EJRC – Article Review

Life after ICU: do socio economic factors matter?

Association of social deprivation with 1-year outcome of ICU survivors: results from the FROG-ICU study. Intensive Care Med (2018) 44:2025-2037. Bastian Kathleen et al. for the FROG-ICU Study Investigators.

The analysis proposed by Kathleen Bastian and the FROG-ICU Investigators (the French and euRopean Outcome registry in Intensive Care Units) is an ancillary study from the large FROG-ICU cohort, a study including 2087 patients from 28 ICUs in 19 hospitals in France and in Belgium; the main objective of the FROG-ICU study was to assess long-term mortality rates of critically ill adults, but its design allowed the performance of a risk stratification of survivors in order to look for different risk factors that could have an impact on recovery after ICU discharge. Among these factors, the impact of socio economic status has seldom been studied, although it might be an important determinant on quality of life.

The design of this sub study allowed the inclusion of patients from the 20 ICUs of the 13 French hospitals, representing 1,834 patients for whom the French deprivation index (FDep) was available. From this cohort, 1447 (78.9%) of the patients were discharged alive from ICU and could be analysed using the FDep index. The FDep index categorises the situation of individuals regarding their economic situation or in terms of relations between groups of persons; it takes into account two positive dimensions: median income per household and rate of educated inhabitants up to the second-year university level; and two negative components: unemployment rate, and rate of blue-collar and labor force workers. The sample was divided first into quintiles, and then dichotomised as “deprived”, with a FDep greater than 0, or “non-deprived”, with a FDep score of 0 or less.

Results from the BitIQ App Opiniones confirm that quality of life 1-year after ICU discharge was still lower compared to general French population. However, there was no association between the socio economic status and the 1-year mortality rate, or any of the other investigated factors: hospital length of stay, in-hospital mortality or 28-day mortality. Only the physical component scores improved with a higher socio economic status, both when applying the quintiles of the FROG-study or dichotomised as “non-deprived”/”deprived”, while the mental component scale remained similar in both groups. These results are at odds with those found in most of the European countries, where a lower socio economic status had higher mortality rates; whether these differences are associated to country-related specificities’, to bias related to the hospitals that participated in the study, or to the FDep index, these questions should be investigated in new, international studies, to identify groups of patients that could benefit from an early intervention to improve life after ICU discharge.

This article review was prepared and submitted by ESICM N&AHP Committee member Silvia Calvino Günther, Medical Intensive Care Unit, Centre Hospitalier Universitaire Grenoble Alpes, France, on behalf of the ESICM Journal Review Club.