Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study View Full Text


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Article Info

DATE

2021-10-24

AUTHORS

Florian Reizine, Agathe Delbove, Alexandre Dos Santos, Laetitia Bodenes, Pierre Bouju, Pierre Fillâtre, Aurélien Frérou, Guillaume Halley, Olivier Lesieur, Maud Jonas, Florian Berteau, Jean Morin, David Luque-Paz, Rémy Marnai, Anthony Le Meur, Cécile Aubron, Jean Reignier, Jean-Marc Tadié, Arnaud Gacouin

ABSTRACT

BACKGROUND: Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients' prognosis remains poorly explored in Intensive Care Units (ICUs) patients. METHODS: We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. RESULTS: Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03-3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51-52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03-1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11-1.3], p < 0.0001). CONCLUSIONS: In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis. More... »

PAGES

372

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13054-021-03792-2

DOI

http://dx.doi.org/10.1186/s13054-021-03792-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1142130552

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34689813


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12 schema:description BACKGROUND: Drowning is a global threat and one of the leading causes of injury around the world. The impact of drowning conditions including water salinity on patients' prognosis remains poorly explored in Intensive Care Units (ICUs) patients. METHODS: We conducted a retrospective multicenter study on patients admitted to 14 ICUs in the west of France from January 2013 to January 2020. We first compared demographic and clinical characteristics at admission as well as clinical courses of these patients according to the salinity of drowning water. Then, we aimed to identify variables associated with 28-day survival using a Cox proportional hazard model. RESULTS: Of the 270 consecutive included patients, drowning occurred in seawater in 199 patients (73.7%) and in freshwater in 71 patients (26.3%). Day-28 mortality was observed in 55 patients (20.4%). Freshwater was independently associated with 28-day mortality (Adjusted Hazard Ratio (aHR) 1.84 [95% Confidence Interval (CI) 1.03-3.29], p = 0.04). A higher proportion of freshwater patients presented psychiatric comorbidities (47.9 vs. 19.1%; p < 0.0001) and the etiology of drowning appeared more frequently to be a suicide attempt in this population (25.7 vs. 4.2%; p < 0.0001). The other factors independently associated with 28-day mortality were the occurrence of a drowning-related cardiac arrest (aHR 11.5 [95% CI 2.51-52.43], p = 0.0017), duration of cardiopulmonary resuscitation (aHR 1.05 [95% CI 1.03-1.07], p < 0.0001) and SOFA score at day 1 (aHR 1.2 [95% CI 1.11-1.3], p < 0.0001). CONCLUSIONS: In this large multicenter cohort, freshwater drowning patients had a poorer prognosis than saltwater drowning patients. Reasons for such discrepancies include differences in underlying psychiatric comorbidity, drowning circumstances and severities. Patients with initial cardiac arrest secondary to drowning remain with a very poor prognosis.
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19 schema:keywords Cox proportional hazards model
20 France
21 French multicenter study
22 ICU
23 SOFA score
24 West
25 admission
26 arrest
27 attempt
28 cardiac arrest
29 cardiopulmonary resuscitation
30 care unit patients
31 cause
32 cause of injury
33 characteristics
34 circumstances
35 clinical characteristics
36 clinical course
37 clinical spectrum
38 cohort
39 comorbidities
40 conditions
41 course
42 day 1
43 day-28 mortality
44 differences
45 discrepancy
46 drowning
47 drowning-related cardiac arrest
48 duration
49 etiology
50 factors
51 freshwater
52 freshwater patients
53 global threat
54 hazards model
55 higher proportion
56 impact
57 initial cardiac arrest
58 injury
59 intensive care unit patients
60 large multicenter cohort
61 model
62 mortality
63 multicenter cohort
64 multicenter study
65 occurrence
66 patient prognosis
67 patients
68 poor prognosis
69 population
70 prognosis
71 proportion
72 proportional hazards model
73 psychiatric comorbidity
74 reasons
75 resuscitation
76 retrospective multicenter study
77 risk factors
78 salinity
79 saltwater
80 scores
81 seawater
82 severity
83 spectra
84 study
85 such discrepancies
86 suicide attempts
87 survival
88 threat
89 unit patients
90 variables
91 water
92 water salinity
93 west of France
94 world
95 schema:name Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study
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