Determinants of mortality for adults with cystic fibrosis admitted in Intensive Care Unit: a multicenter study.
BACKGROUND
Intensive care unit (ICU) admission of adults with cystic fibrosis (CF) is controversial because of poor outcome. This appraisal needs re-evaluation following recent changes in both CF management and ICU daily practice. Objectives were to determine long-term outcome of adults with CF admitted in ICU and to identify prognostic factors.


METHODS
Retrospective multicenter study of 60 ICU hospitalizations for 42 adult CF patients admitted between 2000 and 2003. Reason for ICU admission, ventilatory support provided and one-year survival were recorded. Multiple logistic analysis was used to determine predictors of mortality.


RESULTS
Prior to ICU admission, all patients (mean age 28.1 +/- 8 yr) had a severe lung disease (mean FEV1 28 +/- 12% predicted; mean PaCO2 47 +/- 9 mmHg). Main reason for ICU hospitalization was pulmonary infective exacerbation (40/60). At admission, noninvasive ventilation was used in 57% of cases and was successful in 67% of patients. Endotracheal intubation was implemented in 19 episodes. Overall ICU mortality rate was 14%. One year after ICU discharge, 10 of the 28 survivors have been lung transplanted. Among recognized markers of CF disease severity, only the annual FEV1 loss was associated with a poor outcome (HR = 1.47 [1.18-1.85], p = 0.001). SAPSII (HR = 1.08 [1.03-1.12], p < 0.001) and endotracheal intubation (HR = 16.60 [4.35-63.34], p < 0.001) were identified as strong independent predictors of mortality.


CONCLUSIONS
Despite advanced lung disease, adult patients with CF admitted in ICU have high survival rate. Endotracheal intubation is associated with a poor prognosis and should be used as the last alternative. Although efforts have to be made in selecting patients with CF likely to benefit from ICU resources, ICU admission of these patients should be considered.
Texereau
Joëlle
J
Service de Physiologie, AP-HP, Hôpital Cochin, 27 rue du Faubourg St Jacques, Paris, F-75014, France. texereau@cochin.inserm.fr
Jamal
Dany
D
Choukroun
Gérald
G
Burgel
Pierre-Régis
PR
Diehl
Jean-Luc
JL
Rabbat
Antoine
A
Loirat
Philippe
P
Parrot
Antoine
A
Duguet
Alexandre
A
Coste
Joël
J
Dusser
Daniel
D
Hubert
Dominique
D
Mira
Jean-Paul
JP
D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data*; D003550:Cystic Fibrosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate