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Chapelet A, Foucher Y, Gérard N, Rousseau C, Zambon O, Bretonnière C, Mira JP, Charreau B, Guitton C. An early increase in endothelial protein C receptor is associated with excess mortality in pneumococcal pneumonia with septic shock in the ICU. Crit Care 2018; 22:251. [PMID: 30290852 PMCID: PMC6173894 DOI: 10.1186/s13054-018-2179-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/05/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study investigated changes in plasma level of soluble endothelial protein C receptor (sEPCR) in association with outcome in patients with septic shock. We explored sEPCR for early sepsis prognosis assessment and constructed a scoring system based on clinical and biological data, in order to discriminate between surviving at hospital discharge and non-surviving patients. METHODS Clinical data and samples were extracted from the prospective "STREPTOGENE" cohort. We enrolled 278 patients, from 50 intensive care units (ICUs), with septic shock caused by pneumococcal pneumonia. Patients were divided into survivors (n = 194) and non-survivors (n = 84) based on in-hospital mortality. Soluble EPCR plasma levels were quantified at day 1 (D1) and day 2 (D2) by ELISA. The EPCR gene A3 haplotype was determined. Patients were followed up until hospital discharge. Univariate and multivariate analyses were performed. A scoring system was constructed using least absolute shrinkage and selection operator (lasso) logistic regression for selecting predictive variables. RESULTS In-hospital mortality was 30.2% (n = 84). Plasma sEPCR level was significantly higher at D1 and D2 in non-surviving patients compared to patients surviving to hospital discharge (p = 0.0447 and 0.0047, respectively). Early increase in sEPCR at D2 was found in non-survivors while a decrease was observed in the survival group (p = 0.0268). EPCR A3 polymorphism was not associated with mortality. Baseline sEPCR level and its variation from D1 to D2 were independent predictors of in-hospital mortality. The scoring system including sEPCR predicted mortality with an AUC of 0.75. CONCLUSIONS Our findings confirm that high plasma sEPCR and its increase at D2 are associated with poor outcome in sepsis and thus we propose sEPCR as a key player in the pathogenesis of sepsis and as a potential biomarker of sepsis outcome.
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Affiliation(s)
- Agnès Chapelet
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France.,Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France.,Institute of Transplantation Urology Nephrology (ITUN), Nantes University Hospital, Nantes, France
| | - Yohann Foucher
- INSERM, UMR 1246 - SPHERE, Nantes University, Nantes University Hospital, Nantes, France
| | - Nathalie Gérard
- Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France
| | | | - Olivier Zambon
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Jean-Paul Mira
- Institut Cochin, INSERM U1016, Paris, France.,Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Béatrice Charreau
- Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France.,Institute of Transplantation Urology Nephrology (ITUN), Nantes University Hospital, Nantes, France
| | - Christophe Guitton
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France. .,Centre for Research in Transplantation and Immunology (CRTI) UMR1064, INSERM, Nantes University, Nantes, France. .,Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
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Chapal M, Le Borgne F, Legendre C, Kreis H, Mourad G, Garrigue V, Morelon E, Buron F, Rostaing L, Kamar N, Kessler M, Ladrière M, Soulillou JP, Launay K, Daguin P, Offredo L, Giral M, Foucher Y. A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors. Kidney Int 2014; 86:1130-9. [PMID: 24897036 DOI: 10.1038/ki.2014.188] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 03/04/2014] [Accepted: 04/03/2014] [Indexed: 02/07/2023]
Abstract
Delayed graft function (DGF) is a common complication in kidney transplantation and is known to be correlated with short- and long-term graft outcomes. Here we explored the possibility of developing a simple tool that could predict with good confidence the occurrence of DGF and could be helpful in current clinical practice. We built a score, tentatively called DGFS, from a French multicenter and prospective cohort of 1844 adult recipients of deceased donor kidneys collected since 2007, and computerized in the Données Informatisées et VAlidées en Transplantation databank. Only five explicative variables (cold ischemia time, donor age, donor serum creatinine, recipient body mass index, and induction therapy) contributed significantly to the DGF prediction. These were associated with a good predictive capacity (area under the ROC curve at 0.73). The DGFS calculation is facilitated by an application available on smartphones, tablets, or computers at www.divat.fr/en/online-calculators/dgfs. The DGFS should allow the simple classification of patients according to their DGF risk at the time of transplantation, and thus allow tailored-specific management or therapeutic strategies.
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Affiliation(s)
- Marion Chapal
- 1] Institut de Transplantation et de Recherche en Transplantation, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064 (Immunointervention dans les Allo et Xénotransplantation), Nantes University, boulevard Jean Monnet, Nantes, France [2] Centre d'Investigation Clinique biothérapie, Labex Transplantex, boulevard Jean Monnet, Nantes, France
| | - Florent Le Borgne
- EA 4275 SPHERE-Biostatistics, Clinical Research and Pharmaco-Epidemiology, Nantes University, Nantes, France
| | - Christophe Legendre
- 1] Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, France [2] Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Henri Kreis
- 1] Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, France [2] Universités Paris Descartes et Sorbonne Paris Cité, Paris, France
| | - Georges Mourad
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, Montpellier, Université Montpellier I, Montpellier, France
| | - Valérie Garrigue
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, Montpellier, Université Montpellier I, Montpellier, France
| | - Emmanuel Morelon
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Fanny Buron
- Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France
| | - Lionel Rostaing
- 1] Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France [2] Université Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- 1] Service de Néphrologie, HTA, Dialyse et Transplantation d'Organes, CHU Rangueil, Toulouse, France [2] Université Paul Sabatier, Toulouse, France
| | - Michèle Kessler
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Marc Ladrière
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Jean-Paul Soulillou
- 1] Institut de Transplantation et de Recherche en Transplantation, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064 (Immunointervention dans les Allo et Xénotransplantation), Nantes University, boulevard Jean Monnet, Nantes, France [2] Centre d'Investigation Clinique biothérapie, Labex Transplantex, boulevard Jean Monnet, Nantes, France
| | - Katy Launay
- 1] Institut de Transplantation et de Recherche en Transplantation, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064 (Immunointervention dans les Allo et Xénotransplantation), Nantes University, boulevard Jean Monnet, Nantes, France [2] EA 4275 SPHERE-Biostatistics, Clinical Research and Pharmaco-Epidemiology, Nantes University, Nantes, France
| | - Pascal Daguin
- Institut de Transplantation et de Recherche en Transplantation, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064 (Immunointervention dans les Allo et Xénotransplantation), Nantes University, boulevard Jean Monnet, Nantes, France
| | - Lucile Offredo
- EA 4275 SPHERE-Biostatistics, Clinical Research and Pharmaco-Epidemiology, Nantes University, Nantes, France
| | - Magali Giral
- 1] Institut de Transplantation et de Recherche en Transplantation, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064 (Immunointervention dans les Allo et Xénotransplantation), Nantes University, boulevard Jean Monnet, Nantes, France [2] Centre d'Investigation Clinique biothérapie, Labex Transplantex, boulevard Jean Monnet, Nantes, France
| | - Yohann Foucher
- 1] Institut de Transplantation et de Recherche en Transplantation, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064 (Immunointervention dans les Allo et Xénotransplantation), Nantes University, boulevard Jean Monnet, Nantes, France [2] EA 4275 SPHERE-Biostatistics, Clinical Research and Pharmaco-Epidemiology, Nantes University, Nantes, France
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