Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort.

Humans Intensive Care Units Latent Class Analysis Prospective Studies Quality of Life Sepsis / complications Survivors
Biomarkers Latent profile analysis Mixture modeling Personalized medicine Post-intensive care syndrome (PICS) Prognostic enrichment Sepsis

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
21 04 2022
Historique:
received: 31 12 2021
accepted: 27 03 2022
entrez: 22 4 2022
pubmed: 23 4 2022
medline: 26 4 2022
Statut: epublish

Résumé

Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis. In the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge. At ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16-2.60); p = 0.006). A subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 .

Sections du résumé

BACKGROUND
Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis.
METHODS
In the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge.
RESULTS
At ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16-2.60); p = 0.006).
CONCLUSIONS
A subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 .

Identifiants

DOI: 10.1186/s13054-022-03972-8 PMID: 35449071 PMC: PMC9022336
pubmed: 35449071
doi: 10.1186/s13054-022-03972-8
pii: 10.1186/s13054-022-03972-8
pmc: PMC9022336
doi:

Banques de données

ClinicalTrials.gov
['NCT01367093']

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

114

Subventions

Organisme : Programme Hospitalier de la Recherche Clinique
ID : AON 10-216

Investigateurs

Sabri Soussi (S)
Alexandre Mebazaa (A)
Etienne Gayat (E)
Sabri Soussi (S)
Laurent Brochard (L)
John C Marshall (JC)
Margaret Herridge (M)
Claudia C Dos Santos (CC)

Informations de copyright

© 2022. The Author(s).

Références

Clin Infect Dis. 2019 Jul 2;69(2):332-340
pubmed: 30335142
Intensive Care Med. 2018 Dec;44(12):2025-2037
pubmed: 30353380
Crit Care. 2018 Dec 18;22(1):347
pubmed: 30563548
JAMA Netw Open. 2019 Aug 2;2(8):e198686
pubmed: 31390038
JAMA. 2018 Jan 2;319(1):62-75
pubmed: 29297082
Eur J Heart Fail. 2020 Feb;22(2):279-286
pubmed: 31472039
JAMA. 2019 May 28;321(20):2003-2017
pubmed: 31104070
Crit Care Med. 2019 Dec;47(12):e953-e961
pubmed: 31567524
Am J Respir Crit Care Med. 2019 Oct 15;200(8):972-981
pubmed: 31161771
Int J Surg. 2014 Dec;12(12):1500-24
pubmed: 25046751
Am J Cardiol. 2010 Jan 4;105(1 Suppl):30A-5A
pubmed: 20102971
Intensive Care Med. 2019 Jan;45(1):78-81
pubmed: 29740669
Am J Respir Crit Care Med. 2016 Oct 1;194(7):831-844
pubmed: 26974173
Crit Care. 2019 Nov 28;23(1):384
pubmed: 31779663
Intensive Care Med. 2018 May;44(5):598-605
pubmed: 29766216
JAMA. 2015 Mar 10;313(10):1055-7
pubmed: 25756444
Am J Epidemiol. 2013 Apr 1;177(7):718-25
pubmed: 23445902
Lancet Respir Med. 2020 Jun;8(6):631-643
pubmed: 32526190
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Intensive Care Med. 2020 Apr;46(4):619-636
pubmed: 31974919
Mol Med. 2019 Dec 31;26(1):6
pubmed: 31892321
JAMA Netw Open. 2020 Sep 1;3(9):e2013580
pubmed: 32926114
BMC Anesthesiol. 2015 Oct 12;15:143
pubmed: 26459405
J Trauma Acute Care Surg. 2012 Jun;72(6):1491-501
pubmed: 22695412
Anesthesiology. 2021 Jan 1;134(1):15-25
pubmed: 33216849
Crit Care. 2018 Jan 18;22(1):8
pubmed: 29347987
Crit Care Med. 2020 Jan;48(1):49-55
pubmed: 31625979
Hypertension. 2020 Feb;75(2):483-491
pubmed: 31838905
Crit Care. 2020 Sep 25;24(1):577
pubmed: 32977833
Crit Care. 2020 Dec 9;24(1):686
pubmed: 33298134
Lancet Respir Med. 2014 Aug;2(8):611-20
pubmed: 24853585
Crit Care. 2020 Apr 15;24(1):150
pubmed: 32295614
J Trauma Acute Care Surg. 2015 Feb;78(2):318-23
pubmed: 25757117
Ann Vasc Surg. 2009 Jul-Aug;23(4):458-64
pubmed: 19128926
J Clin Epidemiol. 2014 Jan;67(1):15-32
pubmed: 24262770
Anesth Analg. 2018 May;126(5):1763-1768
pubmed: 29481436
Crit Care Med. 2017 Oct;45(10):1702-1708
pubmed: 28742549
J Clin Epidemiol. 1994 Nov;47(11):1245-51
pubmed: 7722560

Auteurs

Sabri Soussi (S)

Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada. sabri.soussi@uhn.ca.

Divya Sharma (D)

Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Peter Jüni (P)

Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, M5B 1W8, Canada.
Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Gerald Lebovic (G)

Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, M5B 1W8, Canada.
Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Laurent Brochard (L)

Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada.

John C Marshall (JC)

Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada.

Patrick R Lawler (PR)

Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada.

Margaret Herridge (M)

Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada.

Niall Ferguson (N)

Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada.

Lorenzo Del Sorbo (L)

Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada.

Elodie Feliot (E)

Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France.

Alexandre Mebazaa (A)

Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France.

Erica Acton (E)

Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada.

Jason N Kennedy (JN)

Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

Wei Xu (W)

Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Etienne Gayat (E)

Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France.

Claudia C Dos Santos (CC)

Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Identifying clinical subtypes in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Identifying clinical subtypes in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de regroupements › Analyse de structure latente › Identifying clinical subtypes in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Identifying clinical subtypes in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Identifying clinical subtypes in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Inflammation › Sepsie › Identifying clinical subtypes in...
questionsmedicales.fr › Personnes › Survivants › Identifying clinical subtypes in...