Impact on 6-month outcomes of hospital trajectory in critically ill older patients: analysis of the ICE-CUB2 clinical trial
- Type de publi. : Article dans une revue
- Date de publi. : 01/12/2022
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Auteurs :
Sara ThietartAriane BoumendilDominique PateronBertrand GuidetH. ValletBertrand GuidetDominique PateronErwan DebucYouri YordanovAriane BoumendilCaroline ThomasDidier DreyfussJean-Damien RicardPatrick BrunChristophe LeroyYves CohenFrédéric AdnetMaguy WoimantJean-Paul MiraBenoît DoumencKhalil TkuThomas SimilowskiBruno RiouPierre HausfaterSamuel DelermeJean-Pierre QuenotDidier HonnartJean-François TimsitPierrick GuérinFrançoise CarpentierMaxime MaignanFoued MakhlouJean-François PousselYohann PicardFrançois BraunPauline TrognonFrançois FourrierPatrick GoldsteinMarie GirotPierre GosselinFrancesco SantoliPierre CharestanClaire PolyHervé MentecCatherine Le GallKarima SahraouiChristophe BaillardNicolas JavaudBenoît MissetMaité Garrouste-OrgeasOlivier GanansiaFrançois-Xavier RooryckJean Luc AimAbudlrazak El RifaiJean ReignierLaurent Martin-LefevrePhilippe FradinClaire MauriatEmelyne CwicklinskiMichel SlamaHervé DupontChristine AmmiratiJustine GallouMuriel FartoukhMichel DjibrePatrik RayEdwin RouffBertrand SouweineAli Ait HssainJeannot SchmidtDaniel PicFarès MoustafaAlain MercatNicolas LerollePierre-Marie RoyFrédéric BaudPatrick PlaisanceSophie MontagnonBertrand GalichonMichel WolffBruno MourvillierEnrique CasalinoChristophe ChoquetJulien BernardGaëlle JuillienJean-Yves FagonEmmanuel GuerotPhilippe JuvinAnabela PatzakBruno VerdièreVincent IoosMarie-Clément KoukaAudrey BerthoumieuChristian RichardRaphael MauriceSophie SarnelStéphane DiezAntoine Vieillard BaronSébastien BeauneJulie GrenetSylvie AzeradGuillaume LeblancTabassome Simon
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Organismes :
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
Centre d'Immunologie et des Maladies Infectieuses
CHU Saint-Antoine [AP-HP]
CHU Saint-Antoine [AP-HP]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
CHU Saint-Antoine [AP-HP]
Assistance publique - Hôpitaux de Paris (AP-HP)
Institut Pierre Louis d'Epidémiologie et de Santé Publique
CHU Saint-Antoine [AP-HP]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
CHU Saint-Antoine [AP-HP]
Musée du Louvre
Hôpital Louis Mourier - AP-HP [Colombes]
Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
Hôpital d'instruction des Armées Percy
Assistance publique - Hôpitaux de Paris (AP-HP)
Hôpital Avicenne [AP-HP]
Hôpital Avicenne [AP-HP]
SAMU 93 [Bobigny]
Marqueurs cardiovasculaires en situation de stress
Hôpital Avicenne [AP-HP]
Institut Cochin
Hôpital Cochin [AP-HP]
AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
Neurophysiologie Respiratoire Expérimentale et Clinique
CHU Pitié-Salpêtrière [AP-HP]
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
Groupe de recherche clinique Biomarqueurs d’urgence et de réanimation
Centre d'Immunologie et des Maladies Infectieuses
CHU Dijon
Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
Département de Médecine d'Urgence - Centre Régional Universitaire des Urgences (CRUU) (CHU de Dijon)
AP-HP - Hôpital Bichat - Claude Bernard [Paris]
Infection, Anti-microbiens, Modélisation, Evolution
Service d'accueil des urgences médicales
Université Grenoble Alpes
Service de Soins Intensifs [CHR Metz-Thionville]
Centre hospitalier régional Metz-Thionville
Université Henri Poincaré - Nancy 1
Département Anesthésie-Réanimation, Hôpital Roger Salengro, CHRU de Lille
Samu du Nord–pôle de l’urgence [Lille]
Department of Emergency [Lille]
Institut Fourier
Hôpital Robert Ballanger [Aulnay-sous-Bois]
Hôpital Robert Ballanger [Aulnay-sous-Bois]
Centre Hospitalier Victor Dupouy
Centre hospitalier Argenteuil
Hôpital Cochin [AP-HP]
Hôpital Louis Mourier - AP-HP [Colombes]
Centre de référence national des angiœdèmes
Université Paris Cité
Centre Hospitalier Universitaire de Liège
Institut hospitalier Franco-Britannique [Levallois-Perret]
Hôpital Saint-Joseph
Centre hospitalier universitaire de Nantes
- Publié dans Annals of Intensive Care le 23/10/2020
Résumé : Abstract Background Little is known about the impact of hospital trajectory on survival and functional decline of older critically ill patients. We evaluate 6-month outcomes after admission to: intensive care units (ICU), intermediate care units (IMCU) or acute medical wards (AMW). Methods Data from the randomised prospective multicentre clinical trial ICE-CUB2 was secondarily analysed. Inclusion criteria were: presenting at emergency departments in critical condition; age ≥ 75 years; activity of daily living (ADL) ≥ 4; preserved nutritional status; and no active cancer. A Cox model was fitted to compare survival according to admission destination adjusting for patient characteristics. Sensitivity analysis using multiple imputation for missing data and propensity score matching were performed. Results Among 3036 patients, 1675 (55%) were women; median age was 85 [81–99] years; simplified acute physiology score (SAPS-3) 62 [55–69]; 1448 (47%) were hospitalised in an ICU, 504 in IMCU (17%), and 1084 (36%) in AMW. Six-month mortality was 629 (44%), 155 (31%) and 489 (45%) after admission in an ICU, IMCU and AMW ( p < 0.001), respectively. In multivariate analysis, AMW admission was associated with worse 6-month survival (HR 1.31, 95% CI 1.04–1.63) in comparison with IMCU admission, after adjusting for age, gender, comorbidities, ADL, SAPS-3 and diagnosis. Survival was not significantly different between patients admitted in an ICU and an IMCU (HR 1.17, 95% CI 0.95–1.46). Sensitivity analysis using multiple imputation for missing data and propensity score matching found similar results. Hospital destination was not significantly associated with the composite criterion loss of 1-point ADL or mortality. Physical and mental components of the 12-Item Short-Form Health Survey were significantly lower in the acute medical ward group (34.3 [27.5–41.7], p = 0.037 and 44.3 [38.6–48.6], p = 0.028, respectively) than in the ICU group (34.7 [28.4–45.3] and 45.5 [40.0–50.0], respectively) and IMCU group (35.7 [29.7–43.8] and 44.5 [39.7–48.4], respectively). Conclusions Admission in an AMW was associated with worse 6-month survival in older critically ill patients in comparison with IMCU admission, with no difference of survival between ICU and IMCU admission. There were no clinically relevant differences in quality of life in each group. These results should be confirmed in specific studies and raise the question of dedicated geriatric IMCUs.
Fichiers liés :
s13613-022-01042-4.pdf
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