Pulmonary infiltrates in neutropenic patients with acute leukemia during chemotherapy -: Outcome and prognostic factors

Study objective: To determine predictors of mortality from pulmonary infiltrates in neutropenic patients with acute leukemia during chemotherapy, and the significance of those factors related to the underlying malignancy and its therapy as well as of those related to the severity of the illness associated with pulmonary infiltrates. Design: A historical cohort study. Setting: A university teaching hospital and tertiary referral center. Patients and methods: Overall, 53 patients with neutropenia during chemotherapy and with first episodes of pulmonary infiltrates during a 4-year period were studied. Prognostic analysis included 38 variables. Multivariate analyses were performed by logistic regression Results: The survival rate from pneumonia was 57% (30/53). The following eight parameters were significantly associated with death in univariate analysis: comorbidity present; development of "late" pulmonary infiltrates (greater than or equal to 14 days after hospital admission); heart rate greater than or equal to 100 beats/min; a ratio heart rate/systolic blood pressure (HR/SBP) greater than or equal to 1.2; urea nitrogen >7 mmol/L; radiographic score greater than or equal to 3; neutropenia <1.0x10(9)/L at the treatment end point; and failed complete remission, In a multivariate model including only parameters available at diagnosis of pulmonary infiltrates, the Presence of a ratio HR/SBP greater than or equal to 1.2 and of a radiographic score greater than or equal to 3 remained independently associated with death. In a second model also including the evolutionary parameter neutropenia less than or equal to 1.0x10(9)/L at the treatment end point, both parameters remained significant together with neutropenia <1.0 x 10(9)L at the treatment end point. The presence of a ratio HR/SBP greater than or equal to 1.2 was a strong marker of early death. Conclusion: Both therapy- and malignancy-associated neutropenia as well as the severity of illness associated with pulmonary infiltrates are independent prognostic factors. Patients with a ratio HR/SBP greater than or equal to 1.2 at diagnosis of pulmonary infiltrates suffer from potentially reversible acute illness, are at risk for early death and, therefore, may be appropriate candidates for treatment in an ICU.