key: cord-0013144-2bh0aji0
authors: Price, David R.; Hoffman, Katherine L.; Sanchez, Elizabeth; Choi, Augustine M. K.; Siempos, Ilias I.
title: Temporal trends of outcomes of neutropenic patients with ARDS enrolled in therapeutic clinical trials
date: 2020-10-09
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06263-4
sha: e37a289098fec71df3ce06aee99799dc218bc189
doc_id: 13144
cord_uid: 2bh0aji0

nan

Of 4333 subjects with ARDS enrolled in the trials, 204 (4.7%) had neutropenia. Detailed description of patients' characteristics and etiology of neutropenia is provided in Supplementary Tables 1 and 2. Enrollment of neutropenic subjects did not change over time (p = 0.28). The median white blood cell count at enrollment was 277 [interquartile range (IQR) 137-600] cell/µL among neutropenic compared to 11,300 (IQR 7200-15,970) cell/µL among non-neutropenic patients. The unadjusted analysis is shown in the Fig. 1 . After adjusting for variables previously shown to affect mortality of neutropenic patients (namely, age, baseline vasopressor requirement and renal dysfunction) [1] , the odds of 60-day mortality decreased by an estimate 8% [95% confidence intervals (CI) − 0.8 to 16%, p = 0.073] per year among neutropenic patients compared to 5.1% (95% CI 3.6-6.6%, p < 0.001) per year among non-neutropenic patients. This adjusted difference between neutropenic and non-neutropenic patients was significant (p < 0.001). Similarly, both ventilator-free days and ICU-free days increased more among neutropenic than non-neutropenic patients in the adjusted analysis (p < 0.001 for both) (Supplementary Table 3 ).

By analyzing patient-level data from 4333 patients with ARDS enrolled in six rigorous ARDSNet trials, we found that clinically relevant outcomes, such as mortality, ventilator-free days and ICU-free days, of neutropenic patients improved significantly more over the course of two decades compared to outcomes of non-neutropenic patients. Although limited by a highly selected (e.g., exclusion of stem cell transplant subjects) and relatively small number of neutropenic patients as well as by consideration of center-dependent outcomes 

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Neutropenia Status Non-Neutropenic Neutropenic

This study was prepared using ARMA, ALVEOLI, FACTT, ALTA, EDEN, and SAILS research materials obtained from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordination Center (BioLINCC). The manuscript does