Influence of deprivation on initial severity and prognosis of patients admitted to the ICU: the prospective, multicentre, observational IVOIRE cohort study

Jean-Pierre Quenot, Julie Helms, Guylaine Labro, Auguste Dargent, Nicolas Meunier-Beillard, Elea Ksiazek, Pierre-Edouard Bollaert, Guillaume Louis, Audrey Large, Pascal Andreu, Christophe Bein, Jean-Philippe Rigaud, Pierre Perez, Raphaël Clere-Jehl, Hamid Merdji, Hervé Devilliers, Christine Binquet, Ferhat Meziani, Isabelle Fournel, IVOIRE Trial Investigators and the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis), Bruno Lévy, Jérémie Lemarié, Cyril Cadoz, Antoine Marchalot, Alexandra Monnier, Yannick Rabouel, Jean-Pierre Quenot, Julie Helms, Guylaine Labro, Auguste Dargent, Nicolas Meunier-Beillard, Elea Ksiazek, Pierre-Edouard Bollaert, Guillaume Louis, Audrey Large, Pascal Andreu, Christophe Bein, Jean-Philippe Rigaud, Pierre Perez, Raphaël Clere-Jehl, Hamid Merdji, Hervé Devilliers, Christine Binquet, Ferhat Meziani, Isabelle Fournel, IVOIRE Trial Investigators and the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis), Bruno Lévy, Jérémie Lemarié, Cyril Cadoz, Antoine Marchalot, Alexandra Monnier, Yannick Rabouel

Abstract

Background: The influence of socioeconomic status on patient outcomes is unclear. We assessed the impact of socioeconomic deprivation on severity of illness at intensive care unit (ICU) admission, and on the risk of death at 3 months after ICU admission.

Methods: The IVOIRE study was a prospective, observational, multicentre cohort study in the ICU of 8 participating hospitals in France, including patients aged ≥ 18 years admitted to the ICU and receiving at least one life support therapy for organ failure. The primary outcomes were severity at admission (assessed by SAPSII score), and mortality at 3 months. Socioeconomic data were obtained from interviews with patients or family. Deprivation was assessed using the EPICES score.

Results: Among 1294 patents included between 2013 and 2016, 629 (48.6%) were classed as deprived and differed significantly from non-deprived subjects in terms of sociodemographic characteristics and pre-existing conditions. The mean SAPS II score at admission was 50.1 ± 19.4 in deprived patients and 52.3 ± 17.3 in non-deprived patients, with no significant difference by multivariable analysis (β = - 1.85 [95% CI - 3.86; + 0.16, p = 0.072]). The proportion of death was 31.1% at 3 months, without significant differences between deprived and non-deprived patients, even after adjustment for confounders.

Conclusions: Deprivation is frequent in patients admitted to the ICU and is not associated with disease severity at admission, or with mortality at 3 months between deprived and non-deprived patients. Trial registration The IVOIRE cohort is registered with ClinicalTrials.gov under the identifier NCT01907581, registration date 17/7/2013.

Keywords: Critically ill; Deprivation; Intensive care unit; Socioeconomic.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the IVOIRE study population
Fig. 2
Fig. 2
Cumulative probabilities of death within 365 days following ICU admission. ICU intensive care unit

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