ventilation in cancer patients. Analysis of clinical data and outcome. Neth J Med 37:183–188PubMed Dees A, Ligthart JL, van Putten WL, Planting AS, Stoter G (1990) Mechanical ventilation in cancer patients. Analysis of clinical data and outcome. Neth J Med 37:183–188PubMed
13.
go back to reference Kongsgaard UE, Meidell NK (1999) Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources. Support Care Cancer 7:95–99CrossRef Kongsgaard UE, Meidell NK (1999) Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources. Support Care Cancer 7:95–99CrossRef
14.
go back to reference Groeger JS, White P Jr, Nierman DM, Glassman J, Shi W, Horak D, Price K (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17:991–997 Groeger JS, White P Jr, Nierman DM, Glassman J, Shi W, Horak D, Price K (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17:991–997
15.
go back to reference Hauser MJ, Tabak J, Baier H (1982) Survival of patients with cancer in a medical critical care unit. Arch Int Med 142:527–529 Hauser MJ, Tabak J, Baier H (1982) Survival of patients with cancer in a medical critical care unit. Arch Int Med 142:527–529
16.
go back to reference Cox SC, Norwood SH, Duncan CA (1985) Acute respiratory failure: mortality associated with underlying disease. Crit Care Med 13:1005–1008 Cox SC, Norwood SH, Duncan CA (1985) Acute respiratory failure: mortality associated with underlying disease. Crit Care Med 13:1005–1008
17.
go back to reference Schapira DV, Studnicki J, Bradham DD, Wolff P, Jarrett A (1993) Intensive care, survival, and expense of treating critically ill cancer patients. JAMA 269:783–786PubMed Schapira DV, Studnicki J, Bradham DD, Wolff P, Jarrett A (1993) Intensive care, survival, and expense of treating critically ill cancer patients. JAMA 269:783–786PubMed
18.
go back to reference Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770PubMed Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770PubMed
19.
go back to reference Afessa B, Tefferi A, Hoagland HC, Letendre L, Peters SG (1992) Outcome of recipients of bone marrow transplants who require intensive-care unit support. Mayo Clin Proc 67:117–122PubMed Afessa B, Tefferi A, Hoagland HC, Letendre L, Peters SG (1992) Outcome of recipients of bone marrow transplants who require intensive-care unit support. Mayo Clin Proc 67:117–122PubMed
20.
go back to reference Paz HL, Crilley P, Weinar M, Brodsky I (1993) Outcome of patients requiring medical ICU admission following bone marrow transplantation. Chest 104:527–531PubMed Paz HL, Crilley P, Weinar M, Brodsky I (1993) Outcome of patients requiring medical ICU admission following bone marrow transplantation. Chest 104:527–531PubMed
21.
go back to reference Paz HL, Garland A, Weinar M, Crilley P, Brodsky I (1998) Effect of clinical outcomes data on intensive care unit utilization by bone marrow transplant patients. Crit Care Med 26:66–70 Paz HL, Garland A, Weinar M, Crilley P, Brodsky I (1998) Effect of clinical outcomes data on intensive care unit utilization by bone marrow transplant patients. Crit Care Med 26:66–70
22.
go back to reference Huaringa AJ, Leyva FJ, Giralt SA, Blanco J, Signes-Costa J, Velarde H, Champlin RE (2000) Outcome of bone marrow transplantation patients requiring mechanical ventilation [In Process Citation]. Crit Care Med 28:1014–1017 Huaringa AJ, Leyva FJ, Giralt SA, Blanco J, Signes-Costa J, Velarde H, Champlin RE (2000) Outcome of bone marrow transplantation patients requiring mechanical ventilation [In Process Citation]. Crit Care Med 28:1014–1017
23.
go back to reference Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328 Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328
24.
go back to reference Boussat S, El'rini T, Dubiez A, Depierre A, Barale F, Capellier G (2000) Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Med 26:1811–1816CrossRefPubMed Boussat S, El'rini T, Dubiez A, Depierre A, Barale F, Capellier G (2000) Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Med 26:1811–1816CrossRefPubMed
25.
go back to reference Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall JR, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823CrossRefPubMed Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall JR, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823CrossRefPubMed
26.
go back to reference Crawford SW, Petersen FB (1992) Long-term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 145:510–514PubMed Crawford SW, Petersen FB (1992) Long-term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 145:510–514PubMed
27.
go back to reference Blot F, Guiguet M, Antoun S, Leclercq B, Nitenberg G, Escudier B (1995) Early Tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study. Support Care Cancer 3:291–296PubMed Blot F, Guiguet M, Antoun S, Leclercq B, Nitenberg G, Escudier B (1995) Early Tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study. Support Care Cancer 3:291–296PubMed
28.
go back to reference Blot F, Nitenberg G, Guiguet M, Casetta M, Antoun S, Pico JL, Leclercq B, Escudier B (1995) Safety of tracheotomy in neutropenic patients: a retrospective study of 26 consecutive cases. Intensive Care Med 21:687–690PubMed Blot F, Nitenberg G, Guiguet M, Casetta M, Antoun S, Pico JL, Leclercq B, Escudier B (1995) Safety of tracheotomy in neutropenic patients: a retrospective study of 26 consecutive cases. Intensive Care Med 21:687–690PubMed
29.
go back to reference Pettila V, Takkunen O, Varpula T, Markkola A, Porkka K, Valtonen V (2000) Safety of granulocyte colony-stimulating factor (filgrastim) in intubated patients in the intensive care unit: interim analysis of a prospective, placebo-controlled, double-blind study. Crit Care Med 28:3620–3625PubMed Pettila V, Takkunen O, Varpula T, Markkola A, Porkka K, Valtonen V (2000) Safety of granulocyte colony-stimulating factor (filgrastim) in intubated patients in the intensive care unit: interim analysis of a prospective, placebo-controlled, double-blind study. Crit Care Med 28:3620–3625PubMed
30.
go back to reference Conti G, Marino P, Cogliati A, Dell'Utri D, Lappa A, Rosa G, Gasparetto A (1998) Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study. Intensive Care Med 24:1283–1288PubMed Conti G, Marino P, Cogliati A, Dell'Utri D, Lappa A, Rosa G, Gasparetto A (1998) Noninvasive ventilation for the treatment of acute respiratory failure in patients with hematologic malignancies: a pilot study. Intensive Care Med 24:1283–1288PubMed
31.
go back to reference Hilbert G, Gruson D, Vargas F, Valentino R, Chene G, Boiron JM, Pigneux A, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (2000) Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission. Crit Care Med 28:3185–3190 Hilbert G, Gruson D, Vargas F, Valentino R, Chene G, Boiron JM, Pigneux A, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (2000) Noninvasive continuous positive airway pressure in neutropenic patients with acute respiratory failure requiring intensive care unit admission. Crit Care Med 28:3185–3190
32.
go back to reference Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525 Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525
33.
go back to reference Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMed Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMed
Metadata
Title
Leucopenia is an independent predictor in cancer patients requiring invasive mechanical ventilation: a prognostic factor analysis in a series of 168 patients
Authors
F. Vallot
M. Paesmans
T. Berghmans
J. P. Sculier
Publication date
01-04-2003
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 4/2003
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-002-0436-2

Other articles of this Issue 4/2003

Supportive Care in Cancer 4/2003 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine