Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study
| Autor: | Nelson Spector, Jorge I. F. Salluh, Ernesto de Meis, Maíra M. Rosolem, Ligia S.C.F. Rabello, Marcio Soares, Pedro Emmanuel Alvarenga Americano do Brasil, Juliana Vassalo |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Critical Illness medicine.medical_treatment Critical Care and Intensive Care Medicine law.invention Fibrin Fibrinogen Degradation Products immune system diseases law Neoplasms Sepsis Internal medicine Confidence Intervals medicine Humans Prospective Studies Renal replacement therapy Simplified Acute Physiology Score Prospective cohort study Aged Proportional Hazards Models Lupus anticoagulant business.industry Mortality rate Hazard ratio Cancer Middle Aged Prognosis medicine.disease Intensive care unit Surgery Renal Replacement Therapy Intensive Care Units beta 2-Glycoprotein I Hematologic Neoplasms Lupus Coagulation Inhibitor Antibodies Antiphospholipid Female business |
| Zdroj: | Journal of Critical Care. 29:533-538 |
| ISSN: | 0883-9441 |
| DOI: | 10.1016/j.jcrc.2014.02.005 |
| Popis: | Purpose: The purpose of this study is to evaluate the prevalence and the prognostic impact of antiphospholipid antibodies (aPL) in critically ill cancer patients. Methods: This is a prospective cohort study in adult patients admitted to the intensive care unit for more than 48 hours at a cancer center. Clinical and laboratory data including coagulation parameters were obtained. Cox proportional hazard models were used to identify predictors of 6-month mortality. Results: Ninety-five (solid tumor, 79%; hematologic malignancies, 21%) patients were included, and aPL were identified in 74% of them. Median Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment scores were 51 (37-65) and 5 (2-8) points, respectively. The most frequent aPL were lupus anticoagulant (61%) and anti-β2 glicoprotein I (32%). Vascular complications occurred in 18% of patients and were comparable between aPL+ and aPL− patients. Sepsis and need for renal replacement therapy were more frequent in aPL+patients. Hospital and 6-month mortality rates were 44% and 56%, respectively. Higher Sequential Organ Failure Assessment scores (each point) (hazard ratios [HR]=2.83 [95% confidence interval, 1.59-5.00]), medical admissions (HR=2.66 [1.34-5.27]), and D-dimer more than 500 ng/dL (HR=1.89 (1.04- 3.44]) were independently associated with mortality. After adjusting for these covariates, aPL status was not associated with outcomes (HR = 1.22 [0.60-2.47]). Conclusions: Lupus anticoagulants were frequent in critically ill cancer patients. However, they were not associated with medium-term survival in these patients. |
| Databáze: | OpenAIRE |
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