Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study.
Critically ill
Deprivation
Intensive care unit
Socioeconomic
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
11 Feb 2020
11 Feb 2020
Historique:
received:
22
06
2019
accepted:
02
02
2020
entrez:
13
2
2020
pubmed:
13
2
2020
medline:
13
2
2020
Statut:
epublish
Résumé
The influence of socioeconomic status on patient outcomes is unclear. We assessed the impact of socioeconomic deprivation on severity of illness at intensive care unit (ICU) admission, and on the risk of death at 3 months after ICU admission. The IVOIRE study was a prospective, observational, multicentre cohort study in the ICU of 8 participating hospitals in France, including patients aged ≥ 18 years admitted to the ICU and receiving at least one life support therapy for organ failure. The primary outcomes were severity at admission (assessed by SAPSII score), and mortality at 3 months. Socioeconomic data were obtained from interviews with patients or family. Deprivation was assessed using the EPICES score. Among 1294 patents included between 2013 and 2016, 629 (48.6%) were classed as deprived and differed significantly from non-deprived subjects in terms of sociodemographic characteristics and pre-existing conditions. The mean SAPS II score at admission was 50.1 ± 19.4 in deprived patients and 52.3 ± 17.3 in non-deprived patients, with no significant difference by multivariable analysis (β = - 1.85 [95% CI - 3.86; + 0.16, p = 0.072]). The proportion of death was 31.1% at 3 months, without significant differences between deprived and non-deprived patients, even after adjustment for confounders. Deprivation is frequent in patients admitted to the ICU and is not associated with disease severity at admission, or with mortality at 3 months between deprived and non-deprived patients. Trial registration The IVOIRE cohort is registered with ClinicalTrials.gov under the identifier NCT01907581, registration date 17/7/2013.
Sections du résumé
BACKGROUND
BACKGROUND
The influence of socioeconomic status on patient outcomes is unclear. We assessed the impact of socioeconomic deprivation on severity of illness at intensive care unit (ICU) admission, and on the risk of death at 3 months after ICU admission.
METHODS
METHODS
The IVOIRE study was a prospective, observational, multicentre cohort study in the ICU of 8 participating hospitals in France, including patients aged ≥ 18 years admitted to the ICU and receiving at least one life support therapy for organ failure. The primary outcomes were severity at admission (assessed by SAPSII score), and mortality at 3 months. Socioeconomic data were obtained from interviews with patients or family. Deprivation was assessed using the EPICES score.
RESULTS
RESULTS
Among 1294 patents included between 2013 and 2016, 629 (48.6%) were classed as deprived and differed significantly from non-deprived subjects in terms of sociodemographic characteristics and pre-existing conditions. The mean SAPS II score at admission was 50.1 ± 19.4 in deprived patients and 52.3 ± 17.3 in non-deprived patients, with no significant difference by multivariable analysis (β = - 1.85 [95% CI - 3.86; + 0.16, p = 0.072]). The proportion of death was 31.1% at 3 months, without significant differences between deprived and non-deprived patients, even after adjustment for confounders.
CONCLUSIONS
CONCLUSIONS
Deprivation is frequent in patients admitted to the ICU and is not associated with disease severity at admission, or with mortality at 3 months between deprived and non-deprived patients. Trial registration The IVOIRE cohort is registered with ClinicalTrials.gov under the identifier NCT01907581, registration date 17/7/2013.
Identifiants
pubmed: 32048075
doi: 10.1186/s13613-020-0637-1
pii: 10.1186/s13613-020-0637-1
pmc: PMC7013026
doi:
Banques de données
ClinicalTrials.gov
['NCT01907581']
Types de publication
Journal Article
Langues
eng
Pagination
20Subventions
Organisme : PHRC Interregional
ID : A00095-40
Organisme : ANR
ID : ANR-11-LABX-0021-01-LipSTIC Labex
Investigateurs
Bruno Lévy
(B)
Jérémie Lemarié
(J)
Cyril Cadoz
(C)
Antoine Marchalot
(A)
Alexandra Monnier
(A)
Yannick Rabouel
(Y)
Références
Intensive Care Med. 2018 Dec;44(12):2025-2037
pubmed: 30353380
Intensive Care Med. 2012 Apr;38(4):612-9
pubmed: 22273749
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Intensive Care Med. 2017 Jul;43(7):992-1001
pubmed: 28534110
Lancet Neurol. 2006 Feb;5(2):181-8
pubmed: 16426994
Health Policy. 2014 Jan;114(1):31-40
pubmed: 23927846
Lancet Public Health. 2017 May 10;2(6):e267-e276
pubmed: 28626829
Nicotine Tob Res. 2017 Nov 7;19(12):1401-1407
pubmed: 27679607
Eur J Public Health. 2015 Aug;25(4):604-9
pubmed: 25624273
Crit Care Nurse. 2015 Jun;35(3):55-61
pubmed: 26033101
Crit Care. 2013 May 28;17(3):R100
pubmed: 23714692
JAMA. 1963 Sep 21;185:914-9
pubmed: 14044222
Rev Epidemiol Sante Publique. 2007 Apr;55(2):97-105
pubmed: 17434278
Intensive Care Med. 2000 Jul;26(7):929-33
pubmed: 10990108
Eur J Epidemiol. 2013 Oct;28(10):807-14
pubmed: 24037117
Intensive Care Med. 2003 Mar;29(3):368-77
pubmed: 12536269
BMC Med. 2014 Mar 12;12:42
pubmed: 24618083
N Engl J Med. 2008 Jun 5;358(23):2468-81
pubmed: 18525043
Occup Environ Med. 2013 Sep;70(9):663-9
pubmed: 23739492
J Epidemiol Community Health. 2003 Jun;57(6):424-8
pubmed: 12775787
Obes Rev. 2015 Nov;16(11):988-1000
pubmed: 26317685
Crit Care Med. 2011 Mar;39(3):429-35
pubmed: 21187746
JAMA. 1998 Feb 25;279(8):585-92
pubmed: 9486752
Crit Care Med. 2015 Jun;43(6):1246-54
pubmed: 25793435
Crit Care. 2018 Jan 18;22(1):8
pubmed: 29347987
Crit Care Med. 1985 Oct;13(10):818-29
pubmed: 3928249
Chest. 2011 May;139(5):1025-1033
pubmed: 21292758
BMC Public Health. 2015 Apr 18;15:400
pubmed: 25928558
J Crit Care. 2010 Sep;25(3):382-90
pubmed: 20074907
Acta Anaesthesiol Scand. 2018 Aug;62(7):983-992
pubmed: 29569230
Presse Med. 2004 Jun 19;33(11):710-5
pubmed: 15257227
J Clin Epidemiol. 2017 Nov;91:137-145
pubmed: 28859989
Stroke. 2008 Aug;39(8):2191-6
pubmed: 18535278
Intensive Care Med. 2010 Jul;36(7):1196-201
pubmed: 20221748
IARC Sci Publ. 1997;(138):65-176
pubmed: 9353664
Diabetes Metab. 2012 Feb;38(1):82-5
pubmed: 22172401
Cancer Causes Control. 2003 Oct;14(8):761-6
pubmed: 14674740
Sante Publique. 2006 Dec;18(4):513-22
pubmed: 17294755
J Epidemiol Community Health. 2017 Jun;71(6):565-575
pubmed: 27682963
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Int J Epidemiol. 2014 Jun;43(3):721-30
pubmed: 23716619
Sante Publique. 2018 Dec 19;30(5):617-621
pubmed: 30767478
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
J Clin Epidemiol. 1991;44(9):889-94
pubmed: 1890431
JAMA. 2001 Oct 10;286(14):1754-8
pubmed: 11594901
Scand J Public Health. 2015 Nov;43(7):677-86
pubmed: 26138729
Int J Surg. 2014 Dec;12(12):1495-9
pubmed: 25046131
PLoS Med. 2007 Oct 16;4(10):e297
pubmed: 17941715
Arch Surg. 2008 Oct;143(10):945-9
pubmed: 18936372