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.
Highlights
Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population
To reduce the mortality rate of intensive care unit (ICU) survivors, it is important to identify the group of patients who have a higher probability of death in the year following ICU discharge and to recognize the adjustable factors associated with mortality
We focused on circulating cardiovascular biomarkers, namely N-terminal pro-B type natriuretic peptide (NTproBNP), high-sensitive troponin I, bioactiveadrenomedullin and soluble-ST2
Summary
Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Survivors of critical illness will face a period of increased risk of reduced long-term survival and impaired quality of life compared to the general population [1]. This period, lasting several years, is associated with an increased risk of posttraumatic stress, depression, cognitive impairment and physical weakness, all grouped under the entity “postintensive care syndrome” (PICS) [2]. To reduce the mortality rate of intensive care unit (ICU) survivors, it is important to identify the group of patients who have a higher probability of death in the year following ICU discharge and to recognize the adjustable factors associated with mortality. We understand that age, comorbidity burden and severity of acute illness are important predictors of late mortality as described previously [12], we know less about clinical and laboratory values at the time of ICU discharge
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