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

Sara Thietart; Ariane Boumendil; Dominique Pateron; Bertrand Guidet; Hélène Vallet; Bertrand Guidet; Dominique Pateron; Erwan Debuc; Youri Yordanov; Ariane Boumendil; Caroline Thomas; Didier Dreyfuss; Jean-Damien Ricard; Patrick Brun; Christophe Leroy; Yves Cohen; Frédéric Adnet; Maguy Woimant; Jean-Paul Mira; Benoît Doumenc; Khalil Tku; Thomas Similowski; Bruno Riou; Pierre Hausfater; Samuel Delerme; Jean-Pierre Quenot; Didier Honnart; Jean-François Timsit; Pierrick Guérin; Françoise Carpentier; Maxime Maignan; Foued Makhlou; Jean-François Poussel; Yohann Picard; François Braun; Pauline Trognon; François Fourrier; Patrick Goldstein; Marie Girot; Pierre Gosselin; Francesco Santoli; Pierre Charestan; Claire Poly; Hervé Mentec; Catherine Le Gall; Karima Sahraoui; Christophe Baillard; Nicolas Javaud; Benoît Misset; Maité Garrouste-Orgeas; Olivier Ganansia; François-Xavier Rooryck; Jean Luc Aim; Abudlrazak El Rifai; Jean Reignier; 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

doi:10.1186/s13613-022-01042-4

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

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Sara Thietart

Function : Author
PersonId : 1201545
ORCID : 0000-0002-1137-7247

CHU Saint-Antoine [AP-HP]

Ariane Boumendil

Function : Author

CHU Saint-Antoine [AP-HP]

Dominique Pateron

Function : Author

CHU Saint-Antoine [AP-HP]

Bertrand Guidet

Function : Author
PersonId : 988017
IdHAL : bertrand-guidet
ORCID : 0000-0002-7643-6770
IdRef : 076134350

CHU Saint-Antoine [AP-HP]

Institut Pierre Louis d'Epidémiologie et de Santé Publique

Hélène Vallet

Function : Author
PersonId : 1197639
IdHAL : helene-vallet
ORCID : 0000-0002-3593-5055
IdRef : 185807992

Centre d'Immunologie et des Maladies Infectieuses

CHU Saint-Antoine [AP-HP]

Bertrand Guidet

Function : Author
PersonId : 988017
IdHAL : bertrand-guidet
ORCID : 0000-0002-7643-6770
IdRef : 076134350

CHU Saint-Antoine [AP-HP]

Institut Pierre Louis d'Epidémiologie et de Santé Publique

Dominique Pateron

Function : Author

CHU Saint-Antoine [AP-HP]

Erwan Debuc

Function : Author

Assistance publique - Hôpitaux de Paris (AP-HP)

Youri Yordanov

Function : Author

Institut Pierre Louis d'Epidémiologie et de Santé Publique

CHU Saint-Antoine [AP-HP]

Ariane Boumendil

Function : Author

Institut Pierre Louis d'Epidémiologie et de Santé Publique

CHU Saint-Antoine [AP-HP]

Caroline Thomas

Function : Author

Musée du Louvre

Didier Dreyfuss

Function : Author

Hôpital Louis Mourier - AP-HP [Colombes]

Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée

Jean-Damien Ricard

Function : Author

Hôpital d'instruction des Armées Percy

Patrick Brun

Function : Author

Christophe Leroy

Function : Author

Assistance publique - Hôpitaux de Paris (AP-HP)

Yves Cohen

Function : Author

Hôpital Avicenne [AP-HP]

Frédéric Adnet

Function : Author

Hôpital Avicenne [AP-HP]

SAMU 93 [Bobigny]

Marqueurs cardiovasculaires en situation de stress

Maguy Woimant

Function : Author

Hôpital Avicenne [AP-HP]

Jean-Paul Mira

Function : Author
PersonId : 928244

Institut Cochin

Hôpital Cochin [AP-HP]

Benoît Doumenc

Function : Author

AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]

Khalil Tku

Function : Author

Thomas Similowski

Function : Author

Neurophysiologie Respiratoire Expérimentale et Clinique

CHU Pitié-Salpêtrière [AP-HP]

Bruno Riou

Function : Author

Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases

Pierre Hausfater

Function : Author

Groupe de recherche clinique Biomarqueurs d’urgence et de réanimation

Centre d'Immunologie et des Maladies Infectieuses

Samuel Delerme

Function : Author

Jean-Pierre Quenot

Function : Author
PersonId : 998462
ORCID : 0000-0003-2351-682X
IdRef : 079287654

CHU Dijon

Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques

Didier Honnart

Function : Author

Département de Médecine d'Urgence - Centre Régional Universitaire des Urgences (CRUU) (CHU de Dijon)

Jean-François Timsit

Function : Author
PersonId : 758651
ORCID : 0000-0002-6063-7383
IdRef : 077116313

AP-HP - Hôpital Bichat - Claude Bernard [Paris]

Infection, Anti-microbiens, Modélisation, Evolution

Pierrick Guérin

Function : Author

Françoise Carpentier

Function : Author

Service d'accueil des urgences médicales

Maxime Maignan

Function : Author

Université Grenoble Alpes

Foued Makhlou

Function : Author

Jean-François Poussel

Function : Author

Service de Soins Intensifs [CHR Metz-Thionville]

Yohann Picard

Function : Author

François Braun

Function : Author

Centre hospitalier régional Metz-Thionville

Pauline Trognon

Function : Author

Université Henri Poincaré - Nancy 1

François Fourrier

Function : Author

Département Anesthésie-Réanimation, Hôpital Roger Salengro, CHRU de Lille

Patrick Goldstein

Function : Author

Samu du Nord–pôle de l’urgence [Lille]

Marie Girot

Function : Author

Department of Emergency [Lille]

Pierre Gosselin

Function : Author

Francesco Santoli

Function : Author

Hôpital Robert Ballanger [Aulnay-sous-Bois]

Pierre Charestan

Function : Author

Hôpital Robert Ballanger [Aulnay-sous-Bois]

Claire Poly

Function : Author

Hervé Mentec

Function : Author

Centre Hospitalier Victor Dupouy

Catherine Le Gall

Function : Author

Centre hospitalier Argenteuil

Karima Sahraoui

Function : Author

Christophe Baillard

Function : Author

Hôpital Cochin [AP-HP]

Nicolas Javaud

Function : Author

Hôpital Louis Mourier - AP-HP [Colombes]

Centre de référence national des angiœdèmes

Université Paris Cité

Benoît Misset

Function : Author

Centre Hospitalier Universitaire de Liège

Maité Garrouste-Orgeas

Function : Author

Institut hospitalier Franco-Britannique [Levallois-Perret]

Olivier Ganansia

Function : Author

François-Xavier Rooryck

Function : Author

Hôpital Saint-Joseph

Jean Luc Aim

Function : Author

Abudlrazak El Rifai

Function : Author

Jean Reignier

Function : Author

Centre Hospitalier Universitaire de Nantes = Nantes University Hospital

Laurent Martin-Lefevre

Function : Author

Philippe Fradin

Function : Author

Claire Mauriat

Function : Author

Emelyne Cwicklinski

Function : Author

Michel Slama

Function : Author
PersonId : 940185
ORCID : 0000-0003-4474-4282
IdRef : 059808470

Hervé Dupont

Function : Author
PersonId : 913042
ORCID : 0000-0002-5644-3412
IdRef : 089058127

Christine Ammirati

Function : Author
PersonId : 1329806
ORCID : 0000-0002-2398-276X
IdRef : 070662193

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.

Keywords

Geriatrics Outcome Functional status Intensive care Critical care Geriatrics Outcome Functional status Intensive care Critical care

Domains

Life Sciences [q-bio]

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https://hal.sorbonne-universite.fr/hal-03898625

Submitted on : Saturday, February 25, 2023-2:46:02 PM

Last modification on : Monday, December 9, 2024-3:38:34 AM

Long-term archiving on : Friday, May 26, 2023-6:01:08 PM

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

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HAL Id : hal-03898625 , version 1
DOI : 10.1186/s13613-022-01042-4
PUBMED : 35819563
PUBMEDCENTRAL : PMC9274629

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

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