Association of social deprivation with 1-year outcome of ICU survivors: results from the FROG-ICU study
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.
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.
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.
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.
ClinicalTrials.gov NCT01367093; registered on June 6, 2011.
KeywordsSocioeconomic status Post-traumatic stress disorder FDep IES-R SF-36 HADS
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.
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.
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