Impact of Legal Protection on Life-Support Interventions and 3-Month Mortality in the Intensive Care Unit: The Vulne-Rea Study.

Background/

Objectives

Adults under legal protection experience management delays and prolonged hospitalization. This study investigated whether ICU outcomes differ between patients with versus without legal protection.

Methods

This retrospective, single-center study evaluated patients admitted to a French ICU (July 2015-July 2023). Protected patients were compared to autonomous controls matched 1:3 by age and admission year.

Results

Of the 1051 patients included, 266 (25.3%) were under legal protection. The protected group had a higher proportion of women (43.2% vs. 35.7%, p = 0.025), received renal replacement therapy less frequently (8.6% vs. 15.4%, p = 0.007), and required non-invasive ventilation more frequently (25.2% vs. 17.2%, p = 0.004) than controls. Three-month mortality was 38.7% in controls versus 33.1% in protected patients, showing no significant difference after multivariable adjustment for 6 prespecified clinical variables (aOR 0.816, 95% CI 0.564 to 1.180). In the adjusted model, higher SAPS II scores and vasopressor use were significantly associated with increased 3-month mortality, whereas non-invasive ventilation and non-respiratory admission indications (sepsis, renal failure, trauma) were associated with decreased mortality.

Conclusions

No significant association was observed between the presence of a legal protection measure prior to ICU admission and 3-month patient mortality. However, these results must be interpreted with caution due to a potential lack of statistical power. Additionally, legally protected patients were observed to receive renal replacement therapy less frequently, whereas non-invasive ventilation was utilized more frequently. Within this context, further research is required to evaluate the impact of legal protection status on the formal collegial deliberations that lead to decisions regarding the limitation of life-sustaining treatments.