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Huang J, Cai Y, Wu X, Huang X, Liu J, Hu D. Prediction of mortality events of patients with acute heart failure in intensive care unit based on deep neural network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 256:108403. [PMID: 39236563 DOI: 10.1016/j.cmpb.2024.108403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Acute heart failure (AHF) in the intensive care unit (ICU) is characterized by its criticality, rapid progression, complex and changeable condition, and its pathophysiological process involves the interaction of multiple organs and systems. This makes it difficult to predict in-hospital mortality events comprehensively and accurately. Traditional analysis methods based on statistics and machine learning suffer from insufficient model performance, poor accuracy caused by prior dependence, and difficulty in adequately considering the complex relationships between multiple risk factors. Therefore, the application of deep neural network (DNN) techniques to the specific scenario, predicting mortality events of patients with AHF under intensive care, has become a research frontier. METHODS This research utilized the MIMIC-IV critical care database as the primary data source and employed the synthetic minority over-sampling technique (SMOTE) to balance the dataset. Deep neural network models-backpropagation neural network (BPNN) and recurrent neural network (RNN), which are based on electronic medical record data mining, were employed to investigate the in-hospital death event judgment task of patients with AHF under intensive care. Additionally, multiple single machine learning models and ensemble learning models were constructed for comparative experiments. Moreover, we achieved various optimal performance combinations by modifying the classification threshold of deep neural network models to address the diverse real-world requirements in the ICU. Finally, we conducted an interpretable deep model using SHapley Additive exPlanations (SHAP) to uncover the most influential medical record features for each patient from the aspects of global and local interpretation. RESULTS In terms of model performance in this scenario, deep neural network models outperform both single machine learning models and ensemble learning models, achieving the highest Accuracy, Precision, Recall, F1 value, and Area under the ROC curve, which can reach 0.949, 0.925, 0.983, 0.953, and 0.987 respectively. SHAP value analysis revealed that the ICU scores (APSIII, OASIS, SOFA) are significantly correlated with the occurrence of in-hospital fatal events. CONCLUSIONS Our study underscores that DNN-based mortality event classifier offers a novel intelligent approach for forecasting and assessing the prognosis of AHF patients in the ICU. Additionally, the ICU scores stand out as the most predictive features, which implies that in the decision-making process of the models, ICU scores can provide the most crucial information, making the greatest positive or negative contribution to influence the incidence of in-hospital mortality among patients with acute heart failure.
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Affiliation(s)
- Jicheng Huang
- School of Life Sciences, Central South University, Changsha, China
| | - Yufeng Cai
- School of Life Sciences, Central South University, Changsha, China
| | - Xusheng Wu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Xin Huang
- School of Life Sciences, Central South University, Changsha, China
| | - Jianwei Liu
- School of Life Sciences, Central South University, Changsha, China
| | - Dehua Hu
- School of Life Sciences, Central South University, Changsha, China.
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Ning YL, Xu XH, Ma QQ, Zhang Y, Zhou JH, Sun C. Association between early blood glucose dynamic trajectory and mortality for critically ill patients with heart failure: Insights from real-world data. Diabetes Res Clin Pract 2024; 216:111822. [PMID: 39154657 DOI: 10.1016/j.diabres.2024.111822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/26/2024] [Accepted: 08/16/2024] [Indexed: 08/20/2024]
Abstract
AIMS This study endeavors to explore the ramifications of early dynamic blood glucose (BG) trajectories within the initial 48 h of intensive care unit (ICU) admission on mortality among critically ill heart failure (HF) patients. METHODS The study employed a retrospective observational design, analyzing dynamic BG data of HF patients from the Medical Information Mart for Intensive Care IV database. The BG trajectory subphenotypes were identified using the hierarchical clustering based on the dynamic time-warping algorithm. The primary outcome of the study was 28-day mortality, with secondary outcomes including 180-day and 1-year mortality. RESULTS We screened a total of 21,098 HF patients and finally 15,092 patients were included in the study. Our results identified three distinct BG trajectory subphenotypes: increasing (n = 3503), stabilizing (n = 6250), and decreasing (n = 5339). The increasing subphenotype was associated with the highest mortality risk at 28 days, 180 days, and 1 year. The stabilizing and decreasing subphenotypes showed significantly lower mortality risks across all time points, with hazard ratios ranging from 0.85 to 0.88 (P<0.05 for all). Sensitivity analyses confirmed the robustness of these findings after adjusting for various covariates. CONCLUSIONS Increasing BG trajectory within 48 h of admission is significantly associated with higher mortality in patients with HF. It is necessary to devote greater attention to the early BG dynamic changes in HF patients to optimize clinical BG management and enhance patient prognosis.
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Affiliation(s)
- Yi-Le Ning
- Department of Pulmonary and Critical Care Medicine (PCCM), Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China; The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang-Hui Xu
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Critical Care Medicine, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qian-Qian Ma
- Department of Pulmonary and Critical Care Medicine (PCCM), Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yu Zhang
- Department of Critical Care Medicine, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
| | - Ji-Hong Zhou
- Department of Pulmonary and Critical Care Medicine (PCCM), Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
| | - Ce Sun
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Fountoulaki K, Ventoulis I, Drokou A, Georgarakou K, Parissis J, Polyzogopoulou E. Emergency department risk assessment and disposition of acute heart failure patients: existing evidence and ongoing challenges. Heart Fail Rev 2023; 28:781-793. [PMID: 36123519 PMCID: PMC9485013 DOI: 10.1007/s10741-022-10272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/02/2022]
Abstract
Heart failure (HF) is a global public health burden, characterized by frequent emergency department (ED) visits and hospitalizations. Identifying successful strategies to avoid admissions is crucial for the management of acutely decompensated HF, let alone resource utilization. The primary challenge for ED management of patients with acute heart failure (AHF) lies in the identification of those who can be safely discharged home instead of being admitted. This is an elaborate decision, based on limited objective evidence. Thus far, current biomarkers and risk stratification tools have had little impact on ED disposition decision-making. A reliable definition of a low-risk patient profile is warranted in order to accurately identify patients who could be appropriate for early discharge. A brief period of observation can facilitate risk stratification and allow for close monitoring, aggressive treatment, continuous assessment of response to initial therapy and patient education. Lung ultrasound may represent a valid bedside tool to monitor cardiogenic pulmonary oedema and determine the extent of achieved cardiac unloading after treatment in the observation unit setting. Safe discharge mandates multidisciplinary collaboration and thoughtful assessment of socioeconomic and behavioural factors, along with a clear post-discharge plan put forward and a close follow-up in an outpatient setting. Ongoing research to improve ED risk stratification and disposition of AHF patients may mitigate the tremendous public health challenge imposed by the HF epidemic.
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Affiliation(s)
- Katerina Fountoulaki
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece.
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200, Ptolemaida, Greece
| | - Anna Drokou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
| | - Kyriaki Georgarakou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
| | - John Parissis
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
| | - Effie Polyzogopoulou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
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Grupper A, Chernomordik F, Herscovici R, Mazin I, Segev A, Beigel R, Matetzky S. The burden of heart failure in cardiac intensive care unit: a prospective 7 years analysis. ESC Heart Fail 2023; 10:1615-1622. [PMID: 36802123 DOI: 10.1002/ehf2.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/20/2023] Open
Abstract
AIMS The profiles of patients at cardiac intensive care units (CICU) have evolved towards a patient population with an increasing number of co-morbid medical conditions and acute heart failure (HF). The current study was designed to illustrate the burden of HF patients admitted to CICU, and evaluate patient characteristics, in-hospital course and outcomes of CICU patients with HF compared with patients with acute coronary syndrome (ACS). METHODS AND RESULTS A prospective study including all consecutive patients admitted to the CICU at a tertiary medical centre between 2014 and 2020. The main outcome was a direct comparison between HF and ACS patients in processes of care, resource use, and outcomes during CICU hospitalization. A secondary analysis compared ischaemic versus non-ischaemic HF aetiology. Adjusted analysis evaluated parameters associated with prolonged hospitalization. The cohort included 7674 patients with a total annual CICU admissions of 1028-1145 patients. HF diagnosis patients represented 13-18% of the annual CICU admissions and were significantly older with higher incidence of multiple co-morbidities compared with patients with ACS. HF patients also required more intensive therapies and demonstrated higher incidence of acute complications as compared with ACS patients. Length of stay at the CICU was significantly longer among HF patients compared with patients with ACS (either STEMI or NSTEMI) (6.2 ± 4.3 vs. 4.1 ± 2.5 vs. 3.5 ± 2.1, respectively, P < 0.001). HF patients represented a disproportionately higher amount of total CICU patient days during the study period, as the total length of hospitalization of HF patients was 44-56% out of the total cumulative days in CICU of patients with ACS every year. In hospital mortality rates were also significantly higher among patients with HF compared with STEMI or NSTEMI (4.2% vs. 3.1% vs. 0.7%, respectively, P < 0.001). Despite several differences in baseline characteristics between patients with ischaemic versus non-ischaemic HF, which can be attributed mainly to disease aetiology, hospitalization length and outcomes were similar among the groups regardless of HF aetiology. In multivariable analysis for the risk of prolonged hospitalization in the CICU adjusted to potential significant co-morbidities associated with poor outcomes, HF was found to be an independent and significant parameter associated with the risk of prolonged hospitalization with an OR of 3.5 (95% CI 2.9-4.1, P < 0.001). CONCLUSIONS Patients with HF in CICU have higher severity of illness with a prolonged and complicated hospital course, all of which can substantially increase the burden on clinical resources.
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Affiliation(s)
- Avishay Grupper
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Fernando Chernomordik
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Romana Herscovici
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Israel Mazin
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amitai Segev
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Beigel
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomi Matetzky
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-Ha'Shomer, Ramat-Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Cheshire C, Bhagra CJ, Bhagra SK. A review of the management of patients with advanced heart failure in the intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:828. [PMID: 32793673 PMCID: PMC7396251 DOI: 10.21037/atm-20-1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite progress in the medical and device therapy for heart failure (HF), the prognosis for those with advanced HF remains poor. Acute heart failure (AcHF) is the rapid development of, or worsening of symptoms and signs of HF typically leading to hospitalization. Whilst many HF decompensations are managed at a ward-based level, a proportion of patients require higher acuity care in the intensive care unit (ICU). Admission to ICU is associated with a higher risk of in-hospital mortality, and in those who fail to respond to standard supportive and medical therapy, a proportion maybe suitable for mechanical circulatory support (MCS). The optimal pre-operative management of advanced HF patients awaiting durable MCS or cardiac transplantation (CTx) is vital in improving both short and longer-term outcomes. This review will summarize the clinical assessment, hemodynamic profiling and management of the patient with AcHF in the ICU. The general principles of pre-surgical optimization encompassing individual systems (the kidneys, the liver, blood and glycemic control) will be discussed. Other factors impacting upon post-operative outcomes including nutrition and sarcopenia and pre-surgical skin decolonization have been included. Issues specific to durable MCS including the assessment of the right ventricle and strategies for optimization will also be discussed.
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Affiliation(s)
- Caitlin Cheshire
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Catriona Jane Bhagra
- Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sai Kiran Bhagra
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Mercier G, Duflos C, Riondel A, Delmas C, Manzo-Silberman S, Leurent G, Elbaz M, Bonnefoy-Cudraz E, Henry P, Roubille F. Admissions to intensive cardiac care units in France in 2014: A cross-sectional, nationwide population-based study. Medicine (Baltimore) 2018; 97:e12677. [PMID: 30290655 PMCID: PMC6200530 DOI: 10.1097/md.0000000000012677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Geographic variation in admission to the intensive cardiac care unit (ICCU) might question about the efficiency and the equity of the healthcare system. The aim was to explain geographic variation in the rate of admission to ICCU for coronary artery disease (CAD) or heart failure (HF) in France.We conducted a retrospective study based on the French national hospital discharge database. All inpatient stays for CAD or HF with an admission to an ICCU in 2014 were included. We estimated population-based age and sex-standardized ICCU admission rates at the department level. We separately modeled the department-level admission rates for HF and CAD using generalized linear models.In all, 61,010 stays for CAD and 27,828 stays for HF had at least 1 ICCU admission. The ICCU admission rates were explained by the admission rate for CAD, by the diabetes prevalence, by the proportion of the population >75 years, and by the drive time to the ICCU.This work sheds light on the finding of substantial geographic variation in the ICCU admission rates for CAD and HF in France. This variation is explained by both the age and the health status of the population and also by the drive time to the closest ICCU for HF. Moreover, ICCU admission for HF might be more prone to unwarranted variations due to medical practice patterns.
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Affiliation(s)
- Grégoire Mercier
- Economic Evaluation Unit, University Hospital of Montpellier
- CEPEL, UMR CNRS Université de Montpellier, Montpellier
| | - Claire Duflos
- Economic Evaluation Unit, University Hospital of Montpellier
| | - Adeline Riondel
- Economic Evaluation Unit, University Hospital of Montpellier
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, University Hospital of Rangueil, Toulouse
| | - Stéphane Manzo-Silberman
- Department of cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris
| | - Guillaume Leurent
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology department, University Hospital of Rangueil, Toulouse
| | | | - Patrick Henry
- Department of cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex, France
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Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction. Ann Am Thorac Soc 2018; 14:943-951. [PMID: 28208030 DOI: 10.1513/annalsats.201611-847oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Admission to an intensive care unit (ICU) may be beneficial to patients with pneumonia with uncertain ICU needs; however, evidence regarding the association between ICU admission and mortality for other common conditions is largely unknown. OBJECTIVES To estimate the relationship between ICU admission and outcomes for hospitalized patients with exacerbation of chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), or acute myocardial infarction (AMI). METHODS We performed a retrospective cohort study of all acute care hospitalizations from 2010 to 2012 for U.S. fee-for-service Medicare beneficiaries aged 65 years and older admitted with COPD exacerbation, HF exacerbation, or AMI. We used multivariable adjustment and instrumental variable analysis to assess each condition separately. The instrumental variable analysis used differential distance to a high ICU use hospital (defined separately for each condition) as an instrument for ICU admission to examine marginal patients whose likelihood of ICU admission depended on the hospital to which they were admitted. The primary outcome was 30-day mortality. Secondary outcomes included hospital costs. RESULTS Among 1,555,798 Medicare beneficiaries with COPD exacerbation, HF exacerbation, or AMI, 486,272 (31%) were admitted to an ICU. The instrumental variable analysis found that ICU admission was not associated with significant differences in 30-day mortality for any condition. ICU admission was associated with significantly greater hospital costs for HF ($11,793 vs. $9,185, P < 0.001; absolute increase, $2,608 [95% confidence interval, $1,377-$3,840]) and AMI ($19,513 vs. $14,590, P < 0.001; absolute increase, $4,922 [95% confidence interval, $2,665-$7,180]), but not for COPD. CONCLUSIONS ICU admission did not confer a survival benefit for patients with uncertain ICU needs hospitalized with COPD exacerbation, HF exacerbation, or AMI. These findings suggest that the ICU may be overused for some patients with these conditions. Identifying patients most likely to benefit from ICU admission may improve health care efficiency while reducing costs.
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Ambrosy AP, Gheorghiade M. Clinical profiles in acute heart failure: one size fits all or not at all? Eur J Heart Fail 2017; 19:1255-1257. [PMID: 28786165 DOI: 10.1002/ejhf.907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/17/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Andrew P Ambrosy
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, Amin P, Arabi Y, Bajwa EK, Bruhn A, Cerny V, Clarkson K, Heunks L, Kurahashi K, Laake JH, Lorente JA, McNamee L, Nin N, Palo JE, Piquilloud L, Qiu H, Jiménez JIS, Esteban A, McAuley DF, van Haren F, Ranieri M, Rubenfeld G, Wrigge H, Slutsky AS, Pesenti A. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. THE LANCET RESPIRATORY MEDICINE 2017. [PMID: 28624388 DOI: 10.1016/s2213-2600(17)30213-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). METHODS LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. FINDINGS Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO2) to the fractional concentration of oxygen in inspired air (FiO2) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of stay in the intensive-care unit were significantly shorter in patients in rWORLD-High countries than in Europe-High or Middle countries. High gross national income per person was associated with increased survival in ARDS; hospital survival was significantly lower in Middle countries than in Europe-High or rWORLD-High countries. INTERPRETATION Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes. Income per person and outcomes in ARDS are independently associated. FUNDING European Society of Intensive Care Medicine, St Michael's Hospital, University of Milan-Bicocca.
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Affiliation(s)
- John G Laffey
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Department of Critical Care Medicine, St Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| | - Fabiana Madotto
- Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Bellani
- Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Tài Pham
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Pravin Amin
- Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Yaseen Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ednan K Bajwa
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J E Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic; Department of Research and Development, and Department of Anesthesiology and Intensive Care, Charles University in Prague, Prague, Czech Republic; Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kevin Clarkson
- Department of Anaesthesia, Galway University Hospitals and National University of Ireland, Galway, Galway, Ireland
| | - Leo Heunks
- Department of Intensive Care, VU University Medical Centre Amsterdam, Netherlands
| | - Kiyoyasu Kurahashi
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Jon Henrik Laake
- Division of Critical Care, Department of Anaesthesiology, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Jose A Lorente
- CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
| | - Lia McNamee
- Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK; Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland, UK; Regional Intensive Care Unit, Royal Victoria Hospital A&E, Grosvenor Road, Belfast, Northern Ireland, UK
| | - Nicolas Nin
- CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain; Hospital Español, Montevideo, Uruguay
| | - Jose Emmanuel Palo
- Section of Adult Critical Care, Department of Medicine, The Medical City, Pasig, Philippines
| | - Lise Piquilloud
- Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland; Department of Medical Intensive Care, University Hospital of Angers, Angers, France
| | - Haibo Qiu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Juan Ignacio Silesky Jiménez
- Department of Intensive Care, Hospital San Juan de Dios, and Department of Intensive Care, Hospital CIMA San Jose, Council of Critical Medicine, University of Costa Rica, San Pedro Montes de Oca, Costa Rica
| | - Andres Esteban
- CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain; Hospital Español, Montevideo, Uruguay
| | - Daniel F McAuley
- Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK; Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland, UK; Regional Intensive Care Unit, Royal Victoria Hospital A&E, Grosvenor Road, Belfast, Northern Ireland, UK
| | - Frank van Haren
- Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia
| | - Marco Ranieri
- Sapienza Università di Roma, Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Rome, Italy
| | - Gordon Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Hermann Wrigge
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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