Antiphospholipid antibodies in critically ill patients with cancer: a prospective cohort study.
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-β2 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.
['Vassalo|Juliana|J|', 'Spector|Nelson|N|', 'de Meis|Ernesto|E|', 'Rabello|Lígia S C F|LS|', 'Rosolem|Maíra M|MM|', 'do Brasil|Pedro E A A|PE|', 'Salluh|Jorge I F|JI|', 'Soares|Márcio|M|']
D000368:Aged D017152:Antibodies, Antiphospholipid D016001:Confidence Intervals D016638:Critical Illness D005260:Female D005338:Fibrin Fibrinogen Degradation Products D019337:Hematologic Neoplasms D006801:Humans D007362:Intensive Care Units D016682:Lupus Coagulation Inhibitor D008297:Male D008875:Middle Aged D009369:Neoplasms D011379:Prognosis D016016:Proportional Hazards Models D011446:Prospective Studies D017582:Renal Replacement Therapy D018805:Sepsis D053482:beta 2-Glycoprotein I
Antiphospholipid antibodies Cancer Intensive care unit Prognosis