ICU 幸存者长期预后的决定因素：来自 FROG-ICU 研究的结果。
Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study.
机构信息
Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.
Department of Anesthesiology and Intensive Care, University Paris Diderot, INSERM UMR-S 942, Saint Louis-Lariboisière University Hospitals, 2 rue Ambroise Paré, 75010, Paris, France.
出版信息
Crit Care. 2018 Jan 18;22(1):8. doi: 10.1186/s13054-017-1922-8.
BACKGROUND
Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge.
METHODS
FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep).
RESULTS
Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73-4.65), p < 0.001).
CONCLUSIONS
The FROG-ICU study identified, at the time of ICU discharge, potentially actionable clinical and biological factors associated with poor long-term outcome after ICU discharge. Those factors may guide discharge planning and directed interventions.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01367093 . Registered on 6 June 2011.
背景
与普通人群相比，重症监护病房（ICU）幸存者的长期生存率降低。确定 ICU 出院时与不良长期结局相关的参数可能有助于确定高危人群。本研究的主要目的是确定 ICU 出院后一年内死亡的临床和生物学决定因素。
方法
FROG-ICU 是一项前瞻性、观察性、多中心队列研究，对 ICU 幸存者进行了 1 年的随访，包括法国和比利时的 21 个内科、外科或混合 ICU。所有因需要有创机械通气和/或血管活性药物支持而入住 ICU，且 ICU 入住后 24 小时以上仍需要上述支持并从 ICU 出院的患者均被纳入研究。主要观察指标为 ICU 出院后 1 年的全因死亡率。测量了 ICU 出院时的临床和生物学参数，包括循环心血管生物标志物 N 末端脑利钠肽前体、高敏肌钙蛋白 I、生物活性肾上腺髓质素和可溶性 ST2。社会经济状况采用经过验证的剥夺指数（FDep）进行评估。
结果
在 1570 名从 ICU 存活出院的患者中，有 333 名（21%）在随后的 1 年内死亡。多变量分析确定年龄、合并症、红细胞输注、ICU 住院时间以及 ICU 出院时常见临床因素的异常（低收缩压、体温、总蛋白、血小板和白细胞计数）是与 1 年死亡率相关的独立因素。当将心脏和血管衰竭的生物标志物升高加入多变量模型时，它们与 1 年死亡独立相关，当两者结合时，死亡风险增加近 3 倍（校正优势比 2.84（95%置信区间 1.73-4.65），p<0.001）。
结论
FROG-ICU 研究在 ICU 出院时确定了与 ICU 出院后不良长期结局相关的潜在可操作的临床和生物学因素。这些因素可能指导出院计划和有针对性的干预措施。
试验注册
ClinicalTrials.gov NCT01367093。于 2011 年 6 月 6 日注册。
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