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Journal Articles Annals of Intensive Care Year : 2022

Impact on 6-month outcomes of hospital trajectory in critically ill older patients: analysis of the ICE-CUB2 clinical trial

Sara Thietart (1) , Ariane Boumendil (1) , Dominique Pateron (1) , Bertrand Guidet (1, 2) , Hélène Vallet (3, 1) , Bertrand Guidet (1, 2) , Dominique Pateron (1) , Erwan Debuc (4) , Youri Yordanov (2, 1) , Ariane Boumendil (2, 1) , Caroline Thomas (5) , Didier Dreyfuss (6, 7) , Jean-Damien Ricard (8) , Patrick Brun , Christophe Leroy (4) , Yves Cohen (9) , Frédéric Adnet (9, 10, 11) , Maguy Woimant (9) , Jean-Paul Mira (12, 13) , Benoît Doumenc (14) , Khalil Tku , Thomas Similowski (15, 16) , Bruno Riou (17) , Pierre Hausfater (18, 3) , Samuel Delerme , Jean-Pierre Quenot (19, 20) , Didier Honnart (21) , Jean-François Timsit (22, 23) , Pierrick Guérin , Françoise Carpentier (24) , Maxime Maignan (25) , Foued Makhlou , Jean-François Poussel (26) , Yohann Picard , François Braun (27) , Pauline Trognon (28) , François Fourrier (29) , Patrick Goldstein (30) , Marie Girot (31) , Pierre Gosselin (32) , Francesco Santoli (33) , Pierre Charestan (33) , Claire Poly , Hervé Mentec (34) , Catherine Le Gall (35) , Karima Sahraoui , Christophe Baillard (13) , Nicolas Javaud (6, 36, 37) , Benoît Misset (38) , Maité Garrouste-Orgeas (39) , Olivier Ganansia , François-Xavier Rooryck (40) , Jean Luc Aim , Abudlrazak El Rifai , Jean Reignier (41) , Laurent Martin-Lefevre , Philippe Fradin , Claire Mauriat , Emelyne Cwicklinski , Michel Slama , Hervé Dupont , Christine Ammirati , Justine Gallou , Muriel Fartoukh , Michel Djibre , Patrik Ray , Edwin Rouff , Bertrand Souweine , Ali Ait Hssain , Jeannot Schmidt , Daniel Pic , Farès Moustafa , Alain Mercat , Nicolas Lerolle , Pierre-Marie Roy , Frédéric Baud , Patrick Plaisance , Sophie Montagnon , Bertrand Galichon , Michel Wolff , Bruno Mourvillier , Enrique Casalino , Christophe Choquet , Julien Bernard , Gaëlle Juillien , Jean-Yves Fagon , Emmanuel Guerot , Philippe Juvin , Anabela Patzak , Bruno Verdière , Vincent Ioos , Marie-Clément Kouka , Audrey Berthoumieu , Christian Richard , Raphael Maurice , Sophie Sarnel , Stéphane Diez , Antoine Vieillard Baron , Sébastien Beaune , Julie Grenet , Sylvie Azerad , Guillaume Leblanc , Tabassome Simon
1 CHU Saint-Antoine [AP-HP]
2 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
3 CIMI - Centre d'Immunologie et des Maladies Infectieuses
4 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
5 Musée du Louvre
6 Hôpital Louis Mourier - AP-HP [Colombes]
7 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
8 Hôpital d'instruction des Armées Percy
9 Hôpital Avicenne [AP-HP]
10 SAMU 93 [Bobigny]
11 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
12 IC UM3 (UMR 8104 / U1016) - Institut Cochin
13 Hôpital Cochin [AP-HP]
14 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
15 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
16 CHU Pitié-Salpêtrière [AP-HP]
17 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
18 GRC 14 - BIOSFAST - Groupe de recherche clinique Biomarqueurs d’urgence et de réanimation
19 CHU Dijon
20 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
21 Département de Médecine d'Urgence - Centre Régional Universitaire des Urgences (CRUU) (CHU de Dijon)
22 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
23 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
24 Service d'accueil des urgences médicales
25 UGA - Université Grenoble Alpes
26 Service de Soins Intensifs [CHR Metz-Thionville]
27 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
28 UHP - Université Henri Poincaré - Nancy 1
29 Département Anesthésie-Réanimation, Hôpital Roger Salengro, CHRU de Lille
30 Samu du Nord–pôle de l’urgence [Lille]
31 Department of Emergency [Lille]
32 IF - Institut Fourier
33 Hôpital Robert Ballanger [Aulnay-sous-Bois]
34 Centre Hospitalier Victor Dupouy
35 CH Argenteuil - Centre hospitalier Argenteuil
36 CREAK - Centre de référence national des angiœdèmes
37 UPCité - Université Paris Cité
38 CHU-Liège - Centre Hospitalier Universitaire de Liège
39 Institut hospitalier Franco-Britannique [Levallois-Perret]
40 Hôpital Saint-Joseph
41 CHU Nantes - Centre Hospitalier Universitaire de Nantes
Sara Thietart
Caroline Thomas
  • Function : Author
Patrick Brun
  • Function : Author
Jean-Paul Mira
  • Function : Author
  • PersonId : 928244
Khalil Tku
  • Function : Author
Samuel Delerme
  • Function : Author
Pierrick Guérin
  • Function : Author
Foued Makhlou
  • Function : Author
Yohann Picard
  • Function : Author
Pierre Gosselin
  • Function : Author
Claire Poly
  • Function : Author
Karima Sahraoui
  • Function : Author
Olivier Ganansia
  • Function : Author
Jean Luc Aim
  • Function : Author
Abudlrazak El Rifai
  • Function : Author
Laurent Martin-Lefevre
  • Function : Author
Philippe Fradin
  • Function : Author
Claire Mauriat
  • Function : Author
Emelyne Cwicklinski
  • Function : Author
Michel Slama
Hervé Dupont
Christine Ammirati
Justine Gallou
  • Function : Author
Muriel Fartoukh
  • Function : Author
Michel Djibre
  • Function : Author
Patrik Ray
  • Function : Author
Edwin Rouff
  • Function : Author
Bertrand Souweine
  • Function : Author
Ali Ait Hssain
  • Function : Author
Jeannot Schmidt
  • Function : Author
Daniel Pic
  • Function : Author
Farès Moustafa
  • Function : Author
Alain Mercat
  • Function : Author
Nicolas Lerolle
  • Function : Author
Pierre-Marie Roy
  • Function : Author
Frédéric Baud
  • Function : Author
Patrick Plaisance
  • Function : Author
Sophie Montagnon
  • Function : Author
Bertrand Galichon
  • Function : Author
Michel Wolff
  • Function : Author
Bruno Mourvillier
  • Function : Author
Enrique Casalino
  • Function : Author
Christophe Choquet
  • Function : Author
Julien Bernard
  • Function : Author
Gaëlle Juillien
  • Function : Author
Jean-Yves Fagon
  • Function : Author
Emmanuel Guerot
  • Function : Author
Philippe Juvin
  • Function : Author
Anabela Patzak
  • Function : Author
Bruno Verdière
  • Function : Author
Vincent Ioos
  • Function : Author
Marie-Clément Kouka
  • Function : Author
Audrey Berthoumieu
  • Function : Author
Christian Richard
  • Function : Author
Raphael Maurice
  • Function : Author
Sophie Sarnel
  • Function : Author
Stéphane Diez
  • Function : Author
Antoine Vieillard Baron
  • Function : Author
Sébastien Beaune
  • Function : Author
Julie Grenet
  • Function : Author
Sylvie Azerad
  • Function : Author
Guillaume Leblanc
  • Function : Author
Tabassome Simon
  • Function : Author

Abstract

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.
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Dates and versions

hal-03898625 , version 1 (25-02-2023)

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Sara Thietart, Ariane Boumendil, Dominique Pateron, Bertrand Guidet, Hélène Vallet, et al.. Impact on 6-month outcomes of hospital trajectory in critically ill older patients: analysis of the ICE-CUB2 clinical trial. Annals of Intensive Care, 2022, 12 (1), pp.65. ⟨10.1186/s13613-022-01042-4⟩. ⟨hal-03898625⟩
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