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Atchade E, De Tymowski C, Lepitre E, Zappella N, Snauwaert A, Jean-Baptiste S, Tran-Dinh A, Lortat-Jacob B, Messika J, Mal H, Mordant P, Castier Y, Tanaka S, Montravers P. Impact of recipient and donor pretransplantation body mass index on early postosperative complications after lung transplantation. BMC Pulm Med 2024; 24:161. [PMID: 38570744 PMCID: PMC10988822 DOI: 10.1186/s12890-024-02977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Prior studies have assessed the impact of the pretransplantation recipient body mass index (BMI) on patient outcomes after lung transplantation (LT), but they have not specifically addressed early postoperative complications. Moreover, the impact of donor BMI on these complications has not been evaluated. The first aim of this study was to assess complications during hospitalization in the ICU after LT according to donor and recipient pretransplantation BMI. METHODS All the recipients who underwent LT at Bichat Claude Bernard Hospital, Paris, between January 2016 and August 2022 were included in this observational retrospective monocentric study. Postoperative complications were analyzed according to recipient and donor BMIs. Univariate and multivariate analyses were also performed. The 90-day and one-year survival rates were studied. P < 0.05 was considered to indicate statistical significance. The Paris-North Hospitals Institutional Review Board approved the study. RESULTS A total of 304 recipients were analyzed. Being underweight was observed in 41 (13%) recipients, a normal weight in 130 (43%) recipients, and being overweight/obese in 133 (44%) recipients. ECMO support during surgery was significantly more common in the overweight/obese group (p = 0.021), as were respiratory complications (primary graft dysfunction (PGD) (p = 0.006), grade 3 PDG (p = 0.018), neuroblocking agent administration (p = 0.008), prone positioning (p = 0.007)), and KDIGO 3 acute kidney injury (p = 0.036). However, pretransplantation overweight/obese status was not an independent risk factor for 90-day mortality. An overweight or obese donor was associated with a decreased PaO2/FiO2 ratio before organ donation (p < 0.001), without affecting morbidity or mortality after LT. CONCLUSION Pretransplantation overweight/obesity in recipients is strongly associated with respiratory and renal complications during hospitalization in the ICU after LT.
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Affiliation(s)
- E Atchade
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France.
| | - C De Tymowski
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France.
- UMR 1149, INSERM, Immunorecepteur Et Immunopathologie Rénale, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France.
| | - E Lepitre
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - N Zappella
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - A Snauwaert
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - S Jean-Baptiste
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - A Tran-Dinh
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - B Lortat-Jacob
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
| | - J Messika
- Service de Pneumologie B Et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
| | - H Mal
- Service de Pneumologie B Et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
| | - P Mordant
- Université de Paris Cité, UFR Diderot, Paris, France
- Service de Chirurgie Thoracique Et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - Y Castier
- Université de Paris Cité, UFR Diderot, Paris, France
- Service de Chirurgie Thoracique Et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France
| | - S Tanaka
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- UMR 1188, Université de La Réunion, INSERM, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - P Montravers
- DMU PARABOL, APHP, CHU Bichat-Claude Bernard, Département d'anesthésie Reanimation, 46 Rue Henri Huchard, 75018, Paris, France
- Université de Paris Cité, UFR Diderot, Paris, France
- UMR 1152ANR-10LABX17Physiopathologie Et Epidémiologie Des Maladies Respiratoires, INSERM, Paris, France
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Gouiaa F, Vomo-Donfack KL, Tran-Dinh A, Morilla I. Novel dimensionality reduction method, Taelcore, enhances lung transplantation risk prediction. Comput Biol Med 2024; 169:107969. [PMID: 38199210 DOI: 10.1016/j.compbiomed.2024.107969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
In this work, we present a new approach to predict the risk of acute cellular rejection (ACR) after lung transplantation by using machine learning algorithms, such as Multilayer Perceptron (MLP) or Autoencoder (AE), and combining them with topological data analysis (TDA) tools. Our proposed method, named topological autoencoder with best linear combination for optimal reduction of embeddings (Taelcore), effectively reduces the dimensionality of high-dimensional datasets and yields better results compared to other models. We validate the effectiveness of Taelcore in reducing the prediction error rate on four datasets. Furthermore, we demonstrate that Taelcore's topological improvements have a positive effect on the majority of the machine learning algorithms used. By providing a new way to diagnose patients and detect complications early, this work contributes to improved clinical outcomes in lung transplantation.
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Affiliation(s)
- Fatma Gouiaa
- Université Sorbonne Paris Nord, LAGA, CNRS, UMR 7539, Laboratoire d'excellence Inflamex, Villetaneuse, France
| | - Kelly L Vomo-Donfack
- Université Sorbonne Paris Nord, LAGA, CNRS, UMR 7539, Laboratoire d'excellence Inflamex, Villetaneuse, France
| | - Alexy Tran-Dinh
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'anesthésie-Réanimation, INSERM, Paris, France; Universié Paris Cité, LVTS, Inserm U1148, F-75018 Paris, France
| | - Ian Morilla
- Université Sorbonne Paris Nord, LAGA, CNRS, UMR 7539, Laboratoire d'excellence Inflamex, Villetaneuse, France; University of Malaga, Department of Genetics, MLiMO, 29010, Málaga, Spain.
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3
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Bouzid D, Tran-Dinh A, Lortat-Jacob B, Atchade E, Jean-Baptiste S, Tashk P, Snauwaert A, Zappella N, Augustin P, Pellenc Q, Castier Y, Ribeiro L, Gaudemer A, Khalil A, Montravers P, Tanaka S. Ultrasonography in thoracic and abdominal stab wound injury: results from the FETTHA study. Emerg Med J 2023; 40:821-825. [PMID: 37673644 DOI: 10.1136/emermed-2023-213078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed. METHODS Prospective single centre study which included all patients with stab wounds to the thorax or abdomen between December 2016 and December 2018. All patients underwent initial investigation with both eFAST and CT scan, except in cases of haemodynamic or respiratory instability, and in cases with a positive diagnosis by eFAST in which case surgery without CT scan was performed. RESULTS Of the 200 consecutive patients included, 14 unstable patients underwent surgery immediately after eFAST. In these 14 patients, 9 had cardiac tamponade identified by eFAST and all were confirmed by surgery. In the remaining 186 patients, the median time between eFAST and CT scan was 30 min (IQR 20-49 min). Test characteristics (including 95% CI) for eFAST compared with reference standard of CT scan for detecting pneumothorax were as follows: sensitivity 77% (54%-92%), specificity 93% (90%-97%), positive predictive value (PPV) 60% (49%-83%), negative predictive value (NPV) 97% (93%-99%). Test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemothorax were as follows: sensitivity 97% (74%-99%), specificity 96% (92%-98%), PPV 83% (63%-93%) and NPV 99% (96%-100%). Finally, test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemoperitoneum were as follows: sensitivity 75% (35%-97%), specificity 97% (93%-99%), PPV 55% (23%-83%) and NPV 99% (96%-99%). CONCLUSIONS In patients admitted with stab wounds to the torso, eFAST was not sensitive enough to diagnose pneumothorax and haemoperitoneum, but performed better in the detection of cardiac tamponade and haemothorax than the other injuries. More robust multicentre studies are needed to better define the role of eFAST in this specific population.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité, Paris, France
- INSERM UMR1137, IAME, F-75006, Paris, France
- Université de Montpellier, VBMI, INSERM U1047, Nimes, France
- AP-HP Nord, Emergency Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Alexy Tran-Dinh
- Université Paris Cité, Paris, France
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
- INSERM UMR1148, Paris, France
| | - Brice Lortat-Jacob
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Enora Atchade
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Sylvain Jean-Baptiste
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Parvine Tashk
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Aurelie Snauwaert
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Nathalie Zappella
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Pascal Augustin
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Quentin Pellenc
- AP-HP Nord, Thoracic and Vascular Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Yves Castier
- Université Paris Cité, Paris, France
- INSERM UMR1148, Paris, France
- AP-HP Nord, Thoracic and Vascular Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Lara Ribeiro
- AP-HP Nord, Visceral Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Augustin Gaudemer
- AP-HP Nord, Radiology Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Antoine Khalil
- Université Paris Cité, Paris, France
- AP-HP Nord, Radiology Department, Bichat-Claude Bernard University Hospital, Paris, France
- PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Philippe Montravers
- Université Paris Cité, Paris, France
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
- PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Sebastien Tanaka
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
- INSERM UMR1188, Saint-Denis de la Réunion, France
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Nuzzo A, Peoc'h K, Vaittinada Ayar P, Tran-Dinh A, Weiss E, Panis Y, Ronot M, Garzelli L, Eloy P, Ben Abdallah I, Castier Y, Corcos O. Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center. World J Emerg Surg 2023; 18:37. [PMID: 37287011 DOI: 10.1186/s13017-023-00505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge. METHODS In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls). RESULTS We included 137 patients-52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55-74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7-60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2-16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77-0.91), depending on the number of factors. CONCLUSIONS Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.
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Affiliation(s)
- Alexandre Nuzzo
- Université Paris Cité, INSERM UMR 1148, 75018, Paris, France.
- Department of Gastroenterology, IBD and Intestinal Failure, Intestinal Stroke Center, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France.
- Structure d'Urgences Vasculaires Intestinales (SURVI), Hôpital Beaujon, 100 bd du général Leclerc, 92110, Clichy, France.
| | - Katell Peoc'h
- Université Paris Cité, INSERM UMR 1149, 75018, Paris, France
- Department of Clinical Biochemistry, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | | | - Alexy Tran-Dinh
- Université Paris Cité, INSERM UMR 1148, 75018, Paris, France
- Intensive Care Unit, AP-HP. Nord, Bichat Hospital, 75018, Paris, France
| | - Emmanuel Weiss
- Université Paris Cité, INSERM UMR 1149, 75018, Paris, France
- Intensive Care Unit, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Maxime Ronot
- Department of Clinical Biochemistry, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
- Department of Radiology, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Lorenzo Garzelli
- Department of Clinical Biochemistry, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
- Department of Radiology, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
| | - Philippine Eloy
- Department of Epidemiology, Biostatistics and Clinical Research, APHP. Nord, Bichat Hospital, 75018, Paris, France
- Université Paris Cité, INSERM CIC-EC 1425, 75018, Paris, France
| | - Iannis Ben Abdallah
- Department of Vascular Surgery, AP-HP. Nord, Bichat Hospital, 75018, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, AP-HP. Nord, Bichat Hospital, 75018, Paris, France
| | - Olivier Corcos
- Université Paris Cité, INSERM UMR 1148, 75018, Paris, France
- Department of Gastroenterology, IBD and Intestinal Failure, Intestinal Stroke Center, AP-HP. Nord, Beaujon Hospital, 92110, Clichy, France
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Gauthier S, Tran-Dinh A, Morilla I. Plasma proteome dynamics of COVID-19 severity learnt by a graph convolutional network of multi-scale topology. Life Sci Alliance 2023; 6:e202201624. [PMID: 36806094 PMCID: PMC9941303 DOI: 10.26508/lsa.202201624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Efforts to understand the molecular mechanisms of COVID-19 have led to the identification of ACE2 as the main receptor for the SARS-CoV-2 spike protein on cell surfaces. However, there are still important questions about the role of other proteins in disease progression. To address these questions, we modelled the plasma proteome of 384 COVID-19 patients using protein level measurements taken at three different times and incorporating comprehensive clinical evaluation data collected 28 d after hospitalisation. Our analysis can accurately assess the severity of the illness using a metric based on WHO scores. By using topological vectorisation, we identified proteins that vary most in expression based on disease severity, and then utilised these findings to construct a graph convolutional network. This dynamic model allows us to learn the molecular interactions between these proteins, providing a tool to determine the severity of a COVID-19 infection at an early stage and identify potential pharmacological treatments by studying the dynamic interactions between the most relevant proteins.
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Affiliation(s)
- Samy Gauthier
- Université Sorbonne Paris Nord, LAGA, CNRS, UMR 7539, Laboratoire d'excellence Inflamex, Villetaneuse, France
| | - Alexy Tran-Dinh
- Département d'anesthésie-Réanimation, INSERM, Université de Paris, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
- Université de Paris, LVTS, Inserm U1148, Paris, France
| | - Ian Morilla
- Université Sorbonne Paris Nord, LAGA, CNRS, UMR 7539, Laboratoire d'excellence Inflamex, Villetaneuse, France
- Department of Genetics, University of Malaga, MLiMO, Málaga, Spain
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6
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Abdelazeem H, Tu L, Thuillet R, Ottaviani M, Boulfrad A, Beck T, Senbel A, Mani S, Castier Y, Guyard A, Tran-Dinh A, El-Benna J, Longrois D, Silverstein AM, Guignabert C, Norel X. AMPK activation by metformin protects against pulmonary hypertension in rats and relaxes isolated human pulmonary artery. Eur J Pharmacol 2023; 946:175579. [PMID: 36914083 DOI: 10.1016/j.ejphar.2023.175579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 03/13/2023]
Abstract
Pulmonary hypertension (PH) is associated with pulmonary vasoconstriction and endothelial dysfunction leading to impaired nitric oxide (NO) and prostacyclin (PGI2) pathways. Metformin, the first line treatment for type 2 diabetes and AMP-activated protein kinase (AMPK) activator, has been recently highlighted as a potential PH treatment. AMPK activation has been reported to improve endothelial function by enhancing endothelial NO synthase (eNOS) activity and to have relaxant effects in blood vessels. In this study, we examined the effect of metformin treatment on PH as well as on NO and PGI2 pathways in monocrotaline (MCT)-injected rats with established PH. Moreover, we investigated the anti-contractile effects of AMPK activators on endothelium-denuded human pulmonary arteries (HPA) from Non-PH and Group 3 PH patients (due to lung diseases and/or hypoxia). Furthermore, we explored the interaction between treprostinil and the AMPK/eNOS pathway. Our results showed that metformin protected against PH progression in MCT rats where it reduced the mean pulmonary artery pressure, pulmonary vascular remodeling and right ventricular hypertrophy and fibrosis compared to vehicle-treated MCT rats. The protective effects on rat lungs were mediated in part by increasing eNOS activity and protein kinase G-1 expression but not through the PGI2 pathway. In addition, incubation with AMPK activators reduced the phenylephrine-induced contraction of endothelium-denuded HPA from Non-PH and PH patients. Finally, treprostinil also augmented eNOS activity in HPA smooth muscle cells. In conclusion, we found that AMPK activation can enhance the NO pathway, attenuate vasoconstriction by direct effects on smooth muscles, and reverse established MCT-induced PH in rats.
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Affiliation(s)
- Heba Abdelazeem
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Egypt
| | - Ly Tu
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, 92350, Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Raphaël Thuillet
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, 92350, Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Mina Ottaviani
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, 92350, Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Achraf Boulfrad
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France
| | - Thomas Beck
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France
| | - Amira Senbel
- Arab Academy for Science, Technology & Maritime Transport, College of Pharmacy, Alexandria, Egypt
| | - Salma Mani
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France; Université de Monastir-Tunisia, Institut Supérieur de Biotechnologie de Monastir (ISBM), Tunisia
| | - Yves Castier
- Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alice Guyard
- Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alexy Tran-Dinh
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France; Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jamel El-Benna
- Université Paris Cité, INSERM-U1149, CNRS-ERL8252, Centre de Recherche sur l'Inflammation, Laboratoire d'Excellence Inflamex, Faculté de Médecine, Site Xavier Bichat, Paris, F-75018, France
| | - Dan Longrois
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France; Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Christophe Guignabert
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, 92350, Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Xavier Norel
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France.
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7
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Begue F, Chemello K, Veeren B, Lortat-Jacob B, Tran-Dinh A, Zappella N, Snauwaert A, Robert T, Rondeau P, Lagrange-Xelot M, Montravers P, Couret D, Tanaka S, Meilhac O. Plasma Apolipoprotein Concentrations Are Highly Altered in Severe Intensive Care Unit COVID-19 Patients: Preliminary Results from the LIPICOR Cohort Study. Int J Mol Sci 2023; 24:ijms24054605. [PMID: 36902035 PMCID: PMC10003429 DOI: 10.3390/ijms24054605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
SARS-CoV-2 infection goes beyond acute pneumonia, as it also impacts lipid metabolism. Decreased HDL-C and LDL-C levels have been reported in patients with COVID-19. The lipid profile is a less robust biochemical marker than apolipoproteins, components of lipoproteins. However, the association of apolipoprotein levels during COVID-19 is not well described and understood. The objective of our study is to measure plasma levels of 14 apolipoproteins in patients with COVID-19 and to evaluate the relationships between apolipoprotein levels, severity factors and patient outcomes. From November to March 2021, 44 patients were recruited on admission to the intensive care unit because of COVID-19. Fourteen apolipoproteins and LCAT were measured by LC-MS/MS in plasma of 44 COVID-19 patients on admission to the ICU and 44 healthy control subjects. Absolute apolipoprotein concentrations were compared between COVID-19 patients and controls. Plasma apolipoproteins (Apo) A (I, II, IV), C(I, II), D, H, J and M and LCAT were lower in COVID-19 patients, whereas Apo E was higher. COVID-19 severity factors such as PaO2/FiO2 ratio, SO-FA score and CRP were correlated with certain apolipoproteins. Lower Apo B100 and LCAT levels were observed in non-survivors of COVID-19 versus survivors. To conclude, in this study, lipid and apolipoprotein profiles are altered in COVID-19 patients. Low Apo B100 and LCAT levels may be predictive of non-survival in COVID-19 patients.
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Affiliation(s)
- Floran Begue
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
| | - Kévin Chemello
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
| | - Bryan Veeren
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
| | - Brice Lortat-Jacob
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Assistance, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Assistance, Bichat-Claude Bernard Hospital, 75018 Paris, France
- UFR Denis Diderot, University of Paris, 75015 Paris, France
- Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, 75018 Paris, France
| | - Nathalie Zappella
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Assistance, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Aurelie Snauwaert
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Assistance, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Tiphaine Robert
- Assistance Publique—Hôpitaux de Paris (AP-HP), Biochemistry Department, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Philippe Rondeau
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
| | | | - Philippe Montravers
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Assistance, Bichat-Claude Bernard Hospital, 75018 Paris, France
- UFR Denis Diderot, University of Paris, 75015 Paris, France
- French Institute of Health and Medical Research (INSERM) U1152, Physiopathology and Epidemiology of Respiratory Diseases, 75018 Paris, France
| | - David Couret
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
- CHU de La Réunion, 97400 Saint-Denis, France
| | - Sébastien Tanaka
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Assistance, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Olivier Meilhac
- INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, 97410 Saint-Pierre de La Réunion, France
- CHU de La Réunion, 97400 Saint-Denis, France
- Correspondence:
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Tran-Dinh A, Tir I, Tanaka S, Atchade E, Lortat-Jacob B, Jean-Baptiste S, Zappella N, Boudinet S, Castier Y, Mal H, Mordant P, Ben Abdallah I, Bunel V, Messika J, Armand-Lefèvre L, Grall N, Montravers P. Impact of Culture-Positive Preservation Fluid on Early Morbidity and Mortality After Lung Transplantation. Transpl Int 2023; 36:10826. [PMID: 36846604 PMCID: PMC9945515 DOI: 10.3389/ti.2023.10826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
The prevalence, risk factors and outcomes associated with culture-positive preservation fluid (PF) after lung transplantation (LT) are unknown. From January 2015 to December 2020, the microbiologic analyses of PF used to store the cold ischaemia-placed lung graft(s) of 271 lung transplant patients were retrospectively studied. Culture-positive PF was defined as the growth of any microorganism. Eighty-three (30.6%) patients were transplanted with lung grafts stored in a culture-positive PF. One-third of culture-positive PF were polymicrobial. Staphylococcus aureus and Escherichia coli were the most frequently isolated microorganisms. No risk factors for culture-positive PF based on donor characteristics were identified. Forty (40/83; 48.2%) patients had postoperative pneumonia on Day 0 and 2 (2/83; 2.4%) patients had pleural empyema with at least one identical bacteria isolated in culture-positive PF. The 30-day survival rate was lower for patients with culture-positive PF compared with patients with culture-negative PF (85.5% vs. 94.7%, p = 0.01). Culture-positive PF has a high prevalence and may decrease lung transplant recipient survival. Further studies are required to confirm these results and improve understanding of the pathogenesis of culture-positive PF and their management.
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Affiliation(s)
- Alexy Tran-Dinh
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
- INSERM UMR 1148 LVTS, Université de Paris, Paris, France
| | - Imane Tir
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Sébastien Tanaka
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
- Réunion Island University, INSERM U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de la Réunion, France
| | - Enora Atchade
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Brice Lortat-Jacob
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Sylvain Jean-Baptiste
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Nathalie Zappella
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Sandrine Boudinet
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
| | - Yves Castier
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
| | - Hervé Mal
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Pierre Mordant
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Paris Transplant Group, Paris, France
| | - Iannis Ben Abdallah
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
| | - Vincent Bunel
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Jonathan Messika
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
- Paris Transplant Group, Paris, France
| | - Laurence Armand-Lefèvre
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Bactériologie, Paris, France
- INSERM UMR 1137 IAME, Université de Paris, Paris, France
| | - Nathalie Grall
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Bactériologie, Paris, France
- INSERM UMR 1137 IAME, Université de Paris, Paris, France
| | - Philippe Montravers
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Département d'Anesthésie-Réanimation, Paris, France
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
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Tanaka S, Tymowski CD, Tran-Dinh A, Meilhac O, Lortat-Jacob B, Zappella N, Jean-Baptiste S, Robert T, Goletto T, Godet C, Castier Y, Mal H, Mordant P, Atchade E, Messika J, Montravers P. Low HDL-Cholesterol Concentrations in Lung Transplant Candidates are Strongly Associated With One-Year Mortality After Lung Transplantation. Transpl Int 2023; 36:10841. [PMID: 36726695 PMCID: PMC9884674 DOI: 10.3389/ti.2023.10841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
High-density lipoproteins (HDLs), whose main role is the reverse transport of cholesterol, also have pleiotropic anti-inflammatory, antioxidant, anti-apoptotic and anti-infectious properties. During sepsis, HDL cholesterol (HDL-C) concentration is low, HDL particle functionality is altered, and these modifications are correlated with poor outcomes. Based on the protective effects of HDL, we hypothesized that HDL-C levels could be associated with lung transplantation (LT) outcome. We thus looked for an association between basal HDL-C concentration and one-year mortality after LT. In this single-center prospective study including consecutive LTs from 2015 to 2020, 215 patients were included, essentially pulmonary fibrosis (47%) and chronic obstructive pulmonary disease (COPD) (38%) patients. Mortality rate at one-year was 23%. Basal HDL-C concentration stratified nonsurvivors to survivors at one-year (HDL-C = 1.26 [1.12-1.62] mmol/L vs. HDL-C = 1.55 [1.22-1.97] mmol/L, p = 0.006). Multivariate analysis confirmed that HDL-C concentration during the pretransplant assessment period was the only variable inversely associated with mortality. Moreover, mortality at one-year in patients with HDL-C concentrations ≤1.45 mmol/L was significantly higher (log-rank test, p = 0.00085). In conclusion, low basal HDL-C concentrations in candidates for LT are strongly associated with mortality after LT. To better understand this association, further studies in this field are essential and, in particular, a better characterization of HDL particles seems necessary.
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Affiliation(s)
- Sébastien Tanaka
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Réunion Island University, Saint-Denis de La Réunion, France,*Correspondence: Sébastien Tanaka,
| | - Christian De Tymowski
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,French Institute of Health and Medical Research (INSERM) U1149, Center for Research on Inflammation, Paris, France
| | - Alexy Tran-Dinh
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France
| | - Olivier Meilhac
- French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Réunion Island University, Saint-Denis de La Réunion, France,Reunion Island University-Affiliated Hospital, Saint-Denis, France
| | - Brice Lortat-Jacob
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Sylvain Jean-Baptiste
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Robert
- Department of Biochemistry, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Goletto
- Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Cendrine Godet
- Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Yves Castier
- UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France,Department of Vascular and Thoracic Surgery, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Hervé Mal
- UFR Paris Nord, Université Paris Cité, Paris, France,Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Pierre Mordant
- UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France,Department of Vascular and Thoracic Surgery, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Enora Atchade
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Jonathan Messika
- UFR Paris Nord, Université Paris Cité, Paris, France,Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France,Paris Transplant Group, Paris, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,UFR Paris Nord, Université Paris Cité, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
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Sandot A, Grall N, Rodier T, Bunel V, Godet C, Weisenburger G, Tran-Dinh A, Montravers P, Mordant P, Castier Y, Eloy P, Armand-Lefevre L, Mal H, Messika J. Risk of Bronchial Complications After Lung Transplantation With Respiratory Corynebacteria. Results From a Monocenter Retrospective Cohort Study. Transpl Int 2023; 36:10942. [PMID: 36936442 PMCID: PMC10014466 DOI: 10.3389/ti.2023.10942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
Corynebacterium spp. are associated with respiratory infections in immunocompromised hosts. A link with bronchial complications after lung transplantation (LTx) has been suggested. We aimed to assess the link between respiratory sampling of Corynebacterium spp. and significant bronchial complication (SBC) after LTx. We performed a single center retrospective study. Inclusion of LTx recipients with at least one respiratory Corynebacterium spp. sample (July 2014 to December 2018). Subjects were matched to unexposed LTx recipients. Primary outcome was SBC occurrence after Corynebacterium spp. isolation. Secondary outcomes were Corynebacterium spp. persistent sampling, chronic lung allograft dysfunction (CLAD) onset and all-cause mortality. Fifty-nine patients with Corynebacterium spp. sampling with 59 without isolation were included. Corynebacterium spp. identification was not associated with SBC occurrence (32.4% vs. 21.6%, p = 0.342). Previous SBC was associated with further isolation of Corynebacterium spp. (OR 3.94, 95% CI [1.72-9.05]). Previous SBC and corticosteroids pulses in the last 3 months were the only factors associated with increased risk of Corynebacterium spp. isolation in multivariate analysis. Corynebacterium spp. sampling was significantly associated with CLAD onset (27.1% vs. 6.9%, p = 0.021). Corynebacterium spp. isolation was not associated with SBC but with higher risk of CLAD. Whether CLAD evolution is affected by Corynebacterium spp. eradication remains to be investigated.
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Affiliation(s)
- Adèle Sandot
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
| | - Nathalie Grall
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Thomas Rodier
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
| | - Vincent Bunel
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Cendrine Godet
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Gaëlle Weisenburger
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Alexy Tran-Dinh
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Département d’Anesthésie et Réanimation, Paris, France
| | - Philippe Montravers
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Département d’Anesthésie et Réanimation, Paris, France
| | - Pierre Mordant
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France
| | - Yves Castier
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France
| | - Philippine Eloy
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
| | - Laurence Armand-Lefevre
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Hervé Mal
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
| | - Jonathan Messika
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- Paris Transplant Group, Paris, France
- *Correspondence: Jonathan Messika,
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Tran-Dinh A, Guiot M, Tanaka S, Lortat-Jacob B, Atchade E, Zappella N, Mordant P, Castier Y, Mal H, Weisenburger G, Messika J, Grall N, Montravers P. Bacteraemia Is Associated with Increased ICU Mortality in the Postoperative Course of Lung Transplantation. Antibiotics (Basel) 2022; 11:antibiotics11101405. [PMID: 36290063 PMCID: PMC9598225 DOI: 10.3390/antibiotics11101405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia. Forty-six bacteria were isolated from 45 bacteraemic patients in 33/303 (10.9%) patients during the postoperative ICU stay. Staphylococcus aureus (17.8%) was the most frequent bacteria, followed by Pseudomonas aeruginosa (15.6%) and Enterococcus faecium (15.6%). Multidrug-resistant bacteria accounted for 8/46 (17.8%) of the isolates. The most common source of bacteraemia was pneumonia (38.3%). No pre- or intraoperative risk factor for bacteraemia was identified. Recipients who experienced bacteraemia required more renal replacement therapy, invasive mechanical ventilation, norepinephrine support, tracheotomy and more days of hospitalization during the ICU stay. After adjustment for age, sex, type of LT procedure and the need for intraoperative ECMO, the occurrence of bacteraemia was associated with a higher mortality rate in the ICU (aOR = 3.55, 95% CI [1.56–8.08], p = 0.003). Bacteraemia is a major source of concern for lung transplant recipients.
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Affiliation(s)
- Alexy Tran-Dinh
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1148 LVTS, Université Paris Cité, 75018 Paris, France
- Correspondence: ; Tel.: +33-1-40-25-83-55
| | - Marion Guiot
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Sébastien Tanaka
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM U1188 Diabetes Atherothrombosis Réunion Indian OCean (DéTROI), CYROI Plateform, Réunion Island University, 97744 Saint-Denis de la Réunion, France
| | - Brice Lortat-Jacob
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Enora Atchade
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Nathalie Zappella
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Pierre Mordant
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
| | - Hervé Mal
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
- Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Gaelle Weisenburger
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
- Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
| | - Jonathan Messika
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
- Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- Paris Transplant Group, 75018 Paris, France
| | - Nathalie Grall
- Service de Bactériologie, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1137 IAME, Université Paris Cité, 75018 Paris, France
| | - Philippe Montravers
- Département d’Anesthésie-Réanimation, Hôpital Bichat Claude Bernard, AP-HP, Université Paris Cité, 75018 Paris, France
- INSERM UMR 1152 PHERE, Université Paris Cité, 75018 Paris, France
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Charmetant X, Chen CC, Hamada S, Goncalves D, Saison C, Rabeyrin M, Rabant M, Duong van Huyen JP, Koenig A, Mathias V, Barba T, Lacaille F, le Pavec J, Brugière O, Taupin JL, Chalabreysse L, Mornex JF, Couzi L, Graff-Dubois S, Jeger-Madiot R, Tran-Dinh A, Mordant P, Paidassi H, Defrance T, Morelon E, Badet L, Nicoletti A, Dubois V, Thaunat O. Inverted direct allorecognition triggers early donor-specific antibody responses after transplantation. Sci Transl Med 2022; 14:eabg1046. [PMID: 36130013 DOI: 10.1126/scitranslmed.abg1046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The generation of antibodies against donor-specific major histocompatibility complex (MHC) antigens, a type of donor-specific antibodies (DSAs), after transplantation requires that recipient's allospecific B cells receive help from T cells. The current dogma holds that this help is exclusively provided by the recipient's CD4+ T cells that recognize complexes of recipient's MHC II molecules and peptides derived from donor-specific MHC alloantigens, a process called indirect allorecognition. Here, we demonstrated that, after allogeneic heart transplantation, CD3ε knockout recipient mice lacking T cells generate a rapid, transient wave of switched alloantibodies, predominantly directed against MHC I molecules. This is due to the presence of donor CD4+ T cells within the graft that recognize intact recipient's MHC II molecules expressed by B cell receptor-activated allospecific B cells. Indirect evidence suggests that this inverted direct pathway is also operant in patients after transplantation. Resident memory donor CD4+ T cells were observed in perfusion liquids of human renal and lung grafts and acquired B cell helper functions upon in vitro stimulation. Furthermore, T follicular helper cells, specialized in helping B cells, were abundant in mucosa-associated lymphoid tissue of lung and intestinal grafts. In the latter, more graft-derived passenger T cells correlated with the detection of donor T cells in recipient's circulation; this, in turn, was associated with an early transient anti-MHC I DSA response and worse transplantation outcomes. We conclude that this inverted direct allorecognition is a possible explanation for the early transient anti-MHC DSA responses frequently observed after lung or intestinal transplantations.
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Affiliation(s)
- Xavier Charmetant
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
| | - Chien-Chia Chen
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Sarah Hamada
- French National Blood Service (EFS), HLA Laboratory, 69150 Décines, France
| | - David Goncalves
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
| | - Carole Saison
- French National Blood Service (EFS), HLA Laboratory, 69150 Décines, France
| | - Maud Rabeyrin
- Department of Pathology, Hospices Civils de Lyon, Groupement Hospitalier Est, 69500 Bron, France
| | - Marion Rabant
- Pathology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, 75015 Paris, France
| | | | - Alice Koenig
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
- Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), 69008 Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, 69003 Lyon, France
| | - Virginie Mathias
- French National Blood Service (EFS), HLA Laboratory, 69150 Décines, France
| | - Thomas Barba
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
| | - Florence Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker-Enfants malades, 75015 Paris, France
| | - Jérôme le Pavec
- Department of Pulmonology and Lung Transplantation, Marie Lannelongue Hospital, 92350 Le Plessis Robinson, France
| | - Olivier Brugière
- Pulmonology Department, Adult Cystic Fibrosis Centre and Lung Transplantation Department, Foch Hospital, 92150 Suresnes, France
| | - Jean-Luc Taupin
- Laboratory of Immunology and Histocompatibility, Hôpital Saint-Louis APHP, 75010 Paris, France
- INSERM U976 Institut de Recherche Saint-Louis, Université Paris Diderot, 75010 Paris, France
| | - Lara Chalabreysse
- Department of Pathology, Hospices Civils de Lyon, Groupement Hospitalier Est, 69500 Bron, France
| | - Jean-François Mornex
- Université de Lyon, Université Lyon 1, INRAE, IVPC, UMR754, 69000 Lyon, France
- Department of Pneumology, GHE, Hospices Civils de Lyon, 69000 Lyon, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis, Apheresis, Pellegrin Hospital, 33000 Bordeaux, France
| | - Stéphanie Graff-Dubois
- Sorbonne Université, INSERM, Immunology-Immunopathology-Immunotherapy (i3), 75013 Paris, France
| | - Raphaël Jeger-Madiot
- Sorbonne Université, INSERM, Immunology-Immunopathology-Immunotherapy (i3), 75013 Paris, France
| | - Alexy Tran-Dinh
- Université de Paris, LVTS, INSERM U1148, 75018 Paris, France
| | - Pierre Mordant
- Department of Vascular and Thoracic Surgery, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Helena Paidassi
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
| | - Thierry Defrance
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
| | - Emmanuel Morelon
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
- Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), 69008 Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, 69003 Lyon, France
| | - Lionel Badet
- Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), 69008 Lyon, France
- Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Edouard Herriot Hospital, 69003 Lyon, France
| | | | - Valérie Dubois
- French National Blood Service (EFS), HLA Laboratory, 69150 Décines, France
| | - Olivier Thaunat
- CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007 Lyon, France
- Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), 69008 Lyon, France
- Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, 69003 Lyon, France
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Tran-Dinh A, Bouzid D, El Kalai A, Atchade E, Tanaka S, Lortat-Jacob B, Jean-Baptiste S, Zappella N, Boudinet S, Castier Y, Mal H, Mordant P, Messika J, Montravers P. Favorable, arduous or fatal postoperative pathway within 90 days of lung transplantation. BMC Pulm Med 2022; 22:326. [PMID: 36030202 PMCID: PMC9420258 DOI: 10.1186/s12890-022-02120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The maximum gain in quality of life after lung transplantation (LT) is expected between six months and one year after LT, as the occurrence of chronic lung allograft dysfunction may mask the beneficial effects beyond one year. Thus, the postoperative period could be the cornerstone of graft success. We sought to describe the factors present before postoperative admission to the ICU and associated with favorable, arduous or fatal pathway within 90 days of LT. MATERIALS AND METHODS We conducted a retrospective single-center study between January 2015 and December 2020. Using multinomial regression, we assessed the demographic, preoperative and intraoperative characteristics of patients associated with favorable (duration of postoperative mechanical ventilation < 3 days and alive at Day 90), arduous (duration of postoperative mechanical ventilation ≥ 3 days and alive at Day 90) or fatal (dead at Day 90) pathway within 90 days of LT. RESULTS A total of 269 lung transplant patients were analyzed. Maximum graft cold ischemic time ≥ 6 h and intraoperative blood transfusion ≥ 3 packed red blood cells were associated with arduous and fatal pathway at Day 90, whereas intraoperative ECMO was strongly associated with fatal pathway. CONCLUSION No patient demographics influenced the postoperative pathway at Day 90. Only extrinsic factors involving graft ischemia time, intraoperative transfusion, and intraoperative ECMO determined early postoperative pathway.
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Affiliation(s)
- Alexy Tran-Dinh
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France. .,INSERM UMR 1148 LVTS, Université Paris Cité, Paris, France.
| | - Donia Bouzid
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service des Urgences, Paris, France.,INSERM UMR 1137 IAME, Paris, France
| | - Adnan El Kalai
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France
| | - Enora Atchade
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France
| | - Sébastien Tanaka
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France.,INSERM UMR 1188 DéTROI, Université de la Réunion, Saint-Denis de la Réunion, France
| | - Brice Lortat-Jacob
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France
| | - Sylvain Jean-Baptiste
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France
| | - Nathalie Zappella
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France
| | - Sandrine Boudinet
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France
| | - Yves Castier
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France.,INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France
| | - Hervé Mal
- INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France.,Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Pierre Mordant
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Paris, France.,INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France
| | - Jonathan Messika
- INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France.,Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Pneumologie B et Transplantation Pulmonaire, Paris, France.,Paris Transplant Group, Paris, France
| | - Philippe Montravers
- Université Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Anesthésie-Réanimation, Paris, France.,INSERM UMR 1152 PHERE, Université Paris Cité, Paris, France
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14
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Andrei S, Tran-Dinh A, Boutten A, Asssadi M, Tashk P, Castier Y, Popescu BA, Bunel V, Tanaka S, Montravers P, Augustin P. The Perioperative Kinetics Profile of Troponin I in Lung Transplantation - A Pilot Observational Study. J Cardiothorac Vasc Anesth 2022; 36:2842-2845. [PMID: 35525702 DOI: 10.1053/j.jvca.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Stefan Andrei
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France.
| | - Alexy Tran-Dinh
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France; Unité INSERM UMR 1148, CHU Bichat-Claude Bernard, Paris, France
| | - Anne Boutten
- Laboratoire de biochimie, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Maksud Asssadi
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Parvine Tashk
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Bogdan Alexandru Popescu
- Department of Cardiology, CC Iliescu Emergency Institute for Cardiovascular Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vincent Bunel
- Service de Pneumologie, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Sébastien Tanaka
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France; Unité INSERM UMR 1152, UFR de Médecine Xavier Bichat, Paris, France
| | - Pascal Augustin
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
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15
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Tanaka S, Thy M, Rozencwajg S, Tran-Dinh A, Montravers P. In severe necrotising soft-tissue infections, do skin defect surfaces matter? Anaesth Crit Care Pain Med 2022; 41:101071. [PMID: 35470050 DOI: 10.1016/j.accpm.2022.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France; Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France.
| | - Michael Thy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France; University of Paris, UFR Denis Diderot, Paris, France
| | - Sacha Rozencwajg
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France; University of Paris, UFR Denis Diderot, Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France; University of Paris, UFR Denis Diderot, Paris, France; French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France; University of Paris, UFR Denis Diderot, Paris, France; INSERM UMR 1152 - PHERE, Paris, France, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France
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16
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Joannes-Boyau O, Le Conte P, Bonnet MP, Cesareo E, Chousterman B, Chaiba D, Douay B, Futier E, Harrois A, Huraux C, Ichai C, Meaudre Desgouttes E, Mimoz O, Muller L, Oberlin M, Peschanski N, Quintard H, Rousseau G, Savary D, Tran-Dinh A, Villoing B, Chauvin A, Weiss E. Guidelines for the choice of intravenous fluids for vascular filling in critically ill patients, 2021. Anaesth Crit Care Pain Med 2022; 41:101058. [PMID: 35526312 DOI: 10.1016/j.accpm.2022.101058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To provide recommendations for the appropriate choice of fluid therapy for resuscitation of critically ill patients. DESIGN A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Emergency Medicine (Société française de médecine d'urgence, SFMU) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Some recommendations were left ungraded. METHODS Four fields were defined: patients with sepsis or septic shock, patients with haemorrhagic shock, patients with acute brain failure, and patients during the peripartum period. For each field, the panel focused on two questions: (1) Does the use of colloids, as compared to crystalloids, reduce morbidity and mortality, and (2) Does the use of some specific crystalloids effectively reduce morbidity and mortality. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology. RESULTS The SFAR/SFMU guideline panel provided nine statements on the appropriate choice of fluid therapy for resuscitation of critically ill patients. After two rounds of rating and various amendments, strong agreement was reached for 100% of the recommendations. Out of these recommendations, two have a high level of evidence (Grade 1 +/-), six have a moderate level of evidence (Grade 2 +/-), and one is based on expert opinion. Finally, no recommendation was formulated for two questions. CONCLUSIONS Substantial agreement among experts has been obtained to provide a sizable number of recommendations aimed at optimising the choice of fluid therapy for resuscitation of critically ill patients.
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Affiliation(s)
- Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France.
| | - Philippe Le Conte
- Nantes Université, Faculté de Médecine, CHU de Nantes, Service des Urgences, Nantes, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Service d'Anesthésie-Réanimation, Hôpital Trousseau, DMU DREAM, GRC 29, APHP, Paris, France; INSERM U1153, Equipe de Recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Eric Cesareo
- Samu 69, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d'Arsonval, F-69437 Lyon Cedex 03, France
| | - Benjamin Chousterman
- APHP, CHU Lariboisière, Département d'Anesthésie-Réanimation, DMU PARABOL, FHU, PROMICE, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
| | - Djamila Chaiba
- Service des Urgences Médico-Chirurgicales, Hôpital Simone Veil, Eaubonne, France
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Emmanuel Futier
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Anatole Harrois
- Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, Paris, France
| | | | - Carole Ichai
- Université Côte D'Azur, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Service de Réanimation Polyvalente, Nice, France
| | - Eric Meaudre Desgouttes
- Service Anesthésiologie-Réanimation Chirurgicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | - Olivier Mimoz
- Service des Urgences Adultes & SAMU 86, CHU de Poitiers, Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France; Inserm U1070, Pharmacology of Antimicrobial Agents, Poitiers, France
| | - Laurent Muller
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, CHU Nîmes, Montpellier, France
| | - Mathieu Oberlin
- Structure des Urgences, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Peschanski
- Service des Urgences-SAMU-SMUR-CHU Rennes, Rennes, France; Faculté de Médecine-Université Rennes-1, Rennes, France
| | - Hervé Quintard
- Service des Soins Intensifs Adultes, Hôpitaux Universitaires de Genève, Switzerland
| | | | | | - Alexy Tran-Dinh
- Service d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Barbara Villoing
- SAU-SMUR, CHU Cochin Hôtel Dieu, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Anthony Chauvin
- Services des Urgences/SMUR, Hôpital Lariboisière, Université de Paris Cité, Paris, France
| | - Emmanuel Weiss
- Service Anesthésie-Réanimation, Hôpital Beaujon, DMU PARABOL, AP-HP Nord, Clichy, France; Centre de Recherche sur l'Inflammation, UMR_S1149, Université de Paris, Paris, France
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17
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Atchade E, Goldstein V, Viane S, Van Gysel D, Lolom I, Lortat-Jacob B, Tran-Dinh A, Ben Rehouma M, Lucet JC, Montravers P. Economic impact of an outbreak of carbapenemase producing-Enterobacteriaceae in a surgical intensive care unit. Anaesth Crit Care Pain Med 2022; 41:101093. [PMID: 35504523 DOI: 10.1016/j.accpm.2022.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A 15-month outbreak of carbapenemase-producing Enterobacterales (CPE) occurred in the surgical intensive care unit (SICU) of our institution. We aimed to estimate the financial impact of this outbreak from the perspective of the French public health insurance system. METHODS The characteristics of the colonised/infected CPE patients and outbreak management according to French national guidelines were prospectively collected. Loss of productivity was assessed in terms of the reduction in total number of admissions (TNA) and discharges and in ICU length of stay (LoS). The additional financial burden associated with this outbreak was estimated by the accounting department of the hospital, including the impact of the extended LoS and restricted admissions. RESULTS Sixteen CPE patients (19 stays) were hospitalised in the SICU (10/2016-01/2018). The median ICU LoS for the CPE cases was 17 [8-36] days versus 6.5 and 6.1 days in 2016 and 2017, respectively, for the whole SICU population. The total number of lost bed days during the outbreak was 452. The TNA dropped dramatically in 2017 (decrease of 20.6%). The estimated costs were 768,386 EUR for bed days lost; 297,176 EUR and 63,675 EUR for the extended LoS for the CPE cases and the patients on contact precautions, respectively; 34,045 EUR for staff reinforcements; 85,764 EUR for bacteriological screening tests; and 42,857 EUR for antimicrobial treatment. The total financial burden of the outbreak was 1,291,903 EUR. CONCLUSION Management of a CPE outbreak in the SICU is associated with a huge financial burden for the unit and for the institution.
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Affiliation(s)
- Enora Atchade
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France.
| | - Valérie Goldstein
- APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France
| | - Sophie Viane
- APHP, CHU Bichat-Claude Bernard, Département Activité et Ressources, 46 rue Henri Huchard, 75018 Paris, France
| | - Damien Van Gysel
- APHP, CHU Bichat-Claude Bernard, Département d'Information Médicale, 46 rue Henri Huchard, 75018 Paris, France
| | - Isabelle Lolom
- APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France
| | - Brice Lortat-Jacob
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France
| | - Alexy Tran-Dinh
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France; LVTS, InsermU1148, CHU Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Mouna Ben Rehouma
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France
| | - Jean-Christophe Lucet
- APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France; Institut National de la Santé et de la Recherche Médicale UMR 1152, Physiopathologie et Epidémiologie des maladies respiratoires, Paris, France
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18
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Thy M, Augustin P, Tran-Dinh A, Montravers P, de Tymowski C. Renal Replacement Therapy for Patients Requiring Extracorporeal Membrane Oxygenation: A Multicenter International Survey. Blood Purif 2022; 51:899-906. [PMID: 35390796 DOI: 10.1159/000522398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/02/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients receiving extracorporeal membrane oxygenation (ECMO) often require renal replacement therapy (RRT). The challenge of inserting a dialysis catheter (DC) could be solved by direct connection of RRT lines on an ECMO circuit (DCRE) without published guidelines. This study aimed to describe the practice of RRT in patients on ECMO, including the DCRE as well as the perception and concerns related to this technique. METHODS An international survey was worldwide sent via email to professionals involved in the management of ECMO. Respondents always or often performing RRT via the ECMO circuit were classified in the ECMO group, and those using a DC were classified in the DC group. RESULTS From March 2019 to October 2019, 298 participants answered the questionnaire from 46 different countries. Only 28% were working in pediatric departments. Among the 165 participants commonly performing RRT in patients on ECMO, 100 (61%) performed mainly RRT via the ECMO circuit, and 65 (39%) performed RRT via DC. Pediatric practice and a longer experience were the only noticeable characteristics of the ECMO group. The most reported concern regarding DCRE was the risk of air embolism (n = 84, 28%), but the most encountered problem was unmanageable pressure alarms in RRT devices. CONCLUSION The present study showed significant heterogeneity in RRT practices in patients on ECMO. The lower experience of the DC group, the high rates of concerns toward DCRE, and pressure alarm issues suggested that protocols and training may overcome reluctance and technical difficulties.
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Affiliation(s)
- Michael Thy
- Department of Anesthesiology and Surgical Intensive Care Unit, Groupe Hospitalier Bichat-Claude-Bernard, DMU Parabol, APHP, Paris, France.,Université de Paris, Paris, France.,EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Université de Paris, Paris, France
| | - Pascal Augustin
- Department of Anesthesiology and Surgical Intensive Care Unit, Groupe Hospitalier Bichat-Claude-Bernard, DMU Parabol, APHP, Paris, France
| | - Alexy Tran-Dinh
- Department of Anesthesiology and Surgical Intensive Care Unit, Groupe Hospitalier Bichat-Claude-Bernard, DMU Parabol, APHP, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1148, Paris, France
| | - Philippe Montravers
- Department of Anesthesiology and Surgical Intensive Care Unit, Groupe Hospitalier Bichat-Claude-Bernard, DMU Parabol, APHP, Paris, France.,Université de Paris, Paris, France.,Physiopathologie et Epidémiologie des maladies respiratoires, INSERM UMR1152 PHERE, Université de Paris, Paris, France
| | - Christian de Tymowski
- Department of Anesthesiology and Surgical Intensive Care Unit, Groupe Hospitalier Bichat-Claude-Bernard, DMU Parabol, APHP, Paris, France.,Université de Paris, Paris, France.,Centre de Recherche sur l'Inflammation, INSERM UMR 1149, CNRS ERL8252, Université de Paris, Paris, France.,Laboratory of Excellence, Inflamex, Université de Paris, Paris, France
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19
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Peyneau M, de Chaisemartin L, Faille D, Messika J, Mal H, Castier Y, Mordant P, Carrasco JL, Tanaka S, Lortat Jacob B, Ferrari P, Arrault X, Ajzenberg N, Chollet-Martin S, Montravers P, Tran-Dinh A. First Experience With Extracorporeal Cytokine Adsorption Therapy After Lung Transplantation. Transpl Int 2022; 35:10319. [PMID: 35387399 PMCID: PMC8977406 DOI: 10.3389/ti.2022.10319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Marine Peyneau
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Hôpital Bichat-Claude-Bernard, Paris, France
- Faculty of Pharmacy, INSERM UMR 996, Inflammation, Microbiome and Immunosurveillance, Université Paris-Saclay, Châtenay-Malabry, France
| | - Luc de Chaisemartin
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Hôpital Bichat-Claude-Bernard, Paris, France
- Faculty of Pharmacy, INSERM UMR 996, Inflammation, Microbiome and Immunosurveillance, Université Paris-Saclay, Châtenay-Malabry, France
| | - Dorothée Faille
- Hematology Laboratory, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
- Laboratory for Vascular Translational Science, INSERM UMR 1148, Université de Paris, Paris, France
| | - Jonathan Messika
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat-Claude-Bernard, Paris, France
- Paris Transplant Group, Paris, France
| | - Hervé Mal
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Yves Castier
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - Pierre Mordant
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - José Luis Carrasco
- Département d’Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Sébastien Tanaka
- Département d’Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- INSERM UMR 1188 DéTROI, Université de la Réunion, Saint-Denis de la Réunion, France
| | - Brice Lortat Jacob
- Département d’Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Paola Ferrari
- Département d’Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Xavier Arrault
- Service de Pharmacie, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - Nadine Ajzenberg
- Hematology Laboratory, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
- Laboratory for Vascular Translational Science, INSERM UMR 1148, Université de Paris, Paris, France
| | - Sylvie Chollet-Martin
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Hôpital Bichat-Claude-Bernard, Paris, France
- Faculty of Pharmacy, INSERM UMR 996, Inflammation, Microbiome and Immunosurveillance, Université Paris-Saclay, Châtenay-Malabry, France
| | - Philippe Montravers
- INSERM UMR 1152 PHERE, Université de Paris, Paris, France
- Département d’Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Alexy Tran-Dinh
- Laboratory for Vascular Translational Science, INSERM UMR 1148, Université de Paris, Paris, France
- Département d’Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- *Correspondence: Alexy Tran-Dinh,
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20
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Weisenburger G, Gault N, Roux A, Tran-Dinh A, Bunel V, Godet C, Mordant P, Montravers P, Castier Y, Mal H, Gaudry S, Messika J. Patient-important outcomes in lung transplantation: a systematic review. Respir Med Res 2022; 81:100896. [DOI: 10.1016/j.resmer.2022.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
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21
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Tanaka S, Thy M, Khoury R, Tran-Dinh A, Khalil A, Montravers P. Severe necrotizing soft-tissue infection-associated mortality: Have a look at the computed tomography! Crit Care 2022; 26:27. [PMID: 35078494 PMCID: PMC8788076 DOI: 10.1186/s13054-022-03898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
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22
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Peyneau M, Granger V, Wicky PH, Khelifi-Touhami D, Timsit JF, Lescure FX, Yazdanpanah Y, Tran-Dinh A, Montravers P, Monteiro RC, Chollet-Martin S, Hurtado-Nedelec M, de Chaisemartin L. Innate immune deficiencies are associated with severity and poor prognosis in patients with COVID-19. Sci Rep 2022. [PMID: 35022495 DOI: 10.1101/2021.03.29.21254560:2021.03.29.21254560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
COVID-19 can cause acute respiratory distress syndrome, leading to death in many individuals. Evidence of a deleterious role of the innate immune system is accumulating, but the precise mechanisms involved remain unclear. In this study, we investigated the links between circulating innate phagocytes and severity in COVID-19 patients. We performed in-depth phenotyping of neutrophil and monocyte subpopulations and measured soluble activation markers in plasma. Additionally, anti-microbial functions (phagocytosis, oxidative burst, and NETosis) were evaluated on fresh cells from patients. Neutrophils and monocytes had a strikingly disturbed phenotype, and elevated concentrations of activation markers (calprotectin, myeloperoxidase, and neutrophil extracellular traps) were measured in plasma. Critical patients had increased CD13low immature neutrophils, LOX-1 + and CCR5 + immunosuppressive neutrophils, and HLA-DRlow downregulated monocytes. Markers of immature and immunosuppressive neutrophils were strongly associated with severity. Moreover, neutrophils and monocytes of critical patients had impaired antimicrobial functions, which correlated with organ dysfunction, severe infections, and mortality. Together, our results strongly argue in favor of a pivotal role of innate immunity in COVID-19 severe infections and pleads for targeted therapeutic options.
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Affiliation(s)
- Marine Peyneau
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Vanessa Granger
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Paul-Henri Wicky
- AP-HP, Bichat Hospital Medical and Infectious Diseases ICU (MI2), Paris, France
- IAME Université de Paris, Inserm U 1137, Paris, France
| | - Dounia Khelifi-Touhami
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Hospital Medical and Infectious Diseases ICU (MI2), Paris, France
- IAME Université de Paris, Inserm U 1137, Paris, France
| | - François-Xavier Lescure
- IAME Université de Paris, Inserm U 1137, Paris, France
- Infectious Diseases Department, AP-HP, Hôpital Bichat, Paris, France
| | - Yazdan Yazdanpanah
- IAME Université de Paris, Inserm U 1137, Paris, France
- Infectious Diseases Department, AP-HP, Hôpital Bichat, Paris, France
| | - Alexy Tran-Dinh
- Département d'Anesthésie-Réanimation, DMU PARABOL, Université de Paris, AP-HP, Bichat Hospital, Paris, France
- INSERM UMR 1152 - ANR10-LABX-17, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation, DMU PARABOL, Université de Paris, AP-HP, Bichat Hospital, Paris, France
- INSERM UMR 1152 - ANR10-LABX-17, Paris, France
| | - Renato C Monteiro
- Center for Research On Inflammation (CRI), Inflamex Laboratory of Excellence, U1149, CNRS ERL8252, Paris, France
- Immunological Dysfunction Laboratory, APHP, Bichat Hospital, Paris, France
| | - Sylvie Chollet-Martin
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Margarita Hurtado-Nedelec
- Center for Research On Inflammation (CRI), Inflamex Laboratory of Excellence, U1149, CNRS ERL8252, Paris, France
- Immunological Dysfunction Laboratory, APHP, Bichat Hospital, Paris, France
| | - Luc de Chaisemartin
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
- INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France.
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23
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Peyneau M, Granger V, Wicky PH, Khelifi-Touhami D, Timsit JF, Lescure FX, Yazdanpanah Y, Tran-Dinh A, Montravers P, Monteiro RC, Chollet-Martin S, Hurtado-Nedelec M, de Chaisemartin L. Innate immune deficiencies are associated with severity and poor prognosis in patients with COVID-19. Sci Rep 2022; 12:638. [PMID: 35022495 PMCID: PMC8755788 DOI: 10.1038/s41598-021-04705-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023] Open
Abstract
COVID-19 can cause acute respiratory distress syndrome, leading to death in many individuals. Evidence of a deleterious role of the innate immune system is accumulating, but the precise mechanisms involved remain unclear. In this study, we investigated the links between circulating innate phagocytes and severity in COVID-19 patients. We performed in-depth phenotyping of neutrophil and monocyte subpopulations and measured soluble activation markers in plasma. Additionally, anti-microbial functions (phagocytosis, oxidative burst, and NETosis) were evaluated on fresh cells from patients. Neutrophils and monocytes had a strikingly disturbed phenotype, and elevated concentrations of activation markers (calprotectin, myeloperoxidase, and neutrophil extracellular traps) were measured in plasma. Critical patients had increased CD13low immature neutrophils, LOX-1 + and CCR5 + immunosuppressive neutrophils, and HLA-DRlow downregulated monocytes. Markers of immature and immunosuppressive neutrophils were strongly associated with severity. Moreover, neutrophils and monocytes of critical patients had impaired antimicrobial functions, which correlated with organ dysfunction, severe infections, and mortality. Together, our results strongly argue in favor of a pivotal role of innate immunity in COVID-19 severe infections and pleads for targeted therapeutic options.
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Affiliation(s)
- Marine Peyneau
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Vanessa Granger
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Paul-Henri Wicky
- AP-HP, Bichat Hospital Medical and Infectious Diseases ICU (MI2), Paris, France.,IAME Université de Paris, Inserm U 1137, Paris, France
| | - Dounia Khelifi-Touhami
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Hospital Medical and Infectious Diseases ICU (MI2), Paris, France.,IAME Université de Paris, Inserm U 1137, Paris, France
| | - François-Xavier Lescure
- IAME Université de Paris, Inserm U 1137, Paris, France.,Infectious Diseases Department, AP-HP, Hôpital Bichat, Paris, France
| | - Yazdan Yazdanpanah
- IAME Université de Paris, Inserm U 1137, Paris, France.,Infectious Diseases Department, AP-HP, Hôpital Bichat, Paris, France
| | - Alexy Tran-Dinh
- Département d'Anesthésie-Réanimation, DMU PARABOL, Université de Paris, AP-HP, Bichat Hospital, Paris, France.,INSERM UMR 1152 - ANR10-LABX-17, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation, DMU PARABOL, Université de Paris, AP-HP, Bichat Hospital, Paris, France.,INSERM UMR 1152 - ANR10-LABX-17, Paris, France
| | - Renato C Monteiro
- Center for Research On Inflammation (CRI), Inflamex Laboratory of Excellence, U1149, CNRS ERL8252, Paris, France.,Immunological Dysfunction Laboratory, APHP, Bichat Hospital, Paris, France
| | - Sylvie Chollet-Martin
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Margarita Hurtado-Nedelec
- Center for Research On Inflammation (CRI), Inflamex Laboratory of Excellence, U1149, CNRS ERL8252, Paris, France.,Immunological Dysfunction Laboratory, APHP, Bichat Hospital, Paris, France
| | - Luc de Chaisemartin
- Autoimmunity and Hypersensitivity Laboratory, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France. .,INSERM UMR 996, "Inflammation, Microbiome and Immunosurveillance", Faculty of Pharmacy, Université Paris-Saclay, 92290, Châtenay-Malabry, France.
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24
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Andrei S, Kantor E, Asssadi M, Boutten A, Pellenc Q, Jebrak G, Godement M, Abbas S, Atchade E, Tran-Dinh A, Robert-Mercier T, Valeanu L, Longrois D, Montravers P, Augustin P. The Prognostic Role of Early Postoperative Troponin I in Lung Transplantation-A Retrospective 7-Year Analysis. J Cardiothorac Vasc Anesth 2021; 36:2328-2334. [PMID: 34911638 DOI: 10.1053/j.jvca.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Postoperative cardiac troponin I concentration is predictive of worsened outcomes in cardiac surgery. Lung transplantation (LT) surgery shares common features with cardiac surgery, but postoperative troponin has yet to be investigated. The authors aimed to evaluate the association between early postoperative troponin concentration and the 1-year mortality after transplantation. DESIGN A retrospective, observational, single-center study. SETTING At a tertiary care, university hospital. PARTICIPANTS Patients who underwent lung transplantation from January 2011 to December 2017 INTERVENTIONS: For each patient, preoperative, intraoperative, and postoperative data were collected, as well as the troponin I measurement at the moment of postoperative intensive care unit admission. MEASUREMENTS AND MAIN RESULTS Two hundred twenty LT procedures were analyzed. Troponin I was elevated in all LT patients, with a median of 3.82 ng/mL-1 (2-6.42) ng/mL-1 significantly higher in non-survivors than in survivors with 5.39 (2.88-7.44) v 3.50 ng/mL (1.74-5.76), p = 0.005. In the multivariate analysis, the authors found that only the Simplified Acute Physiology Score II score (hazard ratio [HR] 1.03; 95% confidence interval [CI] [1.001; 1.05]; p = 0.007) and the need to maintain extracorporeal life support at the end of surgery (HR 2.54; 95% CI [1.36; 4.73]; p = 0.003) were independently associated with the 1-year mortality. The multiple linear regression model found that troponin levels were associated with the need for extracorporeal life support (ECLS) (p = 0.014), the amount of transfused packed red blood cells (p = 0.008), and bilateral LT (p < 0.001). CONCLUSION Early postoperative troponin serum levels were not independently associated with 1-year mortality. Early postoperative troponin I levels were correlated to bilateral LT, the need for ECLS, and intraoperative blood transfusion.
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Affiliation(s)
- Stefan Andrei
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France.
| | - Elie Kantor
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Maksud Asssadi
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Anne Boutten
- Laboratoire de biochimie, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Quentin Pellenc
- Service de Chirurgie Thoracique et Vasculaire, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Gilles Jebrak
- Service de Pneumologie, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Mathieu Godement
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Samia Abbas
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Enora Atchade
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Alexy Tran-Dinh
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France; Unité INSERM UMR 1148, CHU Bichat-Claude Bernard, Paris, France
| | - Tiphaine Robert-Mercier
- Laboratoire de biochimie, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Liana Valeanu
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Dan Longrois
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France; Unité INSERM UMR 1148, CHU Bichat-Claude Bernard, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France; Unité INSERM UMR 1152, UFR de Médecine Xavier Bichat, Paris, France
| | - Pascal Augustin
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
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25
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Savary A, Hammouda M, Genet L, Godet C, Bunel V, Weisenburger G, Goletto T, Medraoui C, Jebrak G, Marceau A, Tran-Dinh A, Mordant P, Castier Y, Montravers P, Mal H, Messika J. Coping strategies, anxiety and depression related to the COVID-19 pandemic in lung transplant candidates and recipients. Results from a monocenter series. Respir Med Res 2021; 80:100847. [PMID: 34371237 PMCID: PMC8260501 DOI: 10.1016/j.resmer.2021.100847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/17/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with an increase in anxiety and depression symptoms in people. We investigated the impact of the pandemic on coping strategies and anxiety and depression in lung transplantation (LT) recipients and patients with end-stage chronic lung disease awaiting LT. METHODS We retrospectively investigated coping strategies by using the Coping Inventory for Stressful Situations questionnaire and anxiety and depression symptoms by the Hospital Anxiety and Depression scale in 115 LT candidates and recipients. RESULTS Overall, 63 participants (20 women; median age 59 years [interquartile range 52•65]) answered one or both questionnaires (49 LT recipients and 14 LT candidates). The preferred coping strategy was task-focused for 51 (86.4%) participants, with no difference between LT recipients and candidates nor according to the main anamnestic and clinical data. Eleven patients had suspected or proven depression symptoms, and 18 had suspected or proven anxiety symptoms. Coping strategies related to COVID-19 did not differ by presence of anxiety or depression symptoms. CONCLUSION In the current pandemic, healthcare professionals should consider these results to provide relevant psychological help to these fragile populations and promote a systematic and wide multidisciplinary assessment of LT recipients and candidates.
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Affiliation(s)
- Alice Savary
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Malika Hammouda
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Lucie Genet
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Cendrine Godet
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France; Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France
| | - Vincent Bunel
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France; Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France
| | - Gaelle Weisenburger
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France; Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France
| | - Tiphaine Goletto
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Chahine Medraoui
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Gilles Jebrak
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Armelle Marceau
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France
| | - Alexy Tran-Dinh
- Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France; APHP, Hôpital Bichat, Dèc)partement d'Anesthèc)sie et Rèc)animation, F-75018 Paris, France
| | - Pierre Mordant
- Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France; APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, F-75018 Paris, France
| | - Yves Castier
- Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France; APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, F-75018 Paris, France
| | - Philippe Montravers
- Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France; APHP, Hôpital Bichat, Dèc)partement d'Anesthèc)sie et Rèc)animation, F-75018 Paris, France
| | - Herve Mal
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France; Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France
| | - Jonathan Messika
- APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France; Universitèc) de Paris, PHERE UMRS 1152, LVTS UMRS 1148, F-75018 Paris, France; Paris Transplant Group, Paris, France.
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26
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Tanaka S, Thy M, Tashk P, Ribeiro L, Lortat-Jacob B, Hermieu JF, Zappella N, Rozencwajg S, Snauwaert A, Atchade E, Grall N, Assadi M, Tran-Dinh A, Montravers P. Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study. Eur J Clin Microbiol Infect Dis 2021; 41:109-117. [PMID: 34625886 PMCID: PMC8732959 DOI: 10.1007/s10096-021-04354-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022]
Abstract
Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.
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Affiliation(s)
- Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France. .,French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Réunion Island University, Saint-Denis de La Réunion, France.
| | - Michael Thy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France.,EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Paris Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Parvine Tashk
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Lara Ribeiro
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of General and Visceral Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Brice Lortat-Jacob
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Jean-François Hermieu
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Urology, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Sacha Rozencwajg
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France
| | - Aurelie Snauwaert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Enora Atchade
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Grall
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM), IAME, UMR 1137, Paris, France
| | - Maksud Assadi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France.,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Paris, France.,Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, ANR10-LABX-17, Paris, France
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27
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Atchade E, Younsi M, Elmaleh Y, Tran-Dinh A, Jean-Baptiste S, Tanaka S, Tashk P, Snauwaert A, Lortat-Jacob B, Morer L, Roussel A, Castier Y, Mal H, De Tymowski C, Montravers P. Intensive care readmissions in the first year after lung transplantation: Incidence, early risk factors and outcome. Anaesth Crit Care Pain Med 2021; 40:100948. [PMID: 34536593 DOI: 10.1016/j.accpm.2021.100948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predictive factors of intensive care readmissions after lung transplantation (LT) have not been established. The main objective of this study was to assess early risk factors for ICU readmission during the first year after LT. METHODS This retrospective, observational, single-centre study included all consecutive patients who underwent LT in our institution between January 2016 and November 2019. Patients who died during the initial hospitalisation in the ICU were excluded. Surgical and medical ICU readmissions were collected during the first year. The results are expressed as medians, interquartile ranges, absolute numbers and percentages. Statistical analyses were performed using the chi-square test, Fisher's exact test and Mann-Whitney U test as appropriate (p < 0.05 as significance). Multivariate analysis was performed to identify independent risk factors for readmission. The Paris-North-Hospitals Institutional Review Board reviewed and approved the study. RESULTS A total of 156 patients were analysed. Eighteen of them (12%) died during the initial ICU hospitalisation. During the first year after LT, ICU readmission was observed for 49/138 (36%) patients. Among these patients, 14/49 (29%) died during the study period. Readmission was mainly related to respiratory failure (35 (71%) patients), infectious diseases (28 (57%) patients), airway complications (11 (22%) patients), and immunologic complications (4 (8%) patients). In the multivariate analysis, ICU readmission was associated with the use of high doses of catecholamines during surgery, and the increased duration of initial ICU stay. CONCLUSION The initial severity of haemodynamic failure and a prolonged postoperative course seem to be key determinants of ICU readmissions after LT.
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Affiliation(s)
- Enora Atchade
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France.
| | - Malek Younsi
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France
| | - Yoann Elmaleh
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France
| | - Alexy Tran-Dinh
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France; INSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France
| | - Sylvain Jean-Baptiste
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France
| | - Sébastien Tanaka
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France; INSERM UMR 1188 Diabète Athérothrombose Université de la réunion, Réunion Océan Indien, (DéTROI), Saint Denis de la Réunion, France
| | - Parvine Tashk
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France
| | - Aurélie Snauwaert
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France
| | - Brice Lortat-Jacob
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France
| | - Lise Morer
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, 46, rue Henri Huchard, 75018 Paris, France
| | - Arnaud Roussel
- APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation, 46, rue Henri Huchard, 75018 Paris, France
| | - Yves Castier
- APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Vasculaire, Thoracique et Transplantation, 46, rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Paris Diderot, Paris, France; INSERM UMR 1152, ANR-10-LBX-17, Paris, France
| | - Hervé Mal
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, 46, rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Paris Diderot, Paris, France; INSERM UMR 1152, ANR-10-LBX-17, Paris, France
| | - Chris De Tymowski
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Paris Diderot, Paris, France; INSERM U1149, Immunorécepteur et Immunopathologie rénale, CHU Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46, rue Henri Huchard, 75018 Paris, France; Université de Paris, UFR Paris Diderot, Paris, France; INSERM UMR 1152, ANR-10-LBX-17, Paris, France
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28
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Amgoud Y, Senbel A, Bouhadoun A, Abdelazeem H, Ozen G, Savané I, Manikpurage HD, Mani S, Tran-Dinh A, Castier Y, Guyard A, Longrois D, Silverstein AM, Norel X. In search of pulmonary hypertension treatments: Effect of 17β-estradiol on PGI 2 pathway in human pulmonary artery. Prostaglandins Leukot Essent Fatty Acids 2021; 172:102321. [PMID: 34403986 DOI: 10.1016/j.plefa.2021.102321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Prostacyclin (PGI2) is synthetized by PGI2 synthase (PGIS) and induces vasorelaxation via activation of cyclic AMP (cAMP) generating IP-receptor. Several components of the PGI2 signaling pathway are reduced in patients with pulmonary hypertension (PH). AIM To study the effect of 17β-estradiol (E2) on the PGI2 signaling pathway in human pulmonary arteries (HPA) and in their smooth muscle cells (hPASMC) derived from Group-3 PH and non-PH patients. METHODS Following E2-treatments of isolated HPA and cultured hPASMC, we measured: 6-keto-Prostaglandin F1α (PGI2 stable metabolite) by ELISA, PGIS and IP protein levels by Western blot and HPA vasorelaxations with an organ bath system. RESULTS Incubation with E2 (24/48 h, doses ≥ 10 nM) significantly increased the expression of PGIS in hPASMC derived from both PH (65-98%) and non-PH (21-33%) patients, whereas incubation with E2 (2 h, 0.1 and 1 µM) increased 6-keto-PGF1α production in HPA from Group-3 PH patients only, and did not affect 6-keto-PGF1α production in hPASMC from either non-PH or Group-3 PH patients. Increases in IP receptor expression were observed following 10 mM E2-treatment of hPASMC from non-PH (33% after 48 h) and Group-3 PH (23% after 24 h) patient lungs. Finally, preincubation with 100 nM E2 significantly increased arachidonic acid-induced vasorelaxation of HPA from non-PH patient lungs but not of HPA from Group-3 PH patient lungs. CONCLUSION E2-treatment may help to restore the PGI2-pathway in Group-3 PH.
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MESH Headings
- 6-Ketoprostaglandin F1 alpha/metabolism
- Antihypertensive Agents/pharmacology
- Arachidonic Acid/pharmacology
- Case-Control Studies
- Cytochrome P-450 Enzyme System/drug effects
- Cytochrome P-450 Enzyme System/metabolism
- Endothelial Cells/drug effects
- Endothelial Cells/metabolism
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Epoprostenol/analogs & derivatives
- Epoprostenol/pharmacology
- Estradiol/pharmacology
- Estrogens/pharmacology
- Female
- Humans
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Intramolecular Oxidoreductases/drug effects
- Intramolecular Oxidoreductases/metabolism
- Male
- Middle Aged
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Pulmonary Artery/cytology
- Pulmonary Artery/drug effects
- Pulmonary Artery/metabolism
- Pulmonary Artery/physiopathology
- Vasodilation/drug effects
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Affiliation(s)
- Yasmine Amgoud
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Amira Senbel
- Alexandria University, Faculty of Pharmacy, Department of Pharmacology and Toxicology, Alexandria, Egypt; Arab Academy for Science, Technology & Maritime Transport, College of Pharmacy, Alexandria, Egypt
| | - Amel Bouhadoun
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Heba Abdelazeem
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France; Alexandria University, Faculty of Pharmacy, Department of Pharmacology and Toxicology, Alexandria, Egypt
| | - Gulsev Ozen
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Istanbul University, Faculty of Pharmacy, Department of Pharmacology, 34116 Istanbul, Turkey
| | - Ines Savané
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | | | - Salma Mani
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France; Université de Monastir-Tunisia, Institut Supérieur de Biotechnologie de Monastir (ISBM), Tunisia
| | - Alexy Tran-Dinh
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | - Yves Castier
- Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | - Alice Guyard
- Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | - Dan Longrois
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | | | - Xavier Norel
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France.
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29
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Tanaka S, De Tymowski C, Zappella N, Snauwaert A, Robert T, Lortat-Jacob B, Castier Y, Tran-Dinh A, Tashk P, Bouzid D, Para M, Pellenc Q, Atchade E, Meilhac O, Montravers P. Lipoprotein concentration in patients requiring extracorporeal membrane oxygenation. Sci Rep 2021; 11:17225. [PMID: 34446802 PMCID: PMC8390666 DOI: 10.1038/s41598-021-96728-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/10/2021] [Indexed: 11/09/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO), a relevant technology for patients with acute respiratory distress syndrome (ARDS) or acute cardiac failure (ACF), is a frequent cause of systemic inflammatory response syndrome. During sepsis, HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) concentrations decrease, and an association between low lipoprotein levels and poor outcomes was reported. There are no data from patients undergoing ECMO. The goal of this study was to characterize the lipoprotein profiles of ICU patients requiring ECMO. All consecutive patients admitted for ARDS or ACF requiring ECMO were prospectively included. Daily lipoprotein levels and short-term prognosis outcome were assessed. 25 patients were included. On admission, lipoprotein concentrations were low, under the reference values ([HDL-C] = 0.6[0.4–0.8]mmol/L;[LDL-C] = 1.3[1.0–1.7]mmol/L). A statistically significant rise in lipoproteins overtime was observed during the ICU stay. We found no relationship between lipoproteins concentrations and mortality on Day-28 (p = 0.689 and p = 0.979, respectively). Comparison of surviving patients with non-surviving patients did not reveal any differences in lipoproteins concentrations. Stratification between septic and non-septic patients demonstrated that septic patients had lower lipoproteins concentrations on admission (HDL-C: 0.5[0.3–0.6]mmol/l vs 0.8[0.6–0.9]mmol/l, p = 0.003; LDL-C: 1.1[0.9–1.5]mmol/l vs 1.5[1.3–2.6]mmol/l; p = 0.012), whereas these two groups were comparable in terms of severity and outcomes. HDL-C concentrations during ICU hospitalization were also significantly lower in the septic group than in the non-septic group (p = 0.035). In conclusion, Lipoprotein concentrations are low in patients requiring ECMO but are not associated with poor outcomes. The subpopulation of septic patients had lower lipoprotein levels overtime, which reinforces the potential key-role of these particles during sepsis.
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Affiliation(s)
- Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France. .,Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France.
| | - Christian De Tymowski
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Center for Research on Inflammation, French Institute of Health and Medical Research (INSERM) U1149, Paris, France.,Université de Paris, UFR Paris Nord, Paris, France
| | - Nathalie Zappella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Aurélie Snauwaert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Robert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Biochemistry Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Brice Lortat-Jacob
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Yves Castier
- Université de Paris, UFR Paris Nord, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Vascular and Thoracic Surgery Department, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, UFR Paris Nord, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Parvine Tashk
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Donia Bouzid
- Université de Paris, UFR Paris Nord, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Emergency Department, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM) U1137, Infection, Antimicrobials, Modelling, Evolution, Paris, France
| | - Marylou Para
- Université de Paris, UFR Paris Nord, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Cardiac Surgery, Bichat- Claude Bernard Hospital, Paris, France
| | - Quentin Pellenc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Vascular and Thoracic Surgery Department, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Enora Atchade
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Olivier Meilhac
- Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France.,Réunion Island University-Affiliated Hospital, Saint-Denis de la Réunion, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, UFR Paris Nord, Paris, France.,French Institute of Health and Medical Research (INSERM) U1152, ANR-10-LABX-17, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France
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30
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Elmaleh Y, De Tymowski C, Zappella N, Jean-Baptiste S, Tran-Dinh A, Tanaka S, Yung S, Lortat-Jacob B, Mal H, Castier Y, Atchade E, Montravers P. Blood transfusion of the donor is associated with stage 3 primary graft dysfunction after lung transplantation. Clin Transplant 2021; 35:e14407. [PMID: 34173690 DOI: 10.1111/ctr.14407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The first aim of this study was to assess the association between stage 3 PGD and pre-donation blood transfusion of the donor. The secondary objectives were to assess the epidemiology of donor transfusion and the outcome of LT recipients according to donor transfusion status and massive donor transfusion status. METHODS This was an observational, prospective, single-center study. The results are expressed as absolute numbers, percentages, medians, and interquartile ranges. Statistical analyses were performed using Chi squared, Fischer's exact tests, and Mann-Whitney U tests (P < .05 was considered significant). A multivariate analysis was performed. RESULTS Between January 2016 and February 2019, 147 patients were included in the analysis. PGD was observed in 79 (54%) patients, 45 (31%) of whom had stage 3 PGD. Pre-donation blood transfusion was administered in 48 (33%) donors (median of 3[1-9] packed red cells (PRCs)). On multivariate analysis, stage 3 PGD was significantly associated with donor blood transfusion (OR 2.69, IC (1.14-6.38), P = .024). Mortality at days 28 and 90 was not significantly different according to the pre-donation transfusion status of the donor. CONCLUSION Pre-donation blood transfusion is associated with stage 3 PGD occurrence after LT. Transfusion data of the donor should be included in donor lung assessment.
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Affiliation(s)
- Yoann Elmaleh
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
| | - Christian De Tymowski
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France.,INSERM UMR 1149, Immunorecepteur et Immunopathologie Rénale, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Alexy Tran-Dinh
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France.,INSERM U1148, LVTS, CHU Bichat-Claude Bernard, Paris, France
| | - Sébastien Tanaka
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France.,Université de la Réunion, INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de la Réunion, France
| | - Sonia Yung
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
| | | | - Hervé Mal
- APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France.,Université de Paris, UFR Diderot, Paris, France
| | - Yves Castier
- Université de Paris, UFR Diderot, Paris, France.,APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, Paris, France
| | - Enora Atchade
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France.,Université de Paris, UFR Diderot, Paris, France.,INSERM UMR 1152, ANR-10 LABX17, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
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Thy M, Tanaka S, Tran-Dinh A, Ribeiro L, Lortat-Jacob B, Donadio J, Zappella N, Ben-Rehouma M, Tashk P, Snauwaert A, Atchade E, Grall N, Montravers P. Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients. Front Med (Lausanne) 2021; 7:609497. [PMID: 33748150 PMCID: PMC7969649 DOI: 10.3389/fmed.2020.609497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction: Recent studies described the threat of emerging multidrug-resistant (MDR) bacteria in intensive care unit (ICU) patients, but few data are available for necrotizing skin and soft tissue infections (NSTI). In a cohort of ICU patients admitted for NSTI, we describe the dynamic changes of microbial population during repeated surgeries. Materials and Methods: This retrospective study compiled consecutive cases admitted for the management of severe NSTI. Clinical characteristics, NSTI features, morbidity and mortality data were collected. The microbiological characteristics of surgical samples obtained during initial surgery were compared with those obtained during the first reoperation, including persistence of initial pathogens and/or emergence of microorganisms. Risk factors for emergence of microorganisms and MDR bacteria were assessed by univariable and multivariable analyses. Results: Among 100 patients {63% male, 58 years old [interquartile ratio (IQR) 50–68]} admitted for NSTI, 54 underwent reoperation with a median [IQR] delay of 3 (1–7) days. Decreased proportions of susceptible strains and emergence of Gram-negative bacteria, including Pseudomonas aeruginosa, staphylococci and enterococci strains, were reported based on the cultures of surgical specimen collected on reoperation. On reoperation, 22 (27%) of the isolated strains were MDR (p < 0.0001 vs. MDR bacteria cultured from the first samples). Broad-spectrum antibiotic therapy as first-line therapy was significantly associated with a decreased emergence of microorganisms. Adequate antibiotic therapy from the initial surgery did not modify the frequency of emergence of microorganisms (p = 0.79) and MDR bacteria (p = 1.0) or the 1-year survival rate. Conclusion: The emergence of microorganisms, including MDR bacteria, is frequently noted in NSTI without affecting mortality.
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Affiliation(s)
- Michael Thy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Paris Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, UFR Denis Diderot, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Lara Ribeiro
- Université de Paris, UFR Denis Diderot, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of General and Visceral Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Brice Lortat-Jacob
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Julia Donadio
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Orthopedic Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Mouna Ben-Rehouma
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Paris-Saclay University, French Institute of Health and Medical Research, INSERM UMR 1195, Le Kremlin-Bicêtre, France
| | - Parvine Tashk
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Aurelie Snauwaert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Enora Atchade
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Grall
- Université de Paris, UFR Denis Diderot, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM), IAME, UMR 1137, Paris, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, UFR Denis Diderot, Paris, France.,French Institute of Health and Medical Research (INSERM) U1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France
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Tanaka S, Stern J, Bouzid D, Robert T, Dehoux M, Snauwaert A, Zappella N, Cournot M, Lortat-Jacob B, Augustin P, Atchade E, Tran-Dinh A, Meilhac O, Montravers P. Relationship between lipoprotein concentrations and short-term and 1-year mortality in intensive care unit septic patients: results from the HIGHSEPS study. Ann Intensive Care 2021; 11:11. [PMID: 33469739 PMCID: PMC7815878 DOI: 10.1186/s13613-021-00800-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Abstract
Background High-density lipoproteins (HDLs), particles characterized by their reverse cholesterol transport function, display pleiotropic properties, including anti-inflammatory and antioxidant functions. Moreover, all lipoproteins (HDLs but also low-density lipoproteins (LDLs)) neutralize lipopolysaccharides, leading to increased bacterial clearance. These two lipoproteins decrease during sepsis, and an association between low lipoprotein levels and poor outcome was reported. The goals of this study were to characterize the lipid profile of septic patients hospitalized in our intensive care unit (ICU) and to determine the relationship with the outcome. Methods A prospective observational study was conducted in a university hospital ICU. All consecutive patients admitted for septic shock or sepsis were included. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels were assessed at admission (day 1), at day 3, and at ICU discharge. When available, a prehospitalization lipid profile collected prior to the patient’s hospitalization was compiled. Short-term and 1-year prognostic outcomes were prospectively assessed. Results A total of 205 patients were included. We found a decrease in HDL-C concentration between previous values and those at admission, followed by an additional decrease at day 3. At ICU discharge, the concentration was higher than that at day 3 but did not reach the concentration measured prior to hospitalization (prior HDL-C = 1.22 (1.04–1.57) mmol/l; day 1 HDL-C = 0.44 (0.29–0.70) mmol/l; day 3 HDL-C = 0.30 (0.25–0.48) mmol/l; and HDL-C at discharge = 0.65 (0.42–0.82) mmol/l). A similar trend was found for LDL-C (prior LDL-C = 2.7 (1.91–3.33) mmol/l; day 1 LDL-C = 1.0 (0.58–1.50) mmol/l; day 3 LDL-C = 1.04 (0.64–1.54) mmol/l; and LDL-C at discharge = 1.69 (1.26–2.21) mmol/l). Mixed models for repeated measures of lipoprotein concentrations showed a significant difference in HDL-C and LDL-C concentrations over time between survivors and nonsurvivors at day 28. An HDL-C concentration at admission of less than 0.4 mmol/l was associated with increased mortality at day 28 (log-rank test, p = 0.034) but not at 1 year (log-rank test, p = 0.24). An LDL-C concentration at admission of less than 0.72 mmol/l was associated with increased mortality at day 28 and at 1 year (log-rank test, p < 0.001 and p = 0.007, respectively). No link was found between prior lipid profile and mortality. Conclusions We showed no relationship between the prehospitalization lipid profile and patient outcome, but low lipoprotein levels in the ICU were strongly associated with short-term mortality.
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Affiliation(s)
- Sébastien Tanaka
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France. .,Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France.
| | - Jules Stern
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France
| | - Donia Bouzid
- Université de Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Emergency Department, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM) U1137, Infection, Antimicrobials, Modelling, Evolution, Paris, France
| | - Tiphaine Robert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Biochemistry Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Monique Dehoux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Biochemistry Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Aurélie Snauwaert
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France
| | - Maxime Cournot
- Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France
| | - Brice Lortat-Jacob
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France
| | - Pascal Augustin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France
| | - Enora Atchade
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France.,French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Olivier Meilhac
- Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, France.,Réunion Island University-Affiliated Hospital, Saint-Denis de la Réunion, France
| | - Philippe Montravers
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, DMU PARABOL, Bichat-Claude Bernard Hospital, Paris, France.,Université de Paris, Paris, France.,French Institute of Health and Medical Research (INSERM) U1152, Physiopathology and Epidemiology of Respiratory Diseases -ANR-10-LABX-17, Paris, France
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Nuzzo A, Joly F, Ronot M, Castier Y, Huguet A, Paugam-Burtz C, Cazals-Hatem D, Tran-Dinh A, Becq A, Panis Y, Bouhnik Y, Maggiori L, Corcos O. Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia. Am J Gastroenterol 2020; 115:1902-1905. [PMID: 33156109 DOI: 10.14309/ajg.0000000000000836] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To investigate the factors associated with a delayed diagnosis (DD) of acute mesenteric ischemia (AMI). METHODS An observational cohort study from an intestinal failure center. The primary outcome was DD >24 hours. RESULTS Between 2006 and 2015, 74 patients with AMI were included and 39 (53%) had a DD. Plasma lactate <2 mmol/L (odd ratio: 3.2; 95% confidence interval: 1.1-9.1; P = 0.03) and unenhanced computed tomography scan (odds ratio: 5.9; 95% confidence interval: 1.4-25.8; P = 0.01) were independently associated with DD. DISCUSSION Suspicion of AMI should no longer be affected by normal plasma lactate levels and should prompt evaluation by a contrast-enhanced computed tomography-scan.
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Affiliation(s)
- Alexandre Nuzzo
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Francisca Joly
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Maxime Ronot
- University of Paris, Paris, France
- APHP, Department of Radiology, Beaujon Hospital, Clichy, France
| | - Yves Castier
- APHP, Department of Vascular Surgery, Bichat Hospital, Paris, France
| | - Audrey Huguet
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Catherine Paugam-Burtz
- University of Paris, Paris, France
- APHP, Department of Anesthesia and Intensive Care, Beaujon Hospital, Clichy, France
| | - Dominique Cazals-Hatem
- University of Paris, Paris, France
- APHP, Department of Pathology, Beaujon Hospital, Clichy, France
| | - Alexy Tran-Dinh
- University of Paris, Paris, France
- APHP, Department of Anesthesia and Intensive Care, Bichat Hospital, Paris, France
| | - Aymeric Becq
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Yves Panis
- University of Paris, Paris, France
- APHP, Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Yoram Bouhnik
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Leon Maggiori
- University of Paris, Paris, France
- APHP, Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Olivier Corcos
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
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Tanaka S, De Tymowski C, Assadi M, Zappella N, Jean-Baptiste S, Robert T, Peoc'h K, Lortat-Jacob B, Fontaine L, Bouzid D, Tran-Dinh A, Tashk P, Meilhac O, Montravers P. Lipoprotein concentrations over time in the intensive care unit COVID-19 patients: Results from the ApoCOVID study. PLoS One 2020; 15:e0239573. [PMID: 32970772 PMCID: PMC7514065 DOI: 10.1371/journal.pone.0239573] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus2 has caused a global pandemic of coronavirus disease 2019 (COVID-19). High-density lipoproteins (HDLs), particles chiefly known for their reverse cholesterol transport function, also display pleiotropic properties, including anti-inflammatory or antioxidant functions. HDLs and low-density lipoproteins (LDLs) can neutralize lipopolysaccharides and increase bacterial clearance. HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) decrease during bacterial sepsis, and an association has been reported between low lipoprotein levels and poor patient outcomes. The goal of this study was to characterize the lipoprotein profiles of severe ICU patients hospitalized for COVID-19 pneumonia and to assess their changes during bacterial ventilator-associated pneumonia (VAP) superinfection. METHODS A prospective study was conducted in a university hospital ICU. All consecutive patients admitted for COVID-19 pneumonia were included. Lipoprotein levels were assessed at admission and daily thereafter. The assessed outcomes were survival at 28 days and the incidence of VAP. RESULTS A total of 48 patients were included. Upon admission, lipoprotein concentrations were low, typically under the reference values ([HDL-C] = 0.7[0.5-0.9] mmol/L; [LDL-C] = 1.8[1.3-2.3] mmol/L). A statistically significant increase in HDL-C and LDL-C over time during the ICU stay was found. There was no relationship between HDL-C and LDL-C concentrations and mortality on day 28 (log-rank p = 0.554 and p = 0.083, respectively). A comparison of alive and dead patients on day 28 did not reveal any differences in HDL-C and LDL-C concentrations over time. Bacterial VAP was frequent (64%). An association was observed between HDL-C and LDL-C concentrations on the day of the first VAP diagnosis and mortality ([HDL-C] = 0.6[0.5-0.9] mmol/L in survivors vs. [HDL-C] = 0.5[0.3-0.6] mmol/L in nonsurvivors, p = 0.036; [LDL-C] = 2.2[1.9-3.0] mmol/L in survivors vs. [LDL-C] = 1.3[0.9-2.0] mmol/L in nonsurvivors, p = 0.006). CONCLUSION HDL-C and LDL-C concentrations upon ICU admission are low in severe COVID-19 pneumonia patients but are not associated with poor outcomes. However, low lipoprotein concentrations in the case of bacterial superinfection during ICU hospitalization are associated with mortality, which reinforces the potential role of these particles during bacterial sepsis.
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Affiliation(s)
- Sébastien Tanaka
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
- Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, Réunion, France
| | - Christian De Tymowski
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
- French Institute of Health and Medical Research (INSERM) U1149, Center for Research on Inflammation, Paris, France
- University of Paris, UFR Denis Diderot, Paris, France
| | - Maksud Assadi
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
- University of Paris, UFR Denis Diderot, Paris, France
| | - Nathalie Zappella
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Sylvain Jean-Baptiste
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Robert
- Assistance Publique—Hôpitaux de Paris (AP-HP), Biochemistry Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Katell Peoc'h
- French Institute of Health and Medical Research (INSERM) U1149, Center for Research on Inflammation, Paris, France
- University of Paris, UFR Denis Diderot, Paris, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Biochemistry Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Brice Lortat-Jacob
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Lauriane Fontaine
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Donia Bouzid
- University of Paris, UFR Denis Diderot, Paris, France
- INSERM U1137 IAME, Paris, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Emergency Department, Bichat-Claude Bernard Hospital, Paris, France
| | - Alexy Tran-Dinh
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
- French Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Parvine Tashk
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
| | - Olivier Meilhac
- Réunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, Réunion, France
- Réunion Island University-affiliated Hospital, Réunion, France
| | - Philippe Montravers
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France
- University of Paris, UFR Denis Diderot, Paris, France
- French Institute of Health and Medical Research (INSERM) U1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France
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Nuzzo A, Tran-Dinh A, Courbebaisse M, Peyre H, Plaisance P, Matet A, Ranque B, Faye A, de Lastours V. Improved clinical communication OSCE scores after simulation-based training: Results of a comparative study. PLoS One 2020; 15:e0238542. [PMID: 32886733 PMCID: PMC7473530 DOI: 10.1371/journal.pone.0238542] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Simulation-based training (SBT) is increasingly used to teach clinical patient-doctor communication skills (CS) to medical students. However, the long-lasting impact of this training has been poorly studied. METHODS In this observational study we included all fourth-year undergraduate medical students from a French medical school who undertook a CS objective structured clinical examination (OSCE) and who answered a post-examination survey. OSCE scores and students' feedback were compared by whether students had received a specific CS-SBT or not 12 months prior to the OSCE. RESULTS A total of 173 students were included in the study. Of them, 97 (56%) had followed the CS-SBT before the OSCE. Students who had undergone CS-SBT had significantly higher CS-OSCE scores in the multivariate analysis compared to untrained students (mean score 7.5/10 ±1.1 vs. 7.0/10 ±1.6, respectively, Cohen's d = 0.4, p<0.01). They also tended to experience less nervousness during the OSCE (p = 0.09) and increased motivation to further train in "real-life" internships (p = 0.08). However, they overall expressed a general lack of CS in therapeutic patient education, delivering bad news, and disclosing medical errors. CONCLUSIONS Fourth-year medical students who benefited from a CS-SBT 12 months before examination displayed higher CS-OSCE scores than their counterparts. PRACTICE IMPLICATIONS These results support the early introduction of practical training to improve communication skills in undergraduate medical curricula. Studies are required to assess the sustainability of this improvement over time and its effect on further real doctor-patient communication.
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Affiliation(s)
- Alexandre Nuzzo
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
| | - Alexy Tran-Dinh
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
| | | | - Hugo Peyre
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
| | - Patrick Plaisance
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
| | - Alexandre Matet
- Université de Paris, Faculté de Médecine Paris-Descartes, Paris, France
| | - Brigitte Ranque
- Université de Paris, Faculté de Médecine Paris-Descartes, Paris, France
| | - Albert Faye
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
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Ozen G, Amgoud Y, Abdelazeem H, Mani S, Benyahia C, Bouhadoun A, Tran-Dinh A, Castier Y, Guyard A, Longrois D, Silverstein AM, Norel X. Downregulation of PGI 2 pathway in Pulmonary Hypertension Group-III patients. Prostaglandins Leukot Essent Fatty Acids 2020; 160:102158. [PMID: 32673988 DOI: 10.1016/j.plefa.2020.102158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
Pulmonary hypertension (PH) is a progressive and life-threating lung disorder characterized by elevated pulmonary artery pressure and vascular remodeling. PH is classified into five groups, and one of the most common and lethal forms, PH Group-III is defined as PH due to lung diseases and/or hypoxia. Due to the lack of studies in this group, PH-specific drug therapies including prostacyclin (PGI2) analogues have not been approved or recommended for use in these patients. PGI2 is synthesized by the PGI2 synthase (PGIS) enzyme, and its production is determined by measuring its stable metabolite, 6-keto-PGF1α. An impaired PGI2 pathway has been observed in PH animal models and in PH Group-I patients; however, there are contradictory results. The aim of this study is to determine whether PH Group-III is associated with altered expression of PGIS and production of PGI2 in humans. To explore this hypothesis, we measured PGIS expression (by western blot) and PGI2 production (by ELISA) in a large variety of preparations from the pulmonary circulation including human pulmonary artery, pulmonary vein, distal lung tissue, pulmonary artery smooth muscle cells (hPASMC), and bronchi in PH Group-III (n = 35) and control patients (n = 32). Our results showed decreased PGIS expression and/or 6-keto-PGF1α levels in human pulmonary artery, hPASMC, and distal lung tissue derived from PH Group-III patients. Moreover, the production of 6-keto-PGF1α from hPASMC positively correlated with PGIS expression and was inversely correlated with mean pulmonary artery pressure. On the other hand, PH Group-III pulmonary veins and bronchi did not show altered PGI2 production compared to controls. The deficit in PGIS expression and/or PGI2 production observed in pulmonary artery and distal lung tissue in PH Group-III patients may have important implications in the pathogenesis and treatment of PH Group-III.
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Affiliation(s)
- Gulsev Ozen
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Istanbul University, Faculty of Pharmacy, Department of Pharmacology, 34116 Istanbul, Turkey
| | - Yasmine Amgoud
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Heba Abdelazeem
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France; Alexandria University, Faculty of Pharmacy, Department of Pharmacology and Toxicology, Alexandria, Egypt
| | - Salma Mani
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France; Université de Monastir-Tunisia, Institut Supérieur de Biotechnologie de Monastir (ISBM), Tunisia
| | - Chabha Benyahia
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Amel Bouhadoun
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Alexy Tran-Dinh
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | - Yves Castier
- Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | - Alice Guyard
- Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | - Dan Longrois
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Hôpital Bichat-Claude Bernard, AP-HP, Paris Diderot University, USPC, 75018 Paris, France
| | | | - Xavier Norel
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France.
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Affiliation(s)
- Philippe Montravers
- Université de Paris, UFR Denis Diderot , Paris, France.,Université de Paris, INSERM UMR 1152 , Paris, France.,Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, APHP , Paris, France
| | - Sonia Yung
- Université de Paris, UFR Denis Diderot , Paris, France.,Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, APHP , Paris, France
| | - Alexy Tran-Dinh
- Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, APHP , Paris, France.,Université de Paris, INSERM UMR 1148 , Paris, France
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Augustin P, Guivarch E, Pellenc Q, Castier Y, Boudinet S, Tanaka S, Montravers P, Tran-Dinh A. Performance of pre-hospital evaluations in ruling out invasive chest stab wounds. Scand J Trauma Resusc Emerg Med 2020; 28:33. [PMID: 32370808 PMCID: PMC7201546 DOI: 10.1186/s13049-020-00725-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Some guidelines advocate for managing patients with penetrating thoracic wounds in trauma centres with cardiothoracic surgery. This systematic approach is questionable. Only 15% of these patients require surgery. It is known that clinical examination fails to detect hemopneumothorax in penetrating trauma. However, no studies have evaluated the combined diagnostic performance of vital signs and the clinical evaluation of wounds. The clinical characteristics of wounds have not been investigated. We aimed to evaluate the ability of combinations of pre-hospital signs to rule out invasive chest stab trauma. METHODS This was a prospective observational study. All consecutive adult patients hospitalized in the perioperative acute care unit of a tertiary university hospital were included. Injury diagnoses were provided by exploratory surgery and imaging tests. Patients with a final diagnosis of invasive wounds (IWs) and patients with only superficial wounds were compared. Data regarding management and outcome were analysed. RESULTS A total of 153 patients were included. After imaging or surgery, 58 (38%) patients were diagnosed with only superficial wounds, and 95 (62%) were diagnosed with thoracic or abdominal IWs. The false-negative rate of pre-hospital evaluations in the diagnosis of IWs was 42% [31-51]IQR25-75. In stable patients, pre-hospital data could not rule out IWs, with a negative predictive value of 58% and a positive predictive value of 70%. Twenty-nine (19%) patients required early emergent cardiothoracic surgery. Among these patients, 8 (28%) had no evidence of IWs in the pre-hospital period. Among the 59 patients without pre-hospital signs of IWs, 19 (33%) underwent at least one emergent procedure. CONCLUSIONS The combination of pre-hospital vital signs, visual evaluation of wounds, and physical examination failed to rule out IWs in patients with chest stab wounds. This implies that caution is needed in triage decision-making.
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Affiliation(s)
- Pascal Augustin
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
| | - Elise Guivarch
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
| | - Quentin Pellenc
- Department of Thoracic and Vascular Surgery, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Thoracic and Vascular Surgery, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris VII Diderot, Sorbonne Paris Cité, Paris, France
| | - Sandrine Boudinet
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
| | - Sebastien Tanaka
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- INSERM U1188, La Réunion, France
| | - Philippe Montravers
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- Université Paris VII Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1152, Paris, France
| | - Alexy Tran-Dinh
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France
- Université Paris VII Diderot, Sorbonne Paris Cité, Paris, France
- INSERM U1148, Paris, France
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Tanaka S, Couret D, Tran-Dinh A, Duranteau J, Montravers P, Schwendeman A, Meilhac O. High-density lipoproteins during sepsis: from bench to bedside. Crit Care 2020; 24:134. [PMID: 32264946 PMCID: PMC7140566 DOI: 10.1186/s13054-020-02860-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [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: 11/28/2019] [Accepted: 03/30/2020] [Indexed: 02/10/2023]
Abstract
High-density lipoproteins (HDLs) represent a family of particle characterized by the presence of apolipoprotein A-I (apoA-I) and by their ability to transport cholesterol from peripheral tissues back to the liver conferring them a cardioprotective function. HDLs also display pleiotropic properties including antioxidant, anti-apoptotic, anti-thrombotic, anti-inflammatory, or anti-infectious functions. Clinical data demonstrate that HDL cholesterol levels decrease rapidly during sepsis and that these low levels are correlated with morbi-mortality. Experimental studies emphasized notable structural and functional modifications of HDL particles in inflammatory states, including sepsis. Finally, HDL infusion in animal models of sepsis improved survival and provided a global endothelial protective effect. These clinical and experimental studies reinforce the potential of HDL therapy in human sepsis. In this review, we will detail the different effects of HDLs that may be relevant under inflammatory conditions and the lipoprotein changes during sepsis and we will discuss the potentiality of HDL therapy in sepsis.
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Affiliation(s)
- Sébastien Tanaka
- Université de La Réunion, INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France.,AP-HP, Service d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, Paris, France
| | - David Couret
- Université de La Réunion, INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France.,CHU de La Réunion, Saint-Pierre de la Réunion, France
| | - Alexy Tran-Dinh
- AP-HP, Service d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, Paris, France.,Inserm UMR1148, Laboratory for Vascular Translational Science Bichat Hospital, Paris, France
| | - Jacques Duranteau
- AP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,Laboratoire d'étude de la Microcirculation, "Bio-CANVAS: biomarkers in CardioNeuroVascular DISEASES" UMRS 942, Paris, France
| | - Philippe Montravers
- AP-HP, Service d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, Paris, France.,Inserm UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Anna Schwendeman
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Olivier Meilhac
- Université de La Réunion, INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France. .,CHU de La Réunion, Saint-Pierre de la Réunion, France.
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Atchade E, Barour S, Tran-Dinh A, Jean-Baptiste S, Tanaka S, Tashk P, Snauwaert A, Lortat-Jacob B, Mourin G, Mordant P, Castier Y, Mal H, De Tymowski C, Montravers P. Acute Kidney Injury After Lung Transplantation: Perioperative Risk Factors and Outcome. Transplant Proc 2020; 52:967-976. [DOI: 10.1016/j.transproceed.2020.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
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Augustin P, Tanaka S, Tran-Dinh A, Parenti Ribeiro L, Arapis K, Grall N, Al Qarni A, Montravers P. Outcome and Adequacy of Empirical Antibiotherapy in Post-Operative Peritonitis: A Retrospective Study. Surg Infect (Larchmt) 2019; 21:284-292. [PMID: 31770083 DOI: 10.1089/sur.2019.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Empirical antibiotherapy (EA) should target all bacteria in post-operative peritonitis (PP). Nevertheless, recent studies failed to prove a link between adequacy of EA and prognosis of PP. We sought to confirm this loss of association between adequate EA and prognosis and to analyze the evolution of patients' characteristics and antimicrobial strategies. Methods: This is was retrospective study. Patients with a positive fungal culture were excluded. The cohort was divided into two time periods. Data of survivors and non-survivors were compared within each time period. Differences between the two periods were assessed. A multivariable analysis searched for parameters associated with a higher hospital mortality rate. Results: Two hundred fifty-one patients were included, with 92 patients in the first period (P1) and 152 patients in the second period (P2). Inadequate EA was associated with a worse outcome only in P1. The multivariable analysis in the whole cohort showed that inadequate EA was associated with a higher mortality rate. When the differences noticed between the two periods were entered in the model (presence of resistant gram-positive cocci and EA comprising glycopeptides), inadequate EA was no longer associated with worse outcome. In P1, the most severe patients had more resistant bacteria, hence, had a higher rate of inadequate EA. This artifact disappeared in P2, during which broader antibiotherapies with triple EA were more often prescribed for the most severe patients. Conclusion: This study showed that the link between inadequate EA and outcome of patients with PP was at least partly artifactual in older studies.
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Affiliation(s)
- Pascal Augustin
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sebastien Tanaka
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexy Tran-Dinh
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lara Parenti Ribeiro
- Service de Chirurgie digestive, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kostantinos Arapis
- Service de Chirurgie digestive, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nathalie Grall
- Laboratoire de Microbiologie, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Adel Al Qarni
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie et Réanimation, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Press Sorbonne Cité, Paris, France.,INSERM UMR 1152, Paris, France
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Abstract
Introduction: Complicated intra-abdominal infections (cIAIs) are among the most frequent infections, contributing to significant morbidity and healthcare costs. Several medical needs remain unmet, related to the pharmacokinetic capacities of the available drugs and their limited spectrum of activity for targeting multidrug-resistant Gram-negative and Gram-positive bacteria. Eravacycline, a new synthetic fluorocycline, could have useful properties in cIAIs.Areas covered: The antimicrobial activity of eravacycline against the microorganisms most frequently cultured in cIAIs has been confirmed in worldwide panels of clinical isolates, including enterococci, ESBL-producing Enterobacteriaceae, Acinetobacter baumannii and anaerobes. Pharmacokinetic data demonstrate interesting characteristics with good tissue concentrations including biliary tract and digestive tissues. At a conventional dosage of 1 mg/kg q12h, no adjustment is required on the basis of race or gender, or in elderly (≥ 65 years old) patients, patients with renal impairment or patients undergoing hemodialysis. Phase 2 and 3 trials assessing the clinical efficacy and safety of eravacycline demonstrated non-inferiority versus carbapenems and a good safety profile.Expert opinion: Eravacycline may be particularly suitable for the treatment of cIAIs. Results from clinical trials and real-world data are now expected in specific subgroups of patients to confirm the safety profile and efficacy observed in registration trials.
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Affiliation(s)
- Philippe Montravers
- INSERM UMR 1152, Université de Paris, Paris, France.,Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Nathalie Zappella
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Alexy Tran-Dinh
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,INSERM UMR 1148, Université de Paris, Paris, France
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Hoang QT, Nuzzo A, Louedec L, Delbosc S, Andreata F, Khallou-Laschet J, Assadi M, Montravers P, Longrois D, Corcos O, Caligiuri G, Nicoletti A, Michel JB, Tran-Dinh A. Peptide binding to cleaved CD31 dampens ischemia/reperfusion-induced intestinal injury. Intensive Care Med Exp 2018; 6:27. [PMID: 30112663 PMCID: PMC6093833 DOI: 10.1186/s40635-018-0192-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CD31 is a key transmembrane neutrophil immunoregulatory receptor. Mesenteric ischemia/reperfusion-induced neutrophil activation leads to a massive cleavage and shedding of the most extracellular domains of CD31 into plasma, enhancing the deleterious effect of neutrophil activation. We have evaluated the preventive therapeutic potential of an engineered synthetic octapeptide (P8RI), which restores the inhibitory intracellular signaling of cleaved CD31, in an experimental model of acute mesenteric ischemia/reperfusion. METHODS In a randomized, controlled, and experimenter-blinded preclinical study, mesenteric ischemia/reperfusion (I/R) was induced in Wistar rats by superior mesenteric artery occlusion for 30 min followed by 4 h of reperfusion. Three groups of rats were compared: I/R + saline perfusion (I/R controls group, n = 7), I/R + preventive P8RI perfusion (P8RI group, n = 7), and sham-operated rats + saline perfusion (sham group, n = 7). RESULTS Compared with I/R controls, P8RI perfusion significantly decreased intestinal ischemia/reperfusion injury (Chiu's score, P = 0.01; epithelial area, P = 0.001) and bacterial translocation (plasma Escherichia coli DNA, P = 0.04) and could limit intestinal bleeding (P = 0.09). P8RI decreased neutrophil activation assessed by matrix metalloproteinase-9 release in plasma (P < 0.001) and in the intestinal wall, albeit without statistical significance (P = 0.06 and P = 0.058 for myeloperoxydase). Inhibition of CD31 cleavage from neutrophils could play a major role in the protective effects of P8RI (P < 0.0001). CONCLUSIONS Preventive administration of P8RI, a CD31-agonist peptide, could decrease I/R-induced intestinal injury by potentially limiting neutrophil activation.
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Affiliation(s)
- Quoc Thang Hoang
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France.,Department of Anesthesiology and Surgical Critical Care, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Alexandre Nuzzo
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France.,Structure d'URgences Vasculaires Intestinales (SURVI), CHU Beaujon, Clichy, France
| | - Liliane Louedec
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France
| | - Sandrine Delbosc
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France
| | | | | | - Maksud Assadi
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France.,Département d'anesthésie-réanimation, CHU Bichat-Claude Bernard, 46, rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Philippe Montravers
- Département d'anesthésie-réanimation, CHU Bichat-Claude Bernard, 46, rue Henri Huchard, 75877, Paris Cedex 18, France.,INSERM UMR 1152, Paris-Diderot, Université Sorbonne, Paris, France
| | - Dan Longrois
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France.,Département d'anesthésie-réanimation, CHU Bichat-Claude Bernard, 46, rue Henri Huchard, 75877, Paris Cedex 18, France
| | - Olivier Corcos
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France.,Structure d'URgences Vasculaires Intestinales (SURVI), CHU Beaujon, Clichy, France
| | | | | | | | - Alexy Tran-Dinh
- INSERM LVTS U1148, Paris-Diderot, Université Sorbonne, Paris, France. .,Département d'anesthésie-réanimation, CHU Bichat-Claude Bernard, 46, rue Henri Huchard, 75877, Paris Cedex 18, France.
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Tran-Dinh A, Neulier C, Amara M, Nebot N, Troché G, Breton N, Zuber B, Cavelot S, Pangon B, Bedos JP, Merrer J, Grimaldi D. Impact of intensive care unit relocation and role of tap water on an outbreak of Pseudomonas aeruginosa expressing OprD-mediated resistance to imipenem. J Hosp Infect 2018; 100:e105-e114. [PMID: 29857026 DOI: 10.1016/j.jhin.2018.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem (PA-OprD). AIM The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before and after an incidental relocation of the ICU. The role of tap water as a route of contamination for colonization/infection of patients with PA-OprD was assessed as a secondary aim. METHODS A single-centre, observational, before/after comparison study was conducted from October 2013 to October 2015. The ICU was relocated at the end of October 2014. All P. aeruginosa-positive samples isolated from patients hospitalized ≥48 h in the ICU were included. Tap water specimens were collected every three months in the ICU. PA-OprD strains isolated from patients and tap water were genotyped using pulse-field gel electrophoresis. FINDINGS A total of 139 clinical specimens of P. aeruginosa and 19 tap water samples were analysed. The proportion of PA-OprD strains decreased significantly from 31% to 7.7% after the relocation of the ICU (P = 0.004). All PA-OprD clinical specimens had a distinct genotype. Surprisingly, tap water was colonized with a single PA-OprD strain during both periods, but this single clone has never been isolated from clinical specimens. CONCLUSION Relocation of the ICU was associated with a marked decrease in P. aeruginosa strains resistant to imipenem. The polyclonal character of PA-OprD strains isolated from patients and the absence of tap-water-to-patient contamination highlight the complexity of the environmental impact on the endogenous colonization/infection with P. aeruginosa.
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Affiliation(s)
- A Tran-Dinh
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France; Département d'anesthésie et de réanimation chirurgicale, 75018, Centre Hospitalier de Bichat, Paris, France.
| | - C Neulier
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - M Amara
- Service de Biologie, Unité de microbiologie, 78157, Centre Hospitalier De Versailles, Le Chesnay, France
| | - N Nebot
- Service de pharmacie, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - G Troché
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - N Breton
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - B Zuber
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - S Cavelot
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - B Pangon
- Service de Biologie, Unité de microbiologie, 78157, Centre Hospitalier De Versailles, Le Chesnay, France
| | - J P Bedos
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - J Merrer
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - D Grimaldi
- Département de réanimation, CUB-Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Couret D, Bourane S, Catan A, Nativel B, Planesse C, Dorsemans AC, Ait-Arsa I, Cournot M, Rondeau P, Patche J, Tran-Dinh A, Lambert G, Diotel N, Meilhac O. A hemorrhagic transformation model of mechanical stroke therapy with acute hyperglycemia in mice. J Comp Neurol 2018; 526:1006-1016. [PMID: 29277912 DOI: 10.1002/cne.24386] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 12/25/2022]
Abstract
Clinical benefit for mechanical thrombectomy (MT) in stroke was recently demonstrated in multiple large prospective studies. Acute hyperglycemia (HG) is an important risk factor of poor outcome in stroke patients, including those that underwent MT. The aim of this therapy is to achieve a complete reperfusion in a short time, given that reperfusion damage is dependent on the duration of ischemia. Here, we investigated the effects of acute HG in a mouse model of ischemic stroke induced by middle cerebral artery occlusion (MCAO). Hyperglycemic (intraperitoneal [ip] injection of glucose) and control (ip saline injection) 10-week male C57BL6 mice were subjected to MCAO (30, 90, and 180 min) followed by reperfusion obtained by withdrawal of the monofilament. Infarct volume, hemorrhagic transformation (HT), neutrophil infiltration, and neurological scores were assessed at 24 hr by performing vital staining, ELISA immunofluorescence, and behavioral test, respectively. Glucose injection led to transient HG (blood glucose = 250-390 mg/dL) that significantly increased infarct volume, HT, and worsened neurological outcome. In addition, we report that HG promoted blood-brain barrier disruption as shown by hemoglobin accumulation in the brain parenchyma and tended to increase neutrophil extravasation within the infarcted area. Acute HG increased neurovascular damage for all MCAO durations tested. HTs were observed as early as 90 min after ischemia under hyperglycemic conditions. This model mimics MT ischemia/reperfusion and allows the exploration of brain injury in hyperglycemic conditions.
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Affiliation(s)
- David Couret
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France.,CHU de La Réunion, Service de Neuroréanimation, Saint-Pierre de La Réunion, France
| | - Steeve Bourane
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Aurélie Catan
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Brice Nativel
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Cynthia Planesse
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Anne-Claire Dorsemans
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Imade Ait-Arsa
- Plateforme CYROI, Cyclotron Réunion Océan Indien, Sainte-Clotilde, France
| | - Maxime Cournot
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France.,Hôpital Gabriel Martin, Service de Cardiologie, Saint-Paul de La Réunion, France.,CHU de La Réunion, Saint-Denis de La Réunion, France
| | - Philippe Rondeau
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Jessica Patche
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | | | - Gilles Lambert
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Nicolas Diotel
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France
| | - Olivier Meilhac
- Université de La Réunion, INSERM, UMR 1188 Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France.,CHU de La Réunion, Service de Neuroréanimation, Saint-Pierre de La Réunion, France.,CHU de La Réunion, Saint-Denis de La Réunion, France
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Tran-Dinh A, Augustin P, Dufour G, Lasocki S, Allou N, Thabut G, Castier Y, Montravers P, Desmard M. Evaluation of Cardiac Index and Extravascular Lung Water After Single-Lung Transplantation Using the Transpulmonary Thermodilution Technique by the PiCCO2 Device. J Cardiothorac Vasc Anesth 2017; 32:1731-1735. [PMID: 29203299 DOI: 10.1053/j.jvca.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES First evaluation of the transpulmonary thermodilution technique by the PiCCO2 device to assess cardiac index and pulmonary edema during the postoperative course after single-lung transplantation. DESIGN Prospective observational study. SETTINGS Intensive care unit, university hospital (single center). PARTICIPANTS Single-lung transplant patients. INTERVENTIONS The authors compared cardiac index measured by PiCCO2 and pulmonary artery catheter and assessed pulmonary edema using extravascular lung water index and pulmonary vascular permeability index measured by PiCCO2. MEASUREMENTS AND MAIN RESULTS A Bland-Altman method was used to compare cardiac index measured by PiCCO2 and pulmonary artery catheter. Extravascular lung water index and pulmonary vascular permeability index were compared according to the PaO2/FiO2 ratio with a threshold value of 150 mmHg. Ten single-lung transplant patients were included. Cardiac index measured by PiCCO2 and pulmonary artery catheter were 3.3 L/min/m2 (2.9-3.6) and 2.5 L/min/m2 (2.2-3.0). Bias for cardiac index was 0.71 L/min/m2 (-0.03; 1.44) and limit of agreements were -0.03 and 1.44 L/min/m2. Extravascular lung water index was 12 mL/kg (11-16) and pulmonary vascular permeability index was 2.3 (2.0-3.1), consistent with pulmonary edema. Extravascular lung water index was higher in the group of PaO2/FiO2 ratio ≤150 mmHg compared with the group of PaO2/FiO2 ratio >150 mmHg (17 v 12 mL/kg, p = 0.04), whereas pulmonary vascular permeability index only tended to be higher (3.1 v 2.1, p = 0.06). CONCLUSION PiCCO2 device systematically overestimated cardiac index compared with pulmonary artery catheter. However, it might be useful to assess pulmonary edema in acute respiratory failure after single-lung transplantation.
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Affiliation(s)
- Alexy Tran-Dinh
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France; LVTS Inserm U1148, Hôpital Bichat-Claude Bernard, Paris, France.
| | - Pascal Augustin
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Guillaume Dufour
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Sigismond Lasocki
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Nicolas Allou
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Gabriel Thabut
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Yves Castier
- Inserm UMR 1152, Hôpital Bichat-Claude Bernard, Paris, France; Service de Chirurgie Thoracique et Vasculaire, Université Paris Diderot Sorbonne Cite, APHP(,) CHU Bichat-Claude Bernard, Paris, France
| | - Philippe Montravers
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France; Inserm UMR 1152, Hôpital Bichat-Claude Bernard, Paris, France
| | - Mathieu Desmard
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
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Couret D, Catan A, Nativel B, Planesse C, Dorsemans AC, Ait-Arsa I, Cournot M, Tran-Dinh A, Lambert G, Diotel N, Meilhac O. A hemorrhagic transformation model of mechanical stroke therapy with acute hyperglycemia in mice. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hyafil F, Tran-Dinh A, Burg S, Leygnac S, Louedec L, Milliner M, Ben Azzouna R, Reshef A, Ben Ami M, Meilhac O, Le Guludec D. Detection of Apoptotic Cells in a Rabbit Model with Atherosclerosis-Like Lesions Using the Positron Emission Tomography Radiotracer [
18
F]ML-10. Mol Imaging 2015. [DOI: 10.2310/7290.2015.00017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Fabien Hyafil
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Alexy Tran-Dinh
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Samuel Burg
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Sébastien Leygnac
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Liliane Louedec
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Milan Milliner
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Rana Ben Azzouna
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Ayelet Reshef
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Miri Ben Ami
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Olivier Meilhac
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
| | - Dominique Le Guludec
- From the Department of Nuclear Medicine and Inserm Unité Mixte de Recherche 1148, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot-Paris 7, Paris, France; Aposense Ltd, Petach-Tikva, Israel; and Inserm U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, CHU de La Réunion, CYROI, Saint-Denis, France
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Hyafil F, Tran-Dinh A, Burg S, Leygnac S, Louedec L, Milliner M, Ben Azzouna R, Reshef A, Ben Ami M, Meilhac O, Le Guludec D. Detection of Apoptotic Cells in a Rabbit Model with Atherosclerosis-Like Lesions Using the Positron Emission Tomography Radiotracer [18F]ML-10. Mol Imaging 2015; 14:433-442. [PMID: 26431738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
[18F]ML-10 (2-(5-fluoro-pentyl)-2-methylmalonic acid) is a positron emission tomography (PET) radiotracer that accumulates in cells presenting apoptosis-specific membrane alterations. The aim of this study was to test whether [18F]ML-10 allows for the detection of apoptotic cells located in atherosclerotic plaques in rabbits. Atherosclerotic plaques were induced in the aortas of five rabbits, and five additional rabbits were used as controls. Activity in the aortas was quantified in vivo and ex vivo. The localization of [18F]ML-10 to the aortic wall was identified by autoradiography. Average target to background ratios measured in vivo by PET were higher in the aortas of atherosclerotic rabbits compared with those of control rabbits (2.00 ± 0.52 vs 1.22 ± 0.30; p < .05). Differences in [18F]ML-10 uptake between atherosclerotic and control aortas were confirmed ex vivo by PET and gamma counting (23.9 ± 11.2 vs 1.1 ± 2.4 counts/pixel; p <.05; 3.6 ± 2.0 vs 0.05 ± 0.05 % of injected activity/g; p < .05, respectively). Strong correlation was observed between the accumulation of [18F]ML-10 in aortic segments as detected by autoradiography and the number of apoptotic cells on corresponding histologic sections (r2 = .75; p < .05). In this study, we found that atherosclerotic plaques rich in apoptotic cells can be detected with [18F]ML-10 and PET.
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Tran-Dinh A, Diallo D, Delbosc S, Varela-Perez LM, Dang QB, Lapergue B, Burillo E, Michel JB, Levoye A, Martin-Ventura JL, Meilhac O. HDL and endothelial protection. Br J Pharmacol 2014; 169:493-511. [PMID: 23488589 DOI: 10.1111/bph.12174] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/07/2013] [Accepted: 02/24/2013] [Indexed: 12/23/2022] Open
Abstract
High-density lipoproteins (HDLs) represent a family of particles characterized by the presence of apolipoprotein A-I (apoA-I) and by their ability to transport cholesterol from peripheral tissues back to the liver. In addition to this function, HDLs display pleiotropic effects including antioxidant, anti-apoptotic, anti-inflammatory, anti-thrombotic or anti-proteolytic properties that account for their protective action on endothelial cells. Vasodilatation via production of nitric oxide is also a hallmark of HDL action on endothelial cells. Endothelial cells express receptors for apoA-I and HDLs that mediate intracellular signalling and potentially participate in the internalization of these particles. In this review, we will detail the different effects of HDLs on the endothelium in normal and pathological conditions with a particular focus on the potential use of HDL therapy to restore endothelial function and integrity.
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