Days Spent at Home and Mortality After Critical Illness: A Cluster Analysis Using Nationwide Data

BACKGROUND: Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. RESEARCH QUESTION: What are the days spent at home and healthcare trajectories during the year after surviving critical illness? STUDY DESIGN AND METHODS: Data were extracted on adult survivors spending at least two nights in a French intensive care unit (ICU) during 2018 who were treated with invasive mechanical ventilation and/or vasopressors or inotropes. Trauma, burn, organ transplant, stroke and neurosurgical patients were excluded. Stays at home, death, hospitalizations were reported before and after ICU stay, using state sequence analysis. An unsupervised clustering method was performed to identify cohorts based on post-ICU trajectories. RESULTS: Of 77,132 ICU survivors, 89% returned home. In the year post-discharge, these patients spent a median 330 (IQR 283-349) days at home. At one year, 77% of patients were still at home and 17% had died. Fifty-one percent had been re-hospitalized and 10% required a further ICU admission. Forty-eight percent used rehabilitation facilities and 5.7% hospital at home. Three clusters of patients with distinct post-ICU trajectories were identified. Patients in cluster 1 (68% of total) survived and spent most of the year at home (338 (323-354) days). Patients in cluster 2 (18%) had more complex trajectories but most could return home (91%), spending 242 (174-277) days at home. Patients in cluster 3 (14%) died with only 37% returning home for 45 (15-90) days. INTERPRETATION: Many patients had complex healthcare trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge was observed between clusters, which represents an important patient-centered outcome

Evaluation de la performance à l'ANAP : 1ère étape – Des attentes de ses parties prenantes aux valeurs à créer par l'Agence

Identification des parties prenantes de l'ANAP.Objectivation des attentes.Cinq dimensions de la performance de l'ANAP

One-Year Survival and Hospital-Free Days in Critically Illness After Viral Pneumonia

Survivors from critical illness frequently suffer from persistent symptoms and impaired functional status (1, 2). Little is known on long-term outcomes from critical illness specifically related to viral pneumonia. The ability to return home and hospital-free days (HFDs) are important patient-centered outcomes (3–6). In this study, we investigated one-year outcomes (mortality, return to home, and HFDs) in survivors requiring Intensive Care Unit (ICU) admission for seasonal influenza or COVID-19

Association of Age With Short-term and Long-term Mortality Among Patients Discharged From Intensive Care Units in France

International audienc

Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.

BACKGROUND: Cryptococcal infection is a frequent cause of mortality in Cambodian HIV-infected patients with CD4+ count ≤100 cells/µl. This study assessed the cost-effectiveness of three strategies for cryptococcosis prevention in HIV-infected patients. METHODS: A MARKOV DECISION TREE WAS USED TO COMPARE THE FOLLOWING STRATEGIES AT THE TIME OF HIV DIAGNOSIS: no intervention, one time systematic serum cryptococcal antigen (CRAG) screening and treatment of positive patients, and systematic primary prophylaxis with fluconazole. The trajectory of a hypothetical cohort of HIV-infected patients with CD4+ count ≤100 cells/µl initiating care was simulated over a 1-year period (cotrimoxazole initiation at enrollment; antiretroviral therapy within 3 months). Natural history and cost data (US$2009) were from Cambodia. Efficacy data were from international literature. RESULTS: In a population in which 81$ 472) with no intervention, 70% (cost $483) with screening, and 72$ 492) with prophylaxis. After one year of follow-up, the cost-effectiveness of screening vs. no intervention was US$180/life year gained (LYG). The cost-effectiveness of prophylaxis vs. screening was$ 511/LYG. The cost-effectiveness of prophylaxis vs. screening was estimated at $1538/LYG if the proportion of patients with CD4+ count ≤50 cells/µl decreased by 75%. CONCLUSION: In a high endemic area of cryptococcosis and HIV infection, serum CRAG screening and prophylaxis are two cost effective strategies to prevent AIDS associated cryptococcosis in patients with CD4+ count ≤100 cells/µl, at a short-term horizon, screening being more cost-effective but less effective than prophylaxis. Systematic primary prophylaxis may be preferred in patients with CD4+ below 50 cells/µl while systematic serum CRAG screening for early targeted treatment may be preferred in patients with CD4+ between 51-100 cells/µl