PURPOSE: To identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure. MATERIAL AND METHODS: We performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs. RESULTS: The main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54-71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01-1.03,P < 0.001), poor performance status (OR 2.79, 95% CI 1.98-3.93, P < 0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45-2.75, P < 0.001), liver failure (OR 1.59, 95% CI 1.14-2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31-2.46, P < 0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36-2.52, P < 0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11-2.38, P = 0.012). CONCLUSIONS: A DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.

Agostino Gemelli University Hospital Università Cattolica del Sacro Cuore Rome Italy

CIBERES Universitat Autonòma de Barcelona European Study Group of Infections in Critically Ill Patients Barcelona Spain

College Hospital London SE5 9RS UK

Department of Anesthesia and Intensive Care unit Regional University Hospital of Montpellier St Eloi Hospital University of Montpellier Phymedexp Université de Montpellier Inserm CNRS CHRU de Montpellier Montpellier France

Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

Department of Emergencies and Critical Care Oslo University Hospital Oslo Norway

Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization St James's Hospital Dublin Ireland

Department of Medical Intensive Care Medicine University Hospital of Angers France

Department of Medicine 1 Medical University of Vienna Vienna Austria

Division of Intensive Care Medicine Department of Anesthesiology Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki 00014 Finland

Medical ICU Cochin Hospital Assistance Publique Hôpitaux de Paris and University Paris Descartes Paris France

Medical Intensive Care Unit Hôpital Saint Louis and Paris Diderot Sorbonne University 1 avenue Claude Vellefaux cedex 10 75475 Paris

Penn State University College of Medicine Division of Pulmonary and Critical Care Hershey PA USA

Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN USA

Réanimation Polyvalente et Département d'Anesthésie et de Réanimation Institut Paoli Calmettes Marseille France

Terapia Intensiva Hospital Maciel Montevideo Uruguay

The Department of Intensive Care Medicine Radboud University Medical Centre Nijmegen the Netherlands

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