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Neurological failure in ICU patients with hematological malignancies : a prospective cohort study

(2017) PLOS ONE. 12(6).
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Abstract
Background : Epidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure. Methods : Post hoc analysis of a prospective study of adults with hematological malignancies admitted for any reason to one of 17 university or university-affiliated participating ICUs in France and Belgium (2010-2012). The primary outcome was vital status at hospital discharge. Results : Of the 1011 patients enrolled initially, 226 (22.4%) had neurological failure. Presenting manifestations were dominated by drowsiness or stupor (65%), coma (32%), weakness (26%), and seizures (19%). Neuroimaging, lumbar puncture, and electroencephalography were performed in 113 (50%), 73 (32%), and 63 (28%) patients, respectively. A neurosurgical biopsy was done in 1 patient. Hospital mortality was 50%. By multivariate analysis, factors independently associated with higher hospital mortality were poor performance status ( odds ratio [OR], 3.99; 95% CI, 1.82-9.39; P = 0.0009), non-Hodgkin's lymphoma ( OR, 2.60; 95% CI, 1.35-5.15; P = 0.005), shock ( OR, 1.95; 95% CI, 1.04-3.72; P = 0.04), and respiratory failure ( OR, 2.18; 95% CI, 1.140-4.25; P = 0.02); and factors independently associated with lower hospital mortality were GCS score on day 1 ( OR, 0.88/point; 95% CI, 0.81-0.95; P = 0.0009) and autologous stem cell transplantation ( OR, 0.25; 95% CI, 0.07-0.75; P = 0.02). Conclusions : In ICU patients with hematological malignancies, neurological failure is common and often fatal. Independent predictors of higher hospital mortality were type of underlying hematological malignancy, poor performance status, hemodynamic and respiratory failures, and severity of consciousness impairment. Knowledge of these risk factors might help to optimize management strategies.
Keywords
CRITICALLY-ILL PATIENTS, INTENSIVE-CARE-UNIT, NEUTROPENIC CANCER-PATIENTS, ACUTE RESPIRATORY-FAILURE, STATUS EPILEPTICUS, SEVERE SEPSIS, COMPLICATIONS, LYMPHOMA, SURVIVAL, PROGNOSIS

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MLA
Marzorati, Chiara, Djamel Mokart, Frederic Pène, et al. “Neurological Failure in ICU Patients with Hematological Malignancies : a Prospective Cohort Study.” PLOS ONE 12.6 (2017): n. pag. Print.
APA
Marzorati, C., Mokart, D., Pène, F., Lemiale, V., Kouatchet, A., Mayaux, J., Vincent, F., et al. (2017). Neurological failure in ICU patients with hematological malignancies : a prospective cohort study. PLOS ONE, 12(6).
Chicago author-date
Marzorati, Chiara, Djamel Mokart, Frederic Pène, Virginie Lemiale, Achille Kouatchet, Julien Mayaux, François Vincent, et al. 2017. “Neurological Failure in ICU Patients with Hematological Malignancies : a Prospective Cohort Study.” Plos One 12 (6).
Chicago author-date (all authors)
Marzorati, Chiara, Djamel Mokart, Frederic Pène, Virginie Lemiale, Achille Kouatchet, Julien Mayaux, François Vincent, Martine Nyunga, Fabrice Bruneel, Antoine Rabbat, Christine Lebert, Pierre Perez, Dominique Benoit, Giuseppe Citerio, Elie Azoulay, and Stephane Legriel. 2017. “Neurological Failure in ICU Patients with Hematological Malignancies : a Prospective Cohort Study.” Plos One 12 (6).
Vancouver
1.
Marzorati C, Mokart D, Pène F, Lemiale V, Kouatchet A, Mayaux J, et al. Neurological failure in ICU patients with hematological malignancies : a prospective cohort study. PLOS ONE. 2017;12(6).
IEEE
[1]
C. Marzorati et al., “Neurological failure in ICU patients with hematological malignancies : a prospective cohort study,” PLOS ONE, vol. 12, no. 6, 2017.
@article{8551921,
  abstract     = {Background : Epidemiological studies of neurological complications in patients with hematological malignancies are scant. The objective of the study was to identify determinants of survival in patients with hematological malignancy and neurological failure. 
Methods : Post hoc analysis of a prospective study of adults with hematological malignancies admitted for any reason to one of 17 university or university-affiliated participating ICUs in France and Belgium (2010-2012). The primary outcome was vital status at hospital discharge. 
Results : Of the 1011 patients enrolled initially, 226 (22.4%) had neurological failure. Presenting manifestations were dominated by drowsiness or stupor (65%), coma (32%), weakness (26%), and seizures (19%). Neuroimaging, lumbar puncture, and electroencephalography were performed in 113 (50%), 73 (32%), and 63 (28%) patients, respectively. A neurosurgical biopsy was done in 1 patient. Hospital mortality was 50%. By multivariate analysis, factors independently associated with higher hospital mortality were poor performance status ( odds ratio [OR], 3.99; 95% CI, 1.82-9.39; P = 0.0009), non-Hodgkin's lymphoma ( OR, 2.60; 95% CI, 1.35-5.15; P = 0.005), shock ( OR, 1.95; 95% CI, 1.04-3.72; P = 0.04), and respiratory failure ( OR, 2.18; 95% CI, 1.140-4.25; P = 0.02); and factors independently associated with lower hospital mortality were GCS score on day 1 ( OR, 0.88/point; 95% CI, 0.81-0.95; P = 0.0009) and autologous stem cell transplantation ( OR, 0.25; 95% CI, 0.07-0.75; P = 0.02). 
Conclusions : In ICU patients with hematological malignancies, neurological failure is common and often fatal. Independent predictors of higher hospital mortality were type of underlying hematological malignancy, poor performance status, hemodynamic and respiratory failures, and severity of consciousness impairment. Knowledge of these risk factors might help to optimize management strategies.},
  articleno    = {e0178824},
  author       = {Marzorati, Chiara and Mokart, Djamel and Pène, Frederic and Lemiale, Virginie and Kouatchet, Achille and Mayaux, Julien and Vincent, François and Nyunga, Martine and Bruneel, Fabrice and Rabbat, Antoine and Lebert, Christine and Perez, Pierre and Benoit, Dominique and Citerio, Giuseppe and Azoulay, Elie and Legriel, Stephane},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {CRITICALLY-ILL PATIENTS,INTENSIVE-CARE-UNIT,NEUTROPENIC CANCER-PATIENTS,ACUTE RESPIRATORY-FAILURE,STATUS EPILEPTICUS,SEVERE SEPSIS,COMPLICATIONS,LYMPHOMA,SURVIVAL,PROGNOSIS},
  language     = {und},
  number       = {6},
  pages        = {15},
  title        = {Neurological failure in ICU patients with hematological malignancies : a prospective cohort study},
  url          = {http://dx.doi.org/10.1371/journal.pone.0178824},
  volume       = {12},
  year         = {2017},
}

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