Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study

Abstract 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- β 2 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.