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

Abstract

BackgroundThe 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)).MethodsData 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.ResultsOverall, 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).ConclusionAmong 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 registrationPROSPERO CRD42015026347. Date of registration: Sept 18 2015Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2076-z) contains supplementary material, which is available to authorized users.

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

“…In an unselected population of neutropenic critically ill patients, several recent studies failed to demonstrate any impact of neutropenia, neutropenia duration, or resolution of neutropenia on the outcome of critically ill cancer patients [1,43,44]. In a large meta-analysis, it was demonstrated in more than 1700 neutropenic critically ill patients that neutropenia was independently associated with poor outcome despite a meaningful survival [45]. Nevertheless, certain infections together with neutropenia are associated with extremely poor outcome or high mortality (e.g., Fusarium infection [46]).…”

Pretreatment C-reactive protein and neutrophil counts as a predictor of metastasis in patients with osteosarcoma

“…The role of neutrophils in cancer development remains controversial [34,35]. There have been few reports on the correlation between the NC and metastasis in osteosarcoma patients [36][37][38]. A pretreatment NC ≥6400/µL in osteosarcoma patients was reported to be associated with the 5-year lung metastasis-free survival (65% vs. 44%, in comparison with an NC <6400/µL).…”

“…Granulocyte-macrophage colony stimulating factor (GM-CSF) showed no detectable effect in recurrent pulmonary metastasis in osteosarcoma [36]. However, a meta-analysis of the in uence of neutropenia on cancer patients revealed that neutropenia in patients without Granulocyte colony stimulating factor (G-CSF) administration was independently associated with a poor outcome, compared with patients receiving G-CSF administration during chemotherapy [38]. Various stimuli in the tumor microenvironment have been reported to result in the differentiation of neutrophils into either an antitumor or pro-tumor phenotype [39].…”

Hubungan Rasio Neutrofil Limfosit dengan Mortalitas ≤28 hari di General Intensive Care Unit RSUP Dr. Mohammad Hoesin Palembang

“…Konsekuensi klinis neutropenia ini dapat menyebabkan gagal napas akut ataupun sepsis sehingga netropenia menjadi faktor risiko independen yang menyebabkan hasil yang buruk pada perawatan di ruang ICU. 16 Distribusi subjek berdasarkan limfosit terhadap mortalitas terdapat perbedaan rerata limfosit terhadap mortalitas. Penelitian tentang hitung jenis limfosit mendapatkan bahwa hitung limfosit yang rendah berhubungan dengan mortalitas yang lebih tinggi dan hasil akhir kejadian kardiovaskular yang buruk pada pasien dengan nyeri dada, penyakit jantung koroner stabil, angina pektoris tidak stabil dan gagal jantung kronik.…”