Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study
Etienne Gayat,
Alain Cariou,
Nicolas Deye,
Antoine Vieillard-Baron,
Samir Jaber,
Charles Damoisel,
Qin Lu,
Xavier Monnet,
Isabelle Rennuit,
Elie Azoulay,
Marc Léone,
Heikel Oueslati,
Bertrand Guidet,
Diane Friedman,
Antoine Tesnière,
Romain Sonneville,
Philippe Montravers,
Sébastien Pili-Floury,
Jean-Yves Lefrant,
Jacques Duranteau,
Pierre-François Laterre,
Nicolas Brechot,
Karine Chevreul,
Morgane Michel,
Bernard Cholley,
Matthieu Legrand,
Jean-Marie Launay,
Eric Vicaut,
Mervyn Singer,
Matthieu Resche-Rigon,
Alexandre Mebazaa
Affiliations
Etienne Gayat
Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Alain Cariou
Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique—Hôpitaux de Paris, Paris Descartes University, Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris Sudden Death Expertise Center
Nicolas Deye
Medical Intensive Care Unit, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Antoine Vieillard-Baron
Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique—Hopitaux de Paris
Samir Jaber
Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier University
Charles Damoisel
Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Qin Lu
Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, UPMC Paris 6
Xavier Monnet
Medical Intensive Care Unit, Bicêtre Hospital, Paris-Sud University Hospitals, Inserm UMR_S999, Paris-Sud University
Isabelle Rennuit
Department of Anesthesiology and Critical Care, Beaujon Hospital, Assistance Publique Hôpitaux de Paris University
Elie Azoulay
Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Université Paris Diderot Sorbonne
Marc Léone
Service d’anesthésie et de réanimation, Hôpital Nord, Assistance Publique—Hôpitaux de Marseille, Aix Marseille Université
Heikel Oueslati
Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Bertrand Guidet
Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique—Hôpitaux de Paris, Université Pierre et Marie Curie
Diane Friedman
General Intensive Care, Raymond Poincaré University Hosptal, Assistance Publique—Hopitaux de Paris
Antoine Tesnière
Department of Anesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique—Hôpitaux de Paris, Paris Descartes University, Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris Sudden Death Expertise Center
Romain Sonneville
Department of Intensive Care Medicine and Infectious Diseases, Univ Paris Diderot, Sorbonne Paris Cité, Assistance Publique—Hôpitaux de Paris, Hôpital Bichat-Claude
Philippe Montravers
Department of Anesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7
Sébastien Pili-Floury
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon
Jean-Yves Lefrant
Department of Anesthesiology, Emergency and Critical Care Medicine, Nimes University Hospital
Jacques Duranteau
Département d’Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique—Hôpitaux de Paris
Pierre-François Laterre
Medical–Surgical Intensive Care Unit, Cliniques Saint-Luc
Nicolas Brechot
Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris, Sorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition and CIC 1421—Paris Est
Karine Chevreul
URC-Eco, Assistance Publique—Hôpitaux de Paris, Sorbonne Paris Cité, Université Paris Diderot, ECEVE, INSERM
Morgane Michel
Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cite
Bernard Cholley
Service de Biochimie, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Matthieu Legrand
Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Jean-Marie Launay
Service de Biochimie, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Eric Vicaut
Unité de Recherche Clinique, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Mervyn Singer
Bloomsbury Institute of Intensive Care Medicine, University College London, Cruciform Building
Matthieu Resche-Rigon
Service de Biostatistique et Information Médicale, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, ECSTRA Team, INSERM
Alexandre Mebazaa
Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis—Lariboisière, Assistance Publique—Hôpitaux de Paris, Université Paris Diderot—Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM
Abstract 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. Trial registration ClinicalTrials.gov NCT01367093 . Registered on 6 June 2011.
