Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study

Etienne Gayat (1, 2, 3) , Alain Cariou (4) , Nicolas Deye (3, 5) , Antoine Vieillard-Baron (6) , Samir Jaber (7, 8) , Charles Damoisel (3) , Qin Lu (9, 10) , Xavier Monnet (11) , Isabelle Rennuit (12) , Elie Azoulay (13) , Marc Leone (14, 15) , Heikel Oueslati (3) , Bertrand Guidet (16) , Diane Friedman (17) , Antoine Tesniere (18) , Romain Sonneville (19) , Philippe Montravers (20) , Sebastien Pili-Floury (21) , Jean-Yves Lefrant (22) , Jacques Duranteau (23) , Pierre-Francois Laterre (24) , Nicolas Brechot (9) , Karine Chevreul (25, 26, 27) , Morgane Michel (28) , Bernard Cholley (29) , Matthieu Legrand (3, 30, 31) , Jean-Marie Launay (3) , Eric Vicaut (32) , Mervyn Singer , Matthieu Resche-Rigon (33) , Alexandre Mebazaa (1, 2, 3)

1 Département d'Anesthésie Réanimation SMUR [Paris]
2 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
3 BioCANVAS / U942 - Biomarqueurs CArdioNeuroVASCulaires
4 ENeC - Espaces, Nature et Culture
5 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
6 Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré]
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
9 CHU Pitié-Salpêtrière [AP-HP]
10 UPMC - Université Pierre et Marie Curie - Paris 6
11 HPPIT - Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique
12 Hôpital Beaujon
13 Hôpital Saint-Louis
14 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
15 MEPHI - Microbes évolution phylogénie et infections
16 Unité de Soins Intensifs [Saint-Louis]
17 Hôpital Raymond Poincaré [AP-HP]
18 Service d'Anesthésie Réanimation
19 Hôpital Bichat - Claude Bernard
20 Département d'Anesthésie Réanimation [CHU Bichat-Claude-Bernard]
21 Service d'anesthésie et soins intensifs [CHRU Besançon]
22 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
23 Service d'anesthésie et réanimation
24 UCL - Université Catholique de Louvain = Catholic University of Louvain
25 ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables
26 DRCD-URC Eco - Département de la Recherche Clinique et du Développement [AP-HP Hôtel Dieu]
27 DHU PePsy - Psychiatrie et Neurologie personnalisées [AP-HP Hôpital Henri-Mondor]
28 IRSN/DRPH/SRBE - Service de RadioBiologie et d'Epidémiologie
29 Service d'Anesthésie-Réanimation [CHU HEGP]
30 Service d'Anesthésie et Soins Intensifs
31 UPD7 - Université Paris Diderot - Paris 7
32 Unité de Recherche Clinique
33 Département de l'information médicale et de la biostatistique [AP-HP Hôpital Saint-Louis]

Background: Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. Methods: FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). Results: Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73-4.65), p<0.001). Conclusions: The FROG-ICU study identified, at the time of ICU discharge, potentially actionable clinical and biological factors associated with poor long-term outcome after ICU discharge. Those factors may guide discharge planning and directed interventions.

Mots clés: Post-intensive care syndrome; Long-term survival; Biomarkers; Score; Discharge

Domaines: Santé publique et épidémiologie

Etienne Gayat, Alain Cariou, Nicolas Deye, Antoine Vieillard-Baron, Samir Jaber, et al.. Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Critical Care, 2018, 22, pp.8. ⟨10.1186/s13054-017-1922-8⟩. ⟨hal-01791634⟩