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 canc...
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| Veröffentlicht in: | Journal of critical care 2014-08, Vol.29 (4), p.533-538 |
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| creator | Vassalo, Juliana, MD Spector, Nelson, MD, PhD de Meis, Ernesto, MD, PhD Rabello, Lígia S.C.F., MD Rosolem, Maíra M., MD, MSc do Brasil, Pedro E.A.A., MD, PhD Salluh, Jorge I.F., MD, PhD Soares, Márcio, MD, PhD |
| description | 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. |
| doi_str_mv | 10.1016/j.jcrc.2014.02.005 |
| format | Article |
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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.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2014.02.005</identifier><identifier>PMID: 24629573</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Antibodies, Antiphospholipid - blood ; Antiphospholipid antibodies ; beta 2-Glycoprotein I - blood ; Cancer ; Cancer therapies ; Confidence Intervals ; Critical Care ; Critical Illness ; Female ; Fibrin Fibrinogen Degradation Products - analysis ; Hematologic Neoplasms - immunology ; Hematologic Neoplasms - mortality ; Hospitals ; Humans ; Intensive care ; Intensive care unit ; Intensive Care Units ; Lupus Coagulation Inhibitor - blood ; Male ; Middle Aged ; Molecular weight ; Mortality ; Multivariate analysis ; Neoplasms - immunology ; Neoplasms - mortality ; Patients ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Proteins ; Renal Replacement Therapy ; Sepsis ; Sepsis - blood ; Thrombosis ; Variables ; Ventilation</subject><ispartof>Journal of critical care, 2014-08, Vol.29 (4), p.533-538</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-b74782d7894c73e8a1cddd16067342838bbd38c5a573c641a15f258cdafcd82b3</citedby><cites>FETCH-LOGICAL-c439t-b74782d7894c73e8a1cddd16067342838bbd38c5a573c641a15f258cdafcd82b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0883944114000598$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24629573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vassalo, Juliana, MD</creatorcontrib><creatorcontrib>Spector, Nelson, MD, PhD</creatorcontrib><creatorcontrib>de Meis, Ernesto, MD, PhD</creatorcontrib><creatorcontrib>Rabello, Lígia S.C.F., MD</creatorcontrib><creatorcontrib>Rosolem, Maíra M., MD, MSc</creatorcontrib><creatorcontrib>do Brasil, Pedro E.A.A., MD, PhD</creatorcontrib><creatorcontrib>Salluh, Jorge I.F., MD, PhD</creatorcontrib><creatorcontrib>Soares, Márcio, MD, PhD</creatorcontrib><title>Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>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.</description><subject>Aged</subject><subject>Antibodies, Antiphospholipid - blood</subject><subject>Antiphospholipid antibodies</subject><subject>beta 2-Glycoprotein I - blood</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Confidence Intervals</subject><subject>Critical Care</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Fibrin Fibrinogen Degradation Products - analysis</subject><subject>Hematologic Neoplasms - immunology</subject><subject>Hematologic Neoplasms - mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive care unit</subject><subject>Intensive Care Units</subject><subject>Lupus Coagulation Inhibitor - blood</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Molecular weight</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neoplasms - immunology</subject><subject>Neoplasms - mortality</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Proteins</subject><subject>Renal Replacement Therapy</subject><subject>Sepsis</subject><subject>Sepsis - blood</subject><subject>Thrombosis</subject><subject>Variables</subject><subject>Ventilation</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU9rFDEYh4Modq1-AQ8S8OJlxvyfjEhhKWqFgofWqyHzJstmnJ0Zk0xlv70Ztir00EMIhOf3483zIvSakpoSqt73dQ8RakaoqAmrCZFP0IZK2VRaUfkUbYjWvGqFoGfoRUo9IbThXD5HZ0wo1sqGb9CP7ZjDvJ9SOUOYg8O2PHSTCz7hMGKIIQeww3DEYRjwbHPwY074d8h7DHYEHz_gLZ5jafCQw53HMO2nmHHKizu-RM92dkj-1f19jr5__nR7eVVdf_vy9XJ7XYHgba66RjSauUa3AhrutaXgnKOKqIYLprnuOsc1SFtmBiWopXLHpAZnd-A06_g5enfqLYP8WnzK5hAS-GGwo5-WZKjkSmneclnQtw_QflriWKZbKUmUYg0rFDtRUH6Wot-ZOYaDjUdDiVntm96s9s1q3xBmiv0SenNfvXQH7_5F_uouwMcT4IuLu-CjSVB8gnchFnvGTeHx_osHcRjCuK7npz_69P8fJpWAuVn3v66fClLireZ_AK4qqxI</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Vassalo, Juliana, MD</creator><creator>Spector, Nelson, MD, PhD</creator><creator>de Meis, Ernesto, MD, PhD</creator><creator>Rabello, Lígia S.C.F., MD</creator><creator>Rosolem, Maíra M., MD, MSc</creator><creator>do Brasil, Pedro E.A.A., MD, PhD</creator><creator>Salluh, Jorge I.F., MD, PhD</creator><creator>Soares, Márcio, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study</title><author>Vassalo, Juliana, MD ; Spector, Nelson, MD, PhD ; de Meis, Ernesto, MD, PhD ; Rabello, Lígia S.C.F., MD ; Rosolem, Maíra M., MD, MSc ; do Brasil, Pedro E.A.A., MD, PhD ; Salluh, Jorge I.F., MD, PhD ; Soares, Márcio, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-b74782d7894c73e8a1cddd16067342838bbd38c5a573c641a15f258cdafcd82b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Antibodies, Antiphospholipid - blood</topic><topic>Antiphospholipid antibodies</topic><topic>beta 2-Glycoprotein I - blood</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Confidence Intervals</topic><topic>Critical Care</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Fibrin Fibrinogen Degradation Products - analysis</topic><topic>Hematologic Neoplasms - immunology</topic><topic>Hematologic Neoplasms - mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Intensive care unit</topic><topic>Intensive Care Units</topic><topic>Lupus Coagulation Inhibitor - blood</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Molecular weight</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Neoplasms - immunology</topic><topic>Neoplasms - mortality</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Proteins</topic><topic>Renal Replacement Therapy</topic><topic>Sepsis</topic><topic>Sepsis - blood</topic><topic>Thrombosis</topic><topic>Variables</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vassalo, Juliana, MD</creatorcontrib><creatorcontrib>Spector, Nelson, MD, PhD</creatorcontrib><creatorcontrib>de Meis, Ernesto, MD, PhD</creatorcontrib><creatorcontrib>Rabello, Lígia S.C.F., MD</creatorcontrib><creatorcontrib>Rosolem, Maíra M., MD, MSc</creatorcontrib><creatorcontrib>do Brasil, Pedro E.A.A., MD, PhD</creatorcontrib><creatorcontrib>Salluh, Jorge I.F., MD, PhD</creatorcontrib><creatorcontrib>Soares, Márcio, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vassalo, Juliana, MD</au><au>Spector, Nelson, MD, PhD</au><au>de Meis, Ernesto, MD, PhD</au><au>Rabello, Lígia S.C.F., MD</au><au>Rosolem, Maíra M., MD, MSc</au><au>do Brasil, Pedro E.A.A., MD, PhD</au><au>Salluh, Jorge I.F., MD, PhD</au><au>Soares, Márcio, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>29</volume><issue>4</issue><spage>533</spage><epage>538</epage><pages>533-538</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24629573</pmid><doi>10.1016/j.jcrc.2014.02.005</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Antibodies, Antiphospholipid - blood Antiphospholipid antibodies beta 2-Glycoprotein I - blood Cancer Cancer therapies Confidence Intervals Critical Care Critical Illness Female Fibrin Fibrinogen Degradation Products - analysis Hematologic Neoplasms - immunology Hematologic Neoplasms - mortality Hospitals Humans Intensive care Intensive care unit Intensive Care Units Lupus Coagulation Inhibitor - blood Male Middle Aged Molecular weight Mortality Multivariate analysis Neoplasms - immunology Neoplasms - mortality Patients Prognosis Proportional Hazards Models Prospective Studies Proteins Renal Replacement Therapy Sepsis Sepsis - blood Thrombosis Variables Ventilation |
| title | Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study |
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