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

Abstract

BackgroundIntensive 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.MethodsFROG-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).ResultsOf 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).ConclusionsThe 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.Trial registrationClinicalTrials.gov NCT01367093. Registered on 6 June 2011.Electronic supplementary materialThe online version of this article (10.1186/s13054-017-1922-8) contains supplementary material, which is available to authorized users.

Tracheostomy in patients with acute respiratory distress syndrome is not related to quality of life, symptoms of psychiatric disorders or return-to-work: the prospective DACAPO cohort study

“…However, we did observe that TT was associated with a significant increase of ICU length of stay. ICU length of stay is a known independent factor ; the mean score of the general population is 50; one standard deviation is marked in grey associated with increased stationary healthcare use and 1-year mortality after ICU discharge and should be considered when deciding for the best time point of TT in critical ill patients [24,25]. In our study, associations observed in univariate analyses were lost mainly due to the strong confounding effect of ICU length of stay.…”

“…For all 1205 patients, the median duration of mechanical ventilation was 16 days (IQR 10-27) and that of ICU length of stay 22 days (IQR 14-36). The median duration of ventilation (20 days [IQR [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] vs. 11 days [IQR 6-16], p < 0.001) and ICU stay (p < 0.001, Table 1) was twice as long for tracheotomised patients. Primary 877 ARDS patients survived and discharged from ICU.…”

Clinical relevance of copeptin plasma levels as a biomarker of disease severity and mortality in critically ill patients

“…The long-term outcome of critically ill patients after discharge from the ICU depends on manifold clinical and biological factors, including age, comorbidity, and length of stay at the ICU. 28 The association between copeptin plasma levels and overall mortality suggests that copeptin could be a sensitive biomarker for the accurate assessment of the initial disease severity, supporting that the copeptin-related pathologies as biological stress and hypoperfusion are major determinants of the severity of critical illness. Future studies should prospectively evaluate, whether the implementation of copeptin measurements into multifactorial risk models could improve prognostication and thereby management of critically ill patients.…”

“…More strikingly, copeptin plasma concentrations at the admission to the ICU even predicted the long‐term, overall mortality of critically ill patients in our study. The long‐term outcome of critically ill patients after discharge from the ICU depends on manifold clinical and biological factors, including age, comorbidity, and length of stay at the ICU . The association between copeptin plasma levels and overall mortality suggests that copeptin could be a sensitive biomarker for the accurate assessment of the initial disease severity, supporting that the copeptin‐related pathologies as biological stress and hypoperfusion are major determinants of the severity of critical illness.…”

Waiting for ICU admission may increase the risk of death—A plea for better resource organization

“…Overall hospital mortality of critically ill patients has been reported to range from 13.5% to 31%, and it has been the subject of extensive research in order to understand which patients are at a higher risk of dying . The survival curve related to Intensive Care Unit (ICU) admission is known to be determined in the short term by characteristics of the acute illness and the related residual organ dysfunction and by individual characteristics, like age and comorbidities in the long term . Multiple other determinants of post‐ICU early mortality have been described which are related to the resource capacity of the hospital and how those resources are organized.…”