Interest of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs 33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in the intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.0394). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but may reduce the long-term mortality in critically ill patients about to be discharged after a prolonged stay.

Download Full-text

Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

10.21203/rs.3.rs-73447/v3 ◽

2020 ◽

Author(s):

sigismond lasocki ◽

Pierre ASFAR ◽

Samir JABER ◽

Martine FERRANDIERE ◽

Thomas KERFORNE ◽

...

Keyword(s):

Iron Deficiency ◽

Critically Ill ◽

Primary Endpoint ◽

Critically Ill Patients ◽

Standard Care ◽

Intravenous Iron ◽

Icu Stay ◽

Icu Discharge ◽

Prolonged Icu Stay ◽

One Year

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.04). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay.

Download Full-text

Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial

Critical Care ◽

10.1186/s13054-020-03430-3 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Sigismond Lasocki ◽

◽

Pierre Asfar ◽

Samir Jaber ◽

Martine Ferrandiere ◽

...

Keyword(s):

Iron Deficiency ◽

Critically Ill ◽

Primary Endpoint ◽

Critically Ill Patients ◽

Standard Care ◽

Intravenous Iron ◽

Prolonged Stay ◽

Icu Stay ◽

Icu Discharge ◽

Prolonged Icu Stay

Abstract Background Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnose in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥ 5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm, patients were treated with intravenous iron (1 g of ferric carboxymaltose) when hepcidin was < 20 μg/l and with intravenous iron and erythropoietin for 20 ≤ hepcidin < 41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day 90 mortality and 1-year survival. Results Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). A total of 220 patients (55%) had ID at discharge (i.e., a hepcidin < 41 μg/l). Primary endpoint was not different (medians (IQR) post-ICU LOS 33(13;90) vs. 33(11;90) days for intervention and control, respectively, median difference − 1(− 3;1) days, p = 0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference − 8.7 (− 15.1 to − 2.3)%, p = 0.008, OR 95% IC, 0.46, 0.22–0.94, p = 0.035), and one-year survival was improved (p = 0.04). Conclusion Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay. Trial registration www.clinicaltrial.gov NCT02276690 (October 28, 2014; retrospectively registered)

Download Full-text

Interest of Treating Iron Deficiency, Diagnosed According to Hepcidin Quantification, on Outcomes After a Prolonged Icu Stay Compared to Standard Care: A Multicenter, Randomized, Single-blinded Trial

10.21203/rs.3.rs-73447/v1 ◽

2020 ◽

Author(s):

sigismond lasocki ◽

Pierre ASFAR ◽

Samir JABER ◽

Martine FERRANDIERE ◽

Thomas KERFORNE ◽

...

Keyword(s):

Iron Deficiency ◽

Critically Ill ◽

Primary Endpoint ◽

Critically Ill Patients ◽

Standard Care ◽

Intravenous Iron ◽

Prolonged Stay ◽

Icu Stay ◽

Icu Discharge ◽

Prolonged Icu Stay

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue and day 90 mortality. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs 33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in the intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but may reduce the long-term mortality in critically ill patients about to be discharged after a prolonged stay. Trial Registration: www.clinicaltrial.gov NCT02276690 (October 28, 2014; Retrospectively registered)

Download Full-text

Delirium in Critically Ill Patients with and without COVID-19—A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10194412 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4412

Author(s):

Markus Jäckel ◽

Nico Aicher ◽

Paul Marc Biever ◽

Laura Heine ◽

Xavier Bemtgen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Propensity Score ◽

Critically Ill ◽

Primary Endpoint ◽

Critically Ill Patients ◽

Icu Stay ◽

Nursing Delirium Screening Scale ◽

Prolonged Icu Stay ◽

Icu Delirium

Background: Delirium complicating the course of Intensive care unit (ICU) therapy is a known driver of morbidity and mortality. It has been speculated that infection with the neurotrophic SARS-CoV-2 might promote delirium. Methods: Retrospective registry analysis including all patients treated at least 48 h on a medical intensive care unit. The primary endpoint was development of delirium as diagnosed by Nursing Delirium screening scale ≥2. Results were confirmed by propensity score matching. Results: 542 patients were included. The primary endpoint was reached in 352/542 (64.9%) patients, without significant differences between COVID-19 patients and non-COVID-19 patients (51.4% and 65.9%, respectively, p = 0.07) and correlated with prolonged ICU stay in both groups. In a subgroup of patients with ICU stay >10 days delirium was significantly lower in COVID-19 patients (p ≤ 0.01). After adjustment for confounders, COVID-19 correlated independently with less ICU delirium (p ≤ 0.01). In the propensity score matched cohort, patients with COVID-19 had significantly lower delirium incidence compared to the matched control patients (p ≤ 0.01). Conclusion: Delirium is frequent in critically ill patients with and without COVID-19 treated at an intensive care unit. Data suggests that COVID-19 itself is not a driver of delirium per se.

Download Full-text

Relaxation for Critically ill Patient Outcomes andStress-coping Enhancement (REPOSE): a protocol for a pilot randomised trial of an integrative intervention to improve critically ill patients’ delirium and related outcomes

BMJ Open ◽

10.1136/bmjopen-2018-023961 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023961

Author(s):

Elizabeth D E Papathanassoglou ◽

Yoanna Skrobik ◽

Kathleen Hegadoren ◽

Patrica Thompson ◽

Henry Thomas Stelfox ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Patient Outcomes ◽

Critically Ill Patients ◽

Standard Care ◽

Control Group ◽

Moderate Pressure ◽

Icu Discharge ◽

Integrative Intervention

IntroductionDelirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this study is to assess feasibility and treatment effect estimates of a multimodal integrative intervention incorporating relaxation, guided imagery and moderate pressure touch massage for prevention of critical illness delirium and for related outcomes.Methods and analysisRandomised, controlled, single-blinded trial with two parallel groups (1:1 allocation: intervention and standard care) and stratified randomisation (age (18–64 years and ≥65 years) and presence of trauma) with blocking, involving 104 patients with Intensive Care Delirium Screening Checklist (ICDSC): 0–3 recruited from two academic intensive care units (ICUs). Intervention group participants receive the intervention in addition to standard care for up to five consecutive days (or until transfer/discharge); control group participants receive standard care and a sham intervention. We will assess predefined feasibility outcomes, that is, recruitment rates and protocol adherence. The primary clinical outcome is incidence of delirium (ICDSC ≥4). Secondary outcomes include pain scores, inflammatory biomarkers, heart rate variability, stress and quality of life (6 weeks and 4 months) post-ICU discharge. Feasibility measures will be analysed descriptively, and outcomes will be analysed longitudinally. Estimates of effects will be calculated.Ethics and disseminationThe study has received approval from the Human Research Ethics Board, University of Alberta. Results will inform the design of a future multicentre trial.Trial registration numberNCT02905812; Pre-results.

Download Full-text

P044 HYPOCALORIC NUTRITION AND OUTCOME IN CRITICALLY ILL PATIENTS WITH PROLONGED ICU STAY

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(08)70106-6 ◽

2008 ◽

Vol 3 ◽

pp. 47

Author(s):

S. Iff ◽

M. Leuenberger ◽

Z. Stanga ◽

S.M. Jakob

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Icu Stay ◽

Prolonged Icu Stay

Download Full-text

Hypocaloric nutrition and outcome in critically ill patients with prolonged ICU stay

Critical Care ◽

10.1186/cc6362 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P141

Author(s):

S Iff ◽

M Leuenberger ◽

Z Stanga ◽

SM Jakob

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Icu Stay ◽

Prolonged Icu Stay

Download Full-text

Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

BMC Infectious Diseases ◽

10.1186/1471-2334-9-213 ◽

2009 ◽

Vol 9 (1) ◽

Cited By ~ 33

Author(s):

Iraklis Tsangaris ◽

Diamantis Plachouras ◽

Dimitra Kavatha ◽

George Michael Gourgoulis ◽

Argirios Tsantes ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Value ◽

Icu Stay ◽

Prolonged Icu Stay ◽

Diagnostic And Prognostic Value

Download Full-text

Quality of life after prolonged ICU stay: preliminary results of a prospective survey in critically ill patients

Critical Care ◽

10.1186/cc6726 ◽

2008 ◽

Vol 12 (Suppl 2) ◽

pp. P505

Author(s):

R Nakahara ◽

L Weibel ◽

A Zollinger ◽

C Hofer

Keyword(s):

Quality Of Life ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Survey ◽

Preliminary Results ◽

Icu Stay ◽

Prolonged Icu Stay

Download Full-text

Benefits and challenges associated with the timing of tracheostomy in critically ill patients: experience at a tertiary intensive care unit

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212119 ◽

2021 ◽

Vol 7 (6) ◽

pp. 978

Author(s):

Priti S. Hajare ◽

Rajesh Radhakrishna Havaldar

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Tertiary Care ◽

Upper Airways ◽

Early Tracheostomy ◽

Prolonged Intubation ◽

Icu Stay ◽

Prolonged Icu Stay ◽

Late Group

Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tracheostomy is performed with an aim to facilitate pulmonary toileting and also protect the upper airways from the associated ill effects of prolonged endotracheal intubation. The timing of this procedure is a matter of considerable debate and varies according to different centres.Methods: 50 patients were assessed. 34 belonged to the early group and 16 belonged to the late group. The study was carried out in the ICU of a tertiary care referral centre. The timing of occurrence of ventilator associated pneumonia (VAP), duration of ICU stay and duration of tracheostomy and the was compared between the early and late groups respectively.Results: It was found that early tracheostomy leads to reduced ICU stay and delayed occurrence of VAP. The results were statistically significant. Additionally, it was also observed in this study that early tracheostomy leads to reduced duration of tracheostomy as compared to the late group although not statistically significant.Conclusions: Due to large clinical heterogeneity amongst cases admitted to the ICU, the timing of tracheostomy is different in different centres. Hence, guidelines need to be formulated in order to perform tracheostomy in critically ill patients in order to prevent the demerits associated with late tracheostomy such as prolonged ICU stay, early occurrence of VAP and late decannulation. In addition to this, economic advantages also need to be considered as most of the population in developing countries do not have universal health insurance.

Download Full-text