Impact of neutropenia on the outcomes of critically ill patients with cancer: a matched case-control study.

BACKGROUND: The prognostic effect of neutropenia in cancer patients admitted to intensive care units (ICUs) was addressed exclusively in cohort studies with conflicting results. Our aim was to address this question using a matched case-control study. PATIENTS AND METHODS: Ninety-four neutropenic patients and 94 non-neutropenic controls were matched for age, cancer type, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment score, and need for mechanical ventilation and vasopressors. Conditional logistic regression was used to identify factors associated with hospital mortality. RESULTS: The ICU (66% versus 66%, P = 0.999) and hospital (73% versus 78%, P = 0.611) mortality rates were similar in neutropenic and non-neutropenic patients. Adjusting for the type of admission and length of hospital stay before ICU admission, the characteristics associated with increased mortality were the severity of acute disease and organ failures, compromised performance status and sepsis diagnosis. The impact of both previous chemotherapy and neutropenia on the outcomes was not significant. CONCLUSIONS: Using a matched case-control study design, our results provide additional evidence that the presence of neutropenia is no longer associated with worse outcomes in critically ill patients with cancer. Moreover, our results also corroborate that recent exposure to chemotherapy is not associated with increased risk for death.

Early use of terlipressin in catecholamine-resistant shock improves cerebral perfusion pressure in severe traumatic brain injury.

BACKGROUND: Maintaining adequate cerebral perfusion pressure is an essential aspect in the treatment of severe acute brain injury. To accomplish this therapeutic goal vasopressors are usually required. Vasopressin is an important endogenous stress hormone and the infusion of low-dose vasopressin and terlipressin has been used to reverse severe hypotension. CASE REPORT: A 14-year-old male patient was admitted to the emergency room after a motorcycle accident. The patient had suffered severe traumatic brain injury, the Glasgow coma score (GCS) was four and there were signs of aspiration of gastric contents. Systemic inflammatory response syndrome and shock refractory to fluid management, norepinephrine and steroid replacement ensued. A terlipressin infusion, as a bolus dose of 1 mg, is associated with the ability to improve cerebral perfusion pressure with concomitant reduction of 80% of norepinephrine doses. DISCUSSION: The present report illustrates the potential benefits of terlipressin in refractory shock in a patient with severe traumatic brain injury. An increase in cerebral perfusion pressure (CPP) and a huge decrease in the dose of norepinephrine were observed. In the setting of severe brain injury associated with refractory hypotension, terlipressin may improve mean arterial pressure and cerebral perfusion pressure. CONCLUSION: In the setting of severe brain injury associated with refractory hypotension, terlipressin may have a role as a rescue therapy.