Intensive Care Medicine

, Volume 40, Issue 8, pp 1106–1114

Acute respiratory distress syndrome in patients with malignancies

  • Elie Azoulay
  • Virginie Lemiale
  • Djamel Mokart
  • Frédéric Pène
  • Achille Kouatchet
  • Pierre Perez
  • François Vincent
  • Julien Mayaux
  • Dominique Benoit
  • Fabrice Bruneel
  • Anne-Pascale Meert
  • Martine Nyunga
  • Antoine Rabbat
  • Michael Darmon
Original

DOI: 10.1007/s00134-014-3354-0

Cite this article as:
Azoulay, E., Lemiale, V., Mokart, D. et al. Intensive Care Med (2014) 40: 1106. doi:10.1007/s00134-014-3354-0

Abstract

Purpose

Little attention has been given to ARDS in cancer patients, despite their high risk for pulmonary complications. We sought to describe outcomes in cancer patients with ARDS meeting the Berlin definition.

Methods

Data from a cohort of patients admitted to 14 ICUs between 1990 and 2011 were used for a multivariable analysis of risk factors for hospital mortality.

Results

Of 1,004 included patients (86 % with hematological malignancies and 14 % with solid tumors), 444 (44.2 %) had neutropenia. Admission SOFA score was 12 (10–13). Etiological categories were primary infection-related ARDS (n = 662, 65.9 %; 385 bacterial infections, 213 invasive aspergillosis, 64 Pneumocystis pneumonia); extrapulmonary septic shock-related ARDS (n = 225, 22.4 %; 33 % candidemia); noninfectious ARDS (n = 76, 7.6 %); and undetermined cause (n = 41, 4.1 %). Of 387 (38.6 %) patients given noninvasive ventilation (NIV), 276 (71 %) subsequently required endotracheal ventilation. Hospital mortality was 64 % overall. According to the Berlin definition, 252 (25.1 %) patients had mild, 426 (42.4 %) moderate and 326 (32.5 %) severe ARDS; mortality was 59, 63 and 68.5 %, respectively (p = 0.06). Mortality dropped from 89 % in 1990–1995 to 52 % in 2006–2011 (p < 0.0001). Solid tumors, primary ARDS, and later admission period were associated with lower mortality. Risk factors for higher mortality were allogeneic bone-marrow transplantation, modified SOFA, NIV failure, severe ARDS, and invasive fungal infection.

Conclusions

In cancer patients, 90 % of ARDS cases are infection-related, including one-third due to invasive fungal infections. Mortality has decreased over time. NIV failure is associated with increased mortality. The high mortality associated with invasive fungal infections warrants specific studies of early treatment strategies.

Keywords

NeutropeniaBronchoscopyPneumoniaInvasive aspergillosisCandidemiaPneumocystis

Supplementary material

134_2014_3354_MOESM1_ESM.docx (723 kb)
Supplementary material 1 (DOCX 722 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Elie Azoulay
    • 1
    • 13
  • Virginie Lemiale
    • 1
  • Djamel Mokart
    • 2
  • Frédéric Pène
    • 3
  • Achille Kouatchet
    • 4
  • Pierre Perez
    • 5
  • François Vincent
    • 6
  • Julien Mayaux
    • 7
  • Dominique Benoit
    • 8
  • Fabrice Bruneel
    • 9
  • Anne-Pascale Meert
    • 10
  • Martine Nyunga
    • 11
  • Antoine Rabbat
    • 3
  • Michael Darmon
    • 12
  1. 1.Intensive Care Unit of the Saint-Louis University HospitalParisFrance
  2. 2.Intensive Care Unit of Institut Paoli CalmetteMarseilleFrance
  3. 3.Intensive Care Unit of Cochin University HospitalParisFrance
  4. 4.Intensive Care Unit of Angers University HospitalAngersFrance
  5. 5.Intensive Care Unit of Nancy University HospitalNancyFrance
  6. 6.Intensive Care Unit of Bobigny University HospitalBobignyFrance
  7. 7.Intensive Care Unit of Pitié-Salpêtrière University HospitalParisFrance
  8. 8.Intensive Care Unit of Ghent University HospitalGhentBelgium
  9. 9.Intensive Care Unit of Versailles HospitalVersaillesFrance
  10. 10.Intensive Care Unit of Brussels University HospitalBrusselsBelgium
  11. 11.Intensive Care Unit of Roubaix HospitalRoubaixFrance
  12. 12.Intensive Care Unit of Saint-Etienne Teaching HospitalSaint-ÉtienneFrance
  13. 13.Sorbonne Paris-Cité, Medical School, AP-HP, Hôpital Saint-Louis, Medical ICUParis-Diderot UniversityParisFrance