Background
Methods
Study design
Participants
Study objectives
Data collection
Statistical analysis
Results
Variable | % of missing value | Studied patients | 1 year post ICU | p value | |
---|---|---|---|---|---|
(n = 1570) | Survivors (n = 1237) | Nonsurvivors (n = 333) | |||
Age (years) | 0.0 | 61 (49; 73) | 58 (47; 70) | 71 (61; 79) | < 0.01 |
Male gender | 0.0 | 1000 (63.7) | 782 (63%) | 218 (66%) | 0.48 |
BMI (kg/m2) | 37.5 | 26 (23; 31) | 26 (23; 31) | 26 (23; 31) | 0.96 |
Charlson score | 0.1 | 3 (1; 4) | 2 (1; 4) | 4 (3; 6) | < 0.01 |
Deprivation index (FDep) | 10.8 | −0.6 (−1.6; 0.3) | −0.6 (−1.6; 0.3) | −0.6 (−1.5; 0.4) | 0.44 |
SOFA score at admission | 37.2 | 6 (4; 9) | 7 (4; 10) | 8 (5; 11) | 0.11 |
SAPS II score at admission | 0.1 | 46 (34; 59) | 45 (33; 58) | 51 (40; 65) | < 0.01 |
Main cause of admission | < 0.01 | ||||
Septic shock | 0.1 | 339 (22%) | 244 (20%) | 95 (29%) | |
Acute respiratory failure | 303 (19%) | 230 (19%) | 73 (22%) | ||
Acute neurological disorder | 241 (15%) | 210 (17%) | 31 (9%) | ||
Out-of-hospital cardiac arrest | 117 (8%) | 102 (8%) | 15 (5%) | ||
In-ICU management | |||||
In-ICU LOS (days) | 0.0 | 12 (7; 21) | 12 (7; 20) | 13 (7; 24) | 0.03 |
In-hospital LOS (days) | 0.1 | 26 (15; 43) | 25 (15; 43) | 28 (16; 47) | 0.05 |
Tracheotomy | 0.0 | 241 (15%) | 181 (15%) | 60 (18%) | 0.13 |
RRT | 0.0 | 286 (18%) | 202 (16%) | 84 (25%) | < 0.01 |
Inotrope/vasopressor | 0.0 | 1151 (73%) | 888 (72%) | 263 (79%) | < 0.01 |
RBC | 0.0 | 676 (43%) | 490 (40%) | 186 (56%) | < 0.01 |
FFP | 0.0 | 236 (15%) | 171 (14%) | 65 (20%) | < 0.01 |
Status at discharge | |||||
SBP (mmHg) | 12.9 | 125 (111; 139) | 125 (112; 139) | 122 (108; 139) | 0.03 |
DBP (mmHg) | 16.7 | 68 (59; 76) | 69 (60; 77) | 64 (55; 73) | < 0.01 |
HR (bpm) | 14.1 | 90 (79; 101) | 90 (79; 100) | 89 (79; 101) | 0.41 |
Atrial fibrillation | 10.0 | 297 (21%) | 265 (21%) | 32 (21.2) | 0.96 |
Temperature (°C) | 10.3 | 37.1 (36.8; 37.5) | 37.1 (36.8; 37.5) | 37 (36.6; 37.4) | < 0.01 |
Sodium (mmol/l) | 3.1 | 139 (136; 142) | 139 (136; 142) | 139 (136; 142) | 0.6 |
Potassium (mmol/l) | 8.3 | 3.9 (3.6; 4.2) | 3.9 (3.6; 4.2) | 4.0 (3.6; 4.2) | 0.36 |
Creatinine (μmol/l) | 3.7 | 66 (51; 95) | 64 (50; 87) | 80 (57; 131) | < 0.01 |
eGFR (ml/min/1.73 m2) | 3.7 | 91 (51.2; 110) | 110 (75; 146) | 79 (46; 119) | < 0.01 |
Lactate (mmol/l) | 58.3 | 1.0 (0.7; 1.3) | 1.0 (0.7; 1.3) | 1.1 (0.8; 1.4) | < 0.01 |
WBC count (/mm3) | 13.6 | 9600 (7015; 13,100) | 9500 (7000; 12,952) | 10050 (7342; 13,962) | 0.04 |
Hemoglobin (g/dl) | 13.6 | 10.0 (9.0; 11.2) | 10.2 (9.1; 11.3) | 9.6 (8.7; 10.6) | < 0.01 |
Platelets count (/mm3) | 12.9 | 291,500 (181,750; 432,500) | 308,500 (191,000; 457,000) | 240500 (137,500; 347,750) | < 0.01 |
Bilirubin (mmol/l) | 63.2 | 11 (7; 20) | 10 (7; 19) | 14 (9; 36) | < 0.01 |
Glycemia (mmol/l) | 16.8 | 6.8 (5.7; 8.3) | 6.7 (5.7; 8.2) | 7.1 (5.9; 8.7) | 0.01 |
Total protein (g/L) | 18.6 | 62 (56; 69) | 63 (57; 69) | 60 (52; 66) | < 0.01 |
Determinants of 1-year survival after ICU discharge
Association between cardiovascular biomarkers at discharge and 1-year survival after ICU discharge
NT-proBNP (pg/ml) | hs-TnI (pg/ml) | bio-ADM (pg/ml) | sST2 (ng/ml) | |
---|---|---|---|---|
Normal value | < 300 | < 14 | < 43 | < 23.6 for men/< 16.0 for women |
Missing data (%) | ||||
Median (IQR) at discharge | ||||
All patients (n = 1570) | 541 (149; 2073) | 11.2 (4.2; 39.2) | 33.3 (20.2; 60.5) | 122.2 (73.1; 208.8) |
1-year survivor (n = 1237) | 464 (127; 1681) | 9.7 (3.7; 33.8) | 30.5 (18.7; 52.3) | 112.5 (67.9; 188.6) |
1-year nonsurvivor (n = 333) | 1471 (371; 5719) | 18.5 (7.6; 74.7) | 50.4 (28.5; 107.9) | 189.1 (102.4; 301.2) |
Association with prognosis (OR (95% CI) of biomarker > median) | ||||
Univariate analysis | 2.50 (1.85–3.38) | 2.03 (1.51–2.73) | 2.52 (1.86–3.42) | 2.44 (1.81–3.30) |
Multivariable analysis | 2.05 (1.33–3.18) | 1.41 (0.94–2.13) | 1.61 (1.06–2.45) | 1.53 (1.01–2.33) |
AUC of ROC curve (95% CI) | ||||
Biomarker alone | 0.659 (0.619–0.699)* | 0.625 (0.588–0.663)* | 0.672 (0.635–0.711)* | 0.657 (0.618–0.697)* |
Biomarker + clinical score | 0.794 (0.766–0.823)** | 0.789 (0.759–0.817) | 0.794 (0.766–0.822) | 0.800 (0.773–0.827)** |
NRI of biomarkers added to the full clinical model | ||||
% Events to higher risk | 44.3 | 37.4 | 43.4 | 42.5 |
% Nonevents to higher risk | 14.8 | 16.1 | 15.7 | 17.2 |
% Events to lower risk | 55.7 | 62.6 | 56.6 | 57.5 |
% Nonevents to lower risk | 85.2 | 83.9 | 84.3 | 82.8 |
Total NRI for events (95% CI) | −0.115 (−0.263 to 0.033) | −0.253 (−0.397 to −0.109) | −0.133 (−0.281 to 0.015) | −0.149 (−0.296 to −0.003) |
Total NRI for nonevents (95% CI) | 0.705 (0.650–0.759) | 0.678 (0.622–0.734) | 0.686 (0.631–0.742) | 0.656 (0.598–0.714) |
Total cNRI (95% CI) | 0.590 (0.433–0.747) | 0.425 (0.271–0.580) | 0.554 (0.396–0.711) | 0.507 (0.349–0.664) |
IDI of biomarkers added to the full clinical model | ||||
Events to higher risk | 0.014 | –0.009 | 0.018 | 0.005 |
Nonevents to lower risk | 0.023 | 0.016 | 0.024 | 0.02 |
Total (95% CI) | 0.036 (0.019–0.054) | 0.007 (0–0.014) | 0.041 (0.023–0.06) | 0.024 (0.009–0.04) |
Discussion
Limitations of the study
Conclusions
Acknowledgements
Center | Investigators |
Hopital Lariboisiere (Paris) | N Deye, C Fauvaux, A Mebazaa, C Damoisel, D Payen |
Hopital Saint Louis (Paris) | E Azoulay, AS Moreau, L Jacob, O Marie |
Hopital Bichat (Paris) | M Wolf, R Sonneville, R Bronchard |
Hopital Beaujon (Clichy) | I Rennuit, C Paugam |
Hopital Cochin (Paris) | JP Mira, A Cariou, A Tesnieres |
Hopital Bicetre (Le Kremlin-Bicetre) | N Dufour, N Anguel, L Guerin, J Duranteau, C Ract |
Chu De Marseille (Marseille) | M Leone, B Pastene |
Hopital Raymond Poincare (Garches) | T Sharshar, A Fayssoyl |
Hopital Saint-Antoine | J-L Baudel, B Guidet |
Hopital De La Pitie—Salpetriere (Paris) | Q Lu, W Jie Gu, N Brechot, A Combes |
Chu St Eloi (Montpellier) | S Jaber, A Pradel, Y Coisel, M Conseil |
Hopital Ambroise Pare (Boulogne) | A Veillard Baron, L Bodson |
Chu Caremeau (Nimes) | Jy Lefrant, L Elotmani, A Ayral, S Lloret |
Hopital Jean Minjoz (Besançon) | S Pily-Flouri, Jb Pretalli |
Clinique Saint-Luc (Belgium) | Pf Laterre, V Montiel, Mf Dujardin, C Berghe |