Annals of intensive care · 2025
Factors associated with ICU mortality and long-term outcomes in immunocompromised patients admitted to the intensive care unit for acute respiratory failure.
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Métais Mélanie, Frat Jean-Pierre, Ehrmann Stephan, Pène Frédéric, Decavèle Maxens, Terzi Nicolas, Prat Gwenaël, Martin Maëlle, Contou Damien, Gacouin Arnaud, Bourenne Jeremy, Girault Christophe, Vinsonneau Christophe, Dellamonica Jean, Labro Guylaine, Jochmans Sébastien, Herbland Alexandre, Quenot Jean-Pierre, Devaquet Jérôme, Benzekri Dalila, Ragot Stéphanie, Thille Arnaud W, Coudroy Rémi, FLORALI-IM study group and the REVA Research Network
Аннотация
BACKGROUND: Mortality of immunocompromised patients is particularly high in intensive care units (ICUs) and mainly depends on severity at admission. Moreover, mortality is also high during the months following ICU discharge. The reasons for these poor outcomes after ICU discharge have not been adequately studied. RESEARCH QUESTION: We hypothesized that the factors associated with poor outcomes after ICU discharge of immunocompromised patients would be different from those associated with in-ICU mortality.
STUDY DESIGN AND METHODS: This is a post-hoc analysis of a multicenter clinical trial comparing two noninvasive oxygenation strategies in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure. Multivariable analyses were performed to determine early factors (i.e within 6 h of admission) associated with in-ICU mortality, as well as factors associated with poor functional outcomes (i.e death or survival with poor performance status) at 6 months, only in ICU survivors.
RESULTS: Among the 299 patients analyzed, the mortality rate was 31% (94 patients) in the ICU and 49% at 6 months (146 patients). Solid cancer (adjusted odds ratio 2.92 [95% confidence interval, 1.22-7.28]), severity SOFA score at admission (aOR 1.29 [1.14-1.48]), the extent of pulmonary infiltrates on chest X-ray (aOR 1.57 [1.17-2.15]) and increased discomfort one hour after initiation of noninvasive respiratory support (aOR 2.08 [1.12-3.85]) were independently associated with in-ICU mortality. Out of the 202 ICU survivors whose performance status was reported, solid cancer (aOR 3.03 [1.33-9.09]) and poor performance status before ICU admission (aOR 2.43 [1.03-5.88]) were both associated with poor outcome at 6 months, independently from the decision to forgo life-sustaining therapies (aOR 5.88 [2.17-20.00]).
INTERPRETATION: Whereas in-ICU mortality of immunocompromised patients with acute respiratory failure was mainly driven by severity, poor outcomes at 6 months were mainly driven by performance status before ICU admission. Solid cancer was independently associated with both poor short as well as longer-term outcomes. Trial registration Clinical trial registration: NCT04227639.
STUDY DESIGN AND METHODS: This is a post-hoc analysis of a multicenter clinical trial comparing two noninvasive oxygenation strategies in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure. Multivariable analyses were performed to determine early factors (i.e within 6 h of admission) associated with in-ICU mortality, as well as factors associated with poor functional outcomes (i.e death or survival with poor performance status) at 6 months, only in ICU survivors.
RESULTS: Among the 299 patients analyzed, the mortality rate was 31% (94 patients) in the ICU and 49% at 6 months (146 patients). Solid cancer (adjusted odds ratio 2.92 [95% confidence interval, 1.22-7.28]), severity SOFA score at admission (aOR 1.29 [1.14-1.48]), the extent of pulmonary infiltrates on chest X-ray (aOR 1.57 [1.17-2.15]) and increased discomfort one hour after initiation of noninvasive respiratory support (aOR 2.08 [1.12-3.85]) were independently associated with in-ICU mortality. Out of the 202 ICU survivors whose performance status was reported, solid cancer (aOR 3.03 [1.33-9.09]) and poor performance status before ICU admission (aOR 2.43 [1.03-5.88]) were both associated with poor outcome at 6 months, independently from the decision to forgo life-sustaining therapies (aOR 5.88 [2.17-20.00]).
INTERPRETATION: Whereas in-ICU mortality of immunocompromised patients with acute respiratory failure was mainly driven by severity, poor outcomes at 6 months were mainly driven by performance status before ICU admission. Solid cancer was independently associated with both poor short as well as longer-term outcomes. Trial registration Clinical trial registration: NCT04227639.