Advertisement

Intensive Care Medicine

, Volume 44, Issue 12, pp 2025–2037 | Cite as

Association of social deprivation with 1-year outcome of ICU survivors: results from the FROG-ICU study

  • Kathleen Bastian
  • Alexa Hollinger
  • Alexandre Mebazaa
  • Elie Azoulay
  • Elodie Féliot
  • Karine Chevreul
  • Marie-Céline Fournier
  • Bertrand Guidet
  • Morgane Michel
  • Philippe Montravers
  • Sébastien Pili-Floury
  • Romain Sonneville
  • Martin Siegemund
  • Etienne GayatEmail author
  • the FROG-ICU Study Investigators
Original

Abstract

Purpose

Intensive care unit survivors suffer from prolonged impairment, reduced quality of life, and higher mortality rates after discharge compared to the general population. Socioeconomic status may play a partial but important role in mortality and recovery. Therefore, the detection of factors that are responsible for poor long-term outcomes would be beneficial in designing targeted interventions for at-risk populations.

Methods

For an endpoint analysis, 1834 intensive care unit patients with known French Deprivation Index (FDep) scores were included from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study, which was a prospective, observational, multicenter cohort study performed in 20 French intensive care units in 13 different hospitals. Socioeconomic status was defined by using the FDep score [represented as quintiles when referring to the general French population, as quintiles when referring to the FROG-ICU cohort, or as dichotomized data (which was defined as a FDep ≤ 0 for nondeprived patients)] and by using a detailed social questionnaire that was completed 3 months after discharge. The primary outcome included an all-cause, 1-year mortality after ICU discharge when regarding socioeconomic status. The secondary outcomes included both ICU and hospital lengths of stay, both short- and medium-term mortality, and the quality of life, as assessed during the 1-year follow-up by using the Medical Outcome Survey Short Form-36 (SF-36). The Revised Impact of Event Scale (IES-R) was used to evaluate the symptoms of post-traumatic stress disorder, and the Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression.

Results

Of the 1447 patients who were discharged alive from the ICU, 19.2% died over the following year. No association was found between 1-year mortality and socioeconomic status, regardless of whether this association was analyzed in quintiles (p = 0.911 in the quintiles of the general French population; p = 0.589 in the quintiles of the FROG-ICU cohort itself) or as dichotomized data [nondeprived (n = 177; 1-year mortality of 18.2%) versus deprived (n = 97; 1-year mortality of 20.5%; p = 0.304)]. Moreover, no differences were found between the nondeprived and the deprived patients in the ICU and hospital lengths of stay, ICU mortalities, in-hospital mortalities, or 28-day mortalities. The SF-36 was below the score for the normal French population throughout the follow-up period. Socially deprived patients showed significantly lower median scores in the physical function subscale [55, interquartile range (IQR) (28.8–80) vs. 65, IQR (35–90); p = 0.014], the physical role subscale [25, IQR (0–75) vs. 33.3, IQR (0–100); p = 0.022], and the overall physical component scale [47.5, IQR (30–68.8) vs. 54.4, IQR (35–78.8); p = 0.010]. Up to 31.6% of survivors presented symptoms that indicated post-traumatic stress disorder, and up to 31.5% of survivors reported clinically meaningful symptoms of anxiety or depression.

Conclusions

A lower socioeconomic status was associated with lower self-reported physical component scores in the nondeprived patients. Psychiatric symptoms are frequently reported after an ICU stay, and subsequent interventions should target those fields.

Trial registration

ClinicalTrials.gov NCT01367093; registered on June 6, 2011.

Keywords

Socioeconomic status Post-traumatic stress disorder FDep IES-R SF-36 HADS 

Notes

Authors’ contributions

KB, EG, AH, AM, MS: Study concept and design. EG, AM: Acquisition of data. KB, EF, EG, AH, AM, MS: Analysis and interpretation of data. KB, AH: Drafting of the manuscript. EF: Critical revision of the manuscript for important intellectual content: all declared authors. EG, AM: Statistical analysis Obtained funding. EG, AM: Administrative, technical, or material support. EG, AM: Study supervision. All authors read and approved the final manuscript.

Funding

FROG ICU (ClinicalTrials.gov Identifier NCT01367093) was funded by the Programme Hospitalier de la Recherche Clinique (AON 10-216) and by a research grant from the Société Française d’Anesthésie–Réanimation.

Compliance with ethical standards

Ethical approval and consent to participate

The study was conducted in France and Belgium in accordance with Good Clinical Practice (Declaration of Helsinki 2002) and ethics committee approvals (Comité de Protection des Personnes – Ile de France IV, IRB n°00003835 and Commission d’éthique biomédicale hospitalo-facultaire de l’hôpital de Louvain, IRB n°B403201213352). It is registered on ClinicalTrials.gov (NCT01367093). Patients were enrolled from August 2011 to June 2013.

Consent for publication

Consent for study participation was obtained from all included patients.

Availability of supporting data

Prof. Gayat and Prof. Mebazaa had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflicts of interest

None of the authors of this paper has a financial or personal relationship with other persons or organizations that could inappropriately influence or bias the content of the paper. Etienne Gayat received a research grant from sphingotec and consultancy fees from Magnisense and Roche Diagnostics. Alexandre Mebazaa received speaker’s honoraria from Abbott, Novartis, Orion, Roche, and Servier and a fee as a member of the advisory board and/or steering committee from Cardiorentis, Adrenomed, MyCartis, Neurotronik, and sphingotec. Martin Siegemund received speaker’s honoraria from Fresenius, Orion Pharma, and SwissOrpha and a research grant from Octapharma. The original FROG-ICU study was supported by grants from Assistance Publique-Hôpitaux de Paris (AOR01004) and from Société Française d’Anesthésie–Réanimation.

Supplementary material

134_2018_5412_MOESM1_ESM.jpg (37 kb)
Supplementary material 1 (JPEG 36 kb)
134_2018_5412_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 22 kb)
134_2018_5412_MOESM3_ESM.docx (73 kb)
Supplementary material 3 (DOCX 73 kb)
134_2018_5412_MOESM4_ESM.docx (41 kb)
Supplementary material 4 (DOCX 40 kb)
134_2018_5412_MOESM5_ESM.docx (18 kb)
Supplementary material 5 (DOCX 17 kb)
134_2018_5412_MOESM6_ESM.docx (93 kb)
Supplementary material 6 (DOCX 92 kb)

References

  1. 1.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bienvenu OJ, Friedman LA, Colantuoni E, Dinglas VD, Sepulveda KA, Mendez-Tellez P, Shanholz C, Pronovost PJ, Needham DM (2018) Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med 44:38–47CrossRefGoogle Scholar
  3. 3.
    Moitra VK, Guerra C, Linde-Zwirble WT, Wunsch H (2016) Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit Care Med 44:655–662PubMedPubMedCentralGoogle Scholar
  4. 4.
    Graf JJ, Uwe J (2003) Der post-intensivpatient. Langzeitüberleben und lebensqualität nach intensivtherapie. Intensivmed Notfallmedizin 40:184–194CrossRefGoogle Scholar
  5. 5.
    Niskanen M, Kari A, Halonen P (1996) Five-year survival after intensive care–comparison of 12,180 patients with the general population. Finnish ICU study group. Crit Care Med 24:1962–1967CrossRefPubMedGoogle Scholar
  6. 6.
    Riva M, Gauvin L, Barnett TA (2007) Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health 61:853–861CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM (2005) Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 31:611–620CrossRefPubMedGoogle Scholar
  8. 8.
    Alter DA, Franklin B, Ko DT, Austin PC, Lee DS, Oh PI, Stukel TA, Tu JV (2014) Socioeconomic status, functional recovery, and long-term mortality among patients surviving acute myocardial infarction. PLoS One 8:e65130CrossRefPubMedGoogle Scholar
  9. 9.
    Benaïs M, Da Silva D, Ferreira L et al (2018) Socioeconomic status features of ICU patients: the PRECAREA pilot study. Intensive Care Med.  https://doi.org/10.1007/s00134-018-5380-9 CrossRefPubMedGoogle Scholar
  10. 10.
    Adler NE, Ostrove JM (1999) Socioeconomic status and health: what we know and what we don’t. Ann N Y Acad Sci 896:3–15CrossRefPubMedGoogle Scholar
  11. 11.
    Mebazaa A, Casadio MC, Azoulay E, Guidet B, Jaber S, Levy B, Payen D, Vicaut E, Resche-Rigon M, Gayat E (2015) Post-ICU discharge and outcome: rationale and methods of the The [sic] French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) observational study. BMC Anesthesiol 15:143CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305:160–164CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Rash CJ, Coffey SF, Baschnagel JS, Drobes DJ, Saladin ME (2008) Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD. Addict Behav 33:1039–1047CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Murphy D, Ross J, Ashwick R, Armour C, Busuttil W (2017) Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans. Eur J psychotraumatol 8:1398001CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Morina N, Ehring T, Priebe S (2013) Diagnostic utility of the impact of event scale-revised in two samples of survivors of war. PLoS One 8:e83916CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77CrossRefPubMedGoogle Scholar
  17. 17.
    Temam S, Varraso R, Pornet C, Sanchez M, Affret A, Jacquemin B, Clavel-Chapelon F, Rey G, Rican S, Le Moual N (2017) Ability of ecological deprivation indices to measure social inequalities in a French cohort. BMC Public Health 17:956CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Obidoa CA, Reisine SL, Cheniack M (2010) How does the SF-36 perform in healthy populations? A structured review of longitudinal studies. JSBHS 4:30–48Google Scholar
  19. 19.
    Nesseler N, Defontaine A, Launey Y, Morcet J, Malledant Y, Seguin P (2013) Long-term mortality and quality of life after septic shock: a follow-up observational study. Intensive Care Med 39:881–888CrossRefPubMedGoogle Scholar
  20. 20.
    Geyer S, Peter R (2000) Income, occupational position, qualification and health inequalities—competing risks? (comparing indicators of social status). J Epidemiol Community Health 54:299–305CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bouchardy C, Verkooijen HM, Fioretta G (2006) Social class is an important and independent prognostic factor of breast cancer mortality. Int J Cancer 119:1145–1151CrossRefPubMedGoogle Scholar
  22. 22.
    Storm L, Schnegelsberg A, Mackenhauer J, Andersen LW, Jessen MK, Kirkegaard H (2018) Socioeconomic status and risk of intensive care unit admission with sepsis. Acta Anaesthesiol Scand 62:983–992CrossRefPubMedGoogle Scholar
  23. 23.
    Blecha S, Schlitt HJ, Graf BM, Leitzmann M, Bein T (2018) Influence of social characteristics on the duration of treatment, severity of the disease and social support of patients in a surgical intensive care unit. Anaesthesist 67:336–342CrossRefPubMedGoogle Scholar
  24. 24.
    Galiatsatos P, Brigham EP, Pietri J, Littleton K, Hwang S, Grant MC, Hansel NN, Chen ES (2018) The effect of community socioeconomic status on sepsis-attributable mortality. J Crit Care 46:129–133CrossRefPubMedGoogle Scholar
  25. 25.
    Rush B, Wiskar K, Celi LA, Walley KR, Russell JA, McDermid RC, Boyd JH (2018) Association of household income level and in-hospital mortality in patients with sepsis: a nationwide retrospective cohort analysis. J Intensive Care Med 33:551–6CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bradley CJ, Given CW, Roberts C (2001) Disparities in cancer diagnosis and survival. Cancer 91:178–188CrossRefPubMedGoogle Scholar
  27. 27.
    Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, Amin P, Arabi Y, Bajwa EK, Bruhn A, Cerny V, Clarkson K, Heunks L, Kurahashi K, Laake JH, Lorente JA, McNamee L, Nin N, Palo JE, Piquilloud L, Qiu H, Jimenez JIS, Esteban A, McAuley DF, van Haren F, Ranieri M, Rubenfeld G, Wrigge H, Slutsky AS, Pesenti A, Investigators LS, Group ET (2017) Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. Lancet Respir Med 5:627–638CrossRefPubMedGoogle Scholar
  28. 28.
    Gabriel LE, Bailey MJ, Bellomo R, Stow P, Orford N, McGain F, Santamaria J, Scheinkestel C, Pilcher DV (2016) Insurance status and mortality in critically ill patients. Crit Care Resusc 18:43–49PubMedGoogle Scholar
  29. 29.
    OECD iLibrary (2017) Health at a glance.  https://doi.org/10.1787/health_glance-2017-en
  30. 30.
    Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM (2015) Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 43:1121–1129CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Kathleen Bastian
    • 1
    • 2
    • 3
  • Alexa Hollinger
    • 1
    • 2
    • 3
  • Alexandre Mebazaa
    • 1
    • 2
    • 4
  • Elie Azoulay
    • 1
    • 4
  • Elodie Féliot
    • 1
  • Karine Chevreul
    • 5
    • 6
  • Marie-Céline Fournier
    • 1
    • 2
  • Bertrand Guidet
    • 7
  • Morgane Michel
    • 6
  • Philippe Montravers
    • 4
    • 8
  • Sébastien Pili-Floury
    • 9
    • 10
  • Romain Sonneville
    • 11
  • Martin Siegemund
    • 3
  • Etienne Gayat
    • 1
    • 2
    • 4
    Email author return OK on get
  • the FROG-ICU Study Investigators
  1. 1.Department of Anaesthesiology and Reanimation, Burn and Critical Care MedicineAP-HP, Saint Louis and Lariboisière University HospitalsParisFrance
  2. 2.INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT NetworkParisFrance
  3. 3.Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain TherapyUniversity Hospital BaselBaselSwitzerland
  4. 4.Université Paris Diderot-Paris 7, Sorbonne Paris CitéParisFrance
  5. 5.INSERM UMR1123ParisFrance
  6. 6.Unité de Recherche Clinique en Économie de la Santé d’Ile-de-FranceParisFrance
  7. 7.Service de Réanimation Médicale, Hôpital Saint-AntoineAssistance Publique-Hôpitaux de Paris, Université Pierre et Marie CurieParisFrance
  8. 8.Department of Anesthesiology and Intensive Care, Bichat University HospitalAssistance Publique-Hôpitaux de ParisParisFrance
  9. 9.Department of Anesthesiology and Intensive Care MedicineBesançon University HospitalBesançonFrance
  10. 10.EA 3920University of Bourgogne Franche-ComtéBesançonFrance
  11. 11.Department of Intensive Care Medicine and Infectious DiseasesUniversité Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-ClaudeParisFrance

Personalised recommendations