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

Philippe Montravers¹  Sigismond Lasocki²  Soizic Gergaud²  Karim Asehnoune³  Philippe Seguin⁴  Martine Ferrandiere⁵  Samir Jaber⁶  Nicolas Nagot⁷  Pierre Asfar⁸  Thibaud Lefebvre⁹  Katell Peoc’h^1,10  Sylvain Lehmann^1,11  Thomas Kerforne^1,12 

[1] Département Anesthésie Réanimation, APHP, HUPNSV, CHU Bichat, Université Paris Diderot Sorbonne, Paris, France;Département Anesthésie Réanimation, CHU Angers, Université D’Angers, 4 rue Larrey, 49933, Angers Cedex 9, France;Département Anesthésie Réanimation, CHU de Nantes, Université de Nantes, Nantes, France;Département Anesthésie Réanimation, CHU de Rennes, Université de Rennes, Rennes, France;Département Anesthésie Réanimation, CHU de Tours, Université de Tours, Tours, France;Département Anesthésie Réanimation, Université de Montpellier, Montpellier, France;Département D’information médicale, CHU Montpellier, Université de Montpellier, Montpellier, France;Département Médecine Intensive Réanimation, CHU Angers, Université D’Angers, Angers, France;INSERM U1149, UFR de Médecine Bichat, Centre de Recherche Sur L’Inflammation, Université de Paris, Paris, France;INSERM U1149, UFR de Médecine Bichat, Centre de Recherche Sur L’Inflammation, Université de Paris, Paris, France;APHP Nord Hôpital Universitaire Louis Mourier, Assistance Publique des Hôpitaux de Paris, Colombes, France;Laboratoire D’Excellence GR-Ex Ou Laboratory of Excellence GR-Ex, Paris, France;Laboratoire de Biochimie Protéomique Clinique Et IRMB INSERM, CHU de Montpellier, Université de Montpellier, Montpellier, France;Service D’anesthésie-réanimation, CHU de Poitiers, Université de Poitiers, Poitiers, France;

关键词: Critically ill;    Anemia;    Iron deficiency;    Iron (treatment);    Hepcidin;    Mortality;    Length of stay;    Erythropoietin;   

DOI  :  10.1186/s13054-020-03430-3

来源: Springer

【 摘 要 】

BackgroundAnemia 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.MethodsIn 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.ResultsOf 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).ConclusionTreatment 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 registrationwww.clinicaltrial.gov NCT02276690 (October 28, 2014; retrospectively registered)

【 授权许可】

CC BY