Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study
Peter Schellongowski, Michaël Darmon, Kathrin Eller, Laveena Munshi, Tobias Liebregts, Victoria Metaxa, Luca Montini, Tobias Lahmer, Fabio Silvio Taccone, Andry Van de Louw, Martin Balík, Peter Pickkers, Pleun Hemelaar, Hemang Yadav, Andreas Barratt‐Due, Thomas Karvunidis, Jordi Riera, Gennaro Martucci, Ignacio Martín‐Loeches, Pedro Castro, Nina Buchtele, Virginie Lemiale, Stefan Hatzl, Guillaume Dumas, Thomas Staudinger, Elie Azoulay, the YELENNA Investigators and the Nine-I Study Group, Gottfried Heinz, Gürkan Sengölge, Christian Zauner, Elisabeth Lobmeyr, Alexis Maillard, Gennaro De Pascale, Giovanna Panarello, Philippe R. Bauer, Marek Flaksa, Brozek, Fabio Silvio Taccone, Ilaria Alice Crippa, Andreas Barrat-Due, Sandra García-Roche, Cándido Díaz‐Lagares, Andrés Pacheco, Adrián Téllez, Ignacio Martín Loeches
Abstract
PURPOSE: Acute respiratory failure is the leading reason for intensive care unit (ICU) admission among critically ill patients with cancer. We aimed to describe the clinical characteristics, risk factors, and outcomes of patients with cancer and acute respiratory distress syndrome (ARDS) and to evaluate associations of venovenous extracorporeal membrane oxygenation (ECMO) with outcomes in the subgroup with severe ARDS. METHODS: We conducted a multinational, prospective, observational cohort study of patients with cancer and ARDS in 13 countries in Europe and North America. The primary endpoint was 90-day mortality. RESULTS: Among 715 included patients, 73.4% had hematologic malignancies and 26.6% solid tumors; 31.2% had undergone hematopoietic stem-cell transplantation (168 allogeneic). ICU, hospital, and 90-day mortality rates were 55.3%, 70.9%, and 73.2%, respectively. By multivariate analysis, independent predictors of higher 90-day mortality were older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and ICU admission as a time-limited trial (vs. full code). Conversely, lymphoma was associated with lower 90-day mortality. Among the 322 patients (45.7%) with severe ARDS at inclusion, 90-day mortality was 82.2%; with no difference between patients who received ECMO (n = 58, 18%) and those who did not (82.6% vs. 80.7%, P = 0.89). This finding remained unchanged in a double-adjusted overlap- and propensity-weighted Cox mixed-effects model (adjusted hazard ratio, 1.12; 95% confidence interval 0.65-1.94; P = 0.69). CONCLUSION: Patients with cancer and ARDS, particularly severe forms, experience high 90-day mortality, irrespective of ECMO use. These findings suggest a need for nuanced ICU goals-of-care discussions and raise concerns about the generalizability of ECMO guidelines to this population.