• Djamel Mokart, Michael Darmon, Peter Schellongowski, Peter Pickkers, Marcio Soares, Jordi Rello, Philippe R Bauer, Andry van de Louw, Virginie Lemiale, Fabio Silvio Taccone, Ignacio Martin-Loeches, Jorge Salluh, Katerina Rusinova, Sangeeta Mehta, Massimo Antonelli, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Precious Pearl Landburg, Ramin Brandt Bukan, Frédéric Pène, Victoria Metaxa, Gaston Burghi, Colombe Saillard, Lene B Nielsen, Emmanuel Canet, Magali Bisbal, Elie Azoulay, and Efraim investigators and the Nine-I study group.
• Réanimation Polyvalente Et Département D'Anesthésie Et de Réanimation, Institut Paoli-Calmettes, 232 Bd Sainte Marguerite 13009, Marseille Cedex 09, France. mokartd@ipc.unicancer.fr.
• Ann Intensive Care. 2020 Oct 22; 10 (1): 146.

BackgroundThe impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia.MethodsWe performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort.ResultsOverall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%; p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93-2.11). Similar results were observed after matching (52% vs 46%, respectively; p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63-1.72).ConclusionNeutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections.

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