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Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study

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Abstract
Background: Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. Methods: This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders. Results: This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06-21.62); p < 0.005), use of invasive mechanical ventilation (OR 1.65 (95% CI 1.07-2.55); p = 0.02), a SOFA score > 7 (OR 3.32 (95% CI 2.15-5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71-5.07); p < 0.005). Conclusions: In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted.
Keywords
Acute respiratory failure, Hematological malignancies, Outcome, Etiologies, Bronchoalveolar lavage, Diagnostic strategy, ACUTE MYELOID-LEUKEMIA, PROSPECTIVE MULTICENTER DATA, STEM-CELL TRANSPLANTATION, CRITICALLY-ILL PATIENTS, INTENSIVE-CARE-UNIT, CANCER-PATIENTS, NEUTROPENIC PATIENTS, DIAGNOSTIC STRATEGY, FUNGAL-INFECTIONS, SEPTIC SHOCK

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MLA
Contejean, Adrien et al. “Increased Mortality in Hematological Malignancy Patients with Acute Respiratory Failure from Undetermined Etiology : a Groupe De Recherche En Réanimation Respiratoire En Onco-Hématologique (Grrr-OH) Study.” ANNALS OF INTENSIVE CARE 6 (2016): n. pag. Print.
APA
Contejean, A., Lemiale, V., Resche-Rigon, M., Mokart, D., Pène, F., Kouatchet, A., Mayaux, J., et al. (2016). Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. ANNALS OF INTENSIVE CARE, 6.
Chicago author-date
Contejean, Adrien, Virginie Lemiale, Matthieu Resche-Rigon, Djamel Mokart, Frédéric Pène, Achille Kouatchet, Julien Mayaux, et al. 2016. “Increased Mortality in Hematological Malignancy Patients with Acute Respiratory Failure from Undetermined Etiology : a Groupe De Recherche En Réanimation Respiratoire En Onco-Hématologique (Grrr-OH) Study.” Annals of Intensive Care 6.
Chicago author-date (all authors)
Contejean, Adrien, Virginie Lemiale, Matthieu Resche-Rigon, Djamel Mokart, Frédéric Pène, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Pierre Perez, Anne-Pascale Meert, Dominique Benoit, Rebecca Hamidfar, Michael Darmon, Mercé Jourdain, Anne Renault, Benoît Schlemmer, and Elie Azoulay. 2016. “Increased Mortality in Hematological Malignancy Patients with Acute Respiratory Failure from Undetermined Etiology : a Groupe De Recherche En Réanimation Respiratoire En Onco-Hématologique (Grrr-OH) Study.” Annals of Intensive Care 6.
Vancouver
1.
Contejean A, Lemiale V, Resche-Rigon M, Mokart D, Pène F, Kouatchet A, et al. Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. ANNALS OF INTENSIVE CARE. 2016;6.
IEEE
[1]
A. Contejean et al., “Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study,” ANNALS OF INTENSIVE CARE, vol. 6, 2016.
@article{8519175,
  abstract     = {Background: Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. 
Methods: This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders. 
Results: This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06-21.62); p < 0.005), use of invasive mechanical ventilation (OR 1.65 (95% CI 1.07-2.55); p = 0.02), a SOFA score > 7 (OR 3.32 (95% CI 2.15-5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71-5.07); p < 0.005). 
Conclusions: In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted.},
  articleno    = {102},
  author       = {Contejean, Adrien and Lemiale, Virginie and Resche-Rigon, Matthieu and Mokart, Djamel and Pène, Frédéric and Kouatchet, Achille and Mayaux, Julien and Vincent, François and Nyunga, Martine and Bruneel, Fabrice and Rabbat, Antoine and Perez, Pierre and Meert, Anne-Pascale and Benoit, Dominique and Hamidfar, Rebecca and Darmon, Michael and Jourdain, Mercé and Renault, Anne and Schlemmer, Benoît and Azoulay, Elie},
  issn         = {2110-5820},
  journal      = {ANNALS OF INTENSIVE CARE},
  keywords     = {Acute respiratory failure,Hematological malignancies,Outcome,Etiologies,Bronchoalveolar lavage,Diagnostic strategy,ACUTE MYELOID-LEUKEMIA,PROSPECTIVE MULTICENTER DATA,STEM-CELL TRANSPLANTATION,CRITICALLY-ILL PATIENTS,INTENSIVE-CARE-UNIT,CANCER-PATIENTS,NEUTROPENIC PATIENTS,DIAGNOSTIC STRATEGY,FUNGAL-INFECTIONS,SEPTIC SHOCK},
  language     = {eng},
  pages        = {9},
  title        = {Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study},
  volume       = {6},
  year         = {2016},
}

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