Prolonged corrected QT interval is associated with short-term and long-term mortality in critically ill patients : results from the FROG-ICU study

Non peer reviewe

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Back-to-back comparison of penKID with NephroCheck® to predict acute kidney injury at admission in intensive care unit: a brief report

International audienceon behalf of the FROG ICU study investigators Acute kidney injury (AKI) is a frequent condition in critically ill patients that affects both short-and long-term outcome [1]. Its early detection remains a challenge, and diagnosis frequently occurs too late with cell damage already present. Implementation of novel biomarkers that reliably identify patients at risk or at an early stage of AKI could offer more efficient management strategies leading to better outcomes. In our investigation, we compared two promising AKI biomarkers: a marker of tubular injury commercialized as a lateral-flow test (NephroCheck®) [2], the product of urinary TIMP-2 (Tissue inhibitor of metalloprotease), and IGFBP 7 (Insulin-like growth factor binding protein; overall TIMP2xIGFBP7), and the filtration marker proenkephalin A 119-159 (penKid). penKid has been recently described as a valuable plasma biomarker of AKI in the acutely ill, including septic patients [3] and patients suffering from acute heart failure [4]. Proenkephalin represents a stable surrogate analyte of labile enkephalins, which are known as endogenous opioids, but also affects kidney function [5]. The aim of our study was to conduct a parallel assessment of the two biomarkers in an intensive care unit (ICU) population from the data of the FROG-ICU study. FROG-ICU has been designed to better understand long-term outcome after ICU discharge as well as risk factors for all-cause and cardiovascular morbidity and associated mortality (FROG-ICU study, ClinicalTrials.gov identifier NCT01367093). It was a large prospective multicenter cohort study with biological (plasma and urine) collection and one-year follow-up of ICU patients. FROG-ICU aims to allow risk stratification of ICU survivors in order to recognize the subset of patients who may benefit from early intervention to allow decreased cardiovascular morbidity and related mortality. The methodology of the FROG-ICU study was published in 2015. From the FROG study including 2087 critically ill patients we randomly selected 200 requiring mechanical ventilation or vasopressor support for more than 24 h with respect to the four categories of the renal Sequential Organ Failure Assessment (SOFA) score (i.e., creatinine level on admission of < 1.2 mg/dL (n = 80), 1.2 to 1.9 mg/dL (n = 40), 2 to 3.4 mg/dL (n = 40), and ≥ 3.5 mg/dL (n = 40)); 78% were male, with a median age of 65 years (interquartile range (IQR) 54–75). In the investigated cohort of a standard population of critically ill, the main cause of ICU admission was septic shock (26%), the median age was 65 years (IQR 54–75), the median SAPS II score was 51 (IQR 41–68), and the ICU mortality was 26%. Other causes of admission include out-of-hospital cardiac arrest (10%), acute respiratory failure (16%), acute neurological disorder (11%), and cardiogenic shock (8%). On ICU admission, the median (and IQR) value of estimated glomerular filtration rate for penKid and TIMP2xIGFBP7 was 47 mL/min (22–88), 85 pmol/L (48–40), and 0.6 UNIT (0.3–2), respectively. AKI was defined using the Kidney Disease Improvement Global Outcome (KDIGO) definition. Accordingly, we used both the variation in serum creatinine during the first 48 h after ICU admission and the maximal value during the 7 days following ICU admission. Admission serum creatinine was used as baseline serum creatinine when the estimated glomerular filtration rate (eGFR) was above 60 ml/min/1.73 m 2 at admission. Otherwise (n = 117, 59% of the study population), baseline seru

Tracheostomy and long-term mortality in ICU patients undergoing prolonged mechanical ventilation

International audienceIntroductionIn critically ill patients undergoing prolonged mechanical ventilation (MV), the difference in long-term outcomes between patients with or without tracheostomy remains unexplored.MethodsAncillary study of a prospective international multicentre observational cohort in 21 centres in France and Belgium, including 2087 patients, with a one-year follow-up after admission. We included patients with a MV duration ≥10 days, with or without tracheostomy. We explored the one-year mortality with a classical Cox regression model (adjustment on age, SAPS II, baseline diagnosis and withdrawal of life-sustaining therapies) and a Cox regression model using tracheostomy as a time-dependant variable.Results29.5% patients underwent prolonged MV, out of which 25.6% received tracheostomy and 74.4% did not. At one-year, 45.2% patients had died in the tracheostomy group and 51.5% patients had died in the group without tracheostomy (p = 0.001). In the Cox-adjusted regression model, tracheostomy was not associated with improved one-year outcome (HR CI95 0.7 [0.5–1.001], p = 0.051), as well as in the model using tracheostomy as a time-dependent variable (OR CI 95 1 [0.7–1.4], p = 0.9).ConclusionsIn our study, there was no statistically significant difference in the one-year mortality of patients undergoing prolonged MV when receiving tracheostomy or not

Long-term mortality and quality of life after trauma: an ancillary study from the prospective multicenter trial FROG-ICU.

INTRODUCTION: The long-term outcomes of intensive care unit (ICU) patients are known to be worse than those of the general population, but they are poorly known in severe trauma patients. We conducted an ancillary examination of the FROG-ICU study to identify risk factors and biomarkers associated with the poorer long-term outcomes and mortality in trauma ICU patients. METHODS: Mortality, quality of life (QoL) and stress level scores were obtained 1 year after discharge from ICU. Blood samples were collected at ICU admission and discharge for measurement of inflammatory and cardiovascular biomarkers. RESULTS: ICU trauma patients had a significantly lower 1-year mortality than non-trauma patients (7% vs. 23%, p < 0.001), but had worse stress levels scores (19 vs. 13, p = 0.041). No difference was found regarding physical and mental QoL scores (33 vs. 31, p = 0.19 and 30 vs. 28, p = 0.42). Patients with better QoL scores had lower tracheotomy rates (11% vs. 30%, p = 0.01). Worse stress level scores are associated with poor QoL scores and vice versa. Some study biomarkers were significantly higher in those ICU trauma patients who had worse QoL scores at 1 year after discharge. DISCUSSION: Our study suggests that quality of life 1 year after an ICU stay is poor and is similar in both trauma and non-trauma patients, but ICU trauma patients are at greater risk of developing post-traumatic stress disorder-related symptoms. Tracheotomy and high levels of inflammatory biomarkers could be associated with impaired quality of life

Differences in HADS and SF-36 scores 1 year after critical illness in COVID-19 patients.

Dear Editor, Long-term outcomes among coronavirus disease 2019 (COVID-19) survivors have been a cause for concern. Similarly, patients surviving critical illness from other conditions have shown anxiety, depression and altered quality of life, contributing to post-intensive care syndrome (PICS). Te specifc contribution of COVID-19 beyond the non-specifc contribution of critical illness, however, remains unknown. In this study, we matched and compared critically ill survivors admitted to the intensive care unit (ICU) for COVID-19 to critically ill patients admitted for pneumonia or acute respiratory distress syndrome unrelated to COVID-19. We explored hospital Anxiety and Depression Scale (HADS) and the Short Form (36) Health Survey (SF-36) scores 1 year after hospitalization. [...

Gender and survival of critically ill patients: results from the FROG-ICU study

International audiencePurpose: Few studies analyzed gender-related outcome differences of critically ill patients and found inconsistent results. This study aimed to test the independent association of gender and long-term survival of ICU patients.Materials and methods: FROG-ICU was a prospective, observational, multi-center cohort designed to investigate the long-term mortality of critically ill adult patients. The primary endpoint of this study was 1-year mortality after ICU admission of women compared to men.Results: The study included 2087 patients, 726 women and 1361 men. Women and men had similar baseline characteristics, clinical presentation, and disease severity. No significant difference in 1-year mortality was found between women and men (34.9% vs. 37.9%, P = 0.18). After multivariable adjustment, no difference in the hazard of death was observed [HR 0.99 (95% CI 0.77–1.28)]. Similar 1-year survival between women and men was found in a propensity score-matched patient cohort of 506 patients [HR 0.79 (95% CI 0.54–1.14)].Conclusion: Women constituted one-third of the population of critically ill patients and were unexpectedly similar to men regarding demographic characteristics, clinical presentation, and disease severity and had similar risk of death at 1 year after ICU admission

Gender and survival of critically ill patients: results from the FROG-ICU study.

PURPOSE: Few studies analyzed gender-related outcome differences of critically ill patients and found inconsistent results. This study aimed to test the independent association of gender and long-term survival of ICU patients. MATERIALS AND METHODS: FROG-ICU was a prospective, observational, multi-center cohort designed to investigate the long-term mortality of critically ill adult patients. The primary endpoint of this study was 1-year mortality after ICU admission of women compared to men. RESULTS: The study included 2087 patients, 726 women and 1361 men. Women and men had similar baseline characteristics, clinical presentation, and disease severity. No significant difference in 1-year mortality was found between women and men (34.9% vs. 37.9%, P = 0.18). After multivariable adjustment, no difference in the hazard of death was observed [HR 0.99 (95% CI 0.77-1.28)]. Similar 1-year survival between women and men was found in a propensity score-matched patient cohort of 506 patients [HR 0.79 (95% CI 0.54-1.14)]. CONCLUSION: Women constituted one-third of the population of critically ill patients and were unexpectedly similar to men regarding demographic characteristics, clinical presentation, and disease severity and had similar risk of death at 1 year after ICU admission. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011

Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury.

PURPOSE: Acute kidney injury (AKI) is associated with the activation of the renin-angiotensin system. Whether angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) improve outcome in patients recovering from AKI remains unexplored. The purpose was to investigate the association between prescription of ACEi/ARB at intensive care unit (ICU) discharge and 1-year outcome in patients recovering from AKI. METHODS: Association between ACEi/ARB and 1-year mortality rate was explored in 1551 patients discharged from 21 European ICUs in an observational cohort. One-year all-cause mortality after ICU discharge was the primary endpoint. AKI was defined using the kidney disease improvement global outcome definition. Propensity score matching was used to consider the probability to receive ACEi/ARB at ICU discharge and included chronic heart failure, ACEi/ARB on ICU admission, Charlson Comorbidity Index, age, diabetes mellitus, chronic kidney disease, estimated glomerular filtration rate and arterial blood pressure at ICU discharge vasopressors and renal replacement therapy. RESULTS: Overall, 1-year mortality was 28 and 15% in patients with AKI (n = 611, 39%) and without AKI (n = 940), respectively. In patients with AKI, unadjusted, adjusted and propensity-score matched 1-year mortality rates were lower in patients treated with ACEi/ARB at ICU discharge [HR of 0.55 (0.35-0.89), HR of 0.45 (0.27-0.75), and HR of 0.48 (0.27-0.85, p < 0.001), respectively]. These results were consistent across sensitivity analysis. No association was observed in patients without AKI. CONCLUSIONS: In patients discharged alive from the ICU after experiencing AKI, ACEi/ARB prescription at discharge is associated with a decrease in 1-year mortality. TRIAL REGISTRATION: ClinicalTrials.gov NCT01367093. Registered on 6 June 2011