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Ruiz I, Huard G, Fournier C, Bissonnette J, Castel H, Giard JM, Villeneuve JP, Fenyves D, Marleau D, Willems B, Corsilli D, Correal F, Ferreira V, Martel D, Mathieu A, Vincent C, Bilodeau M. A real-world experience of SARS-CoV-2 infection in a tertiary referral centre of Montréal: Unexpected low prevalence and low mortality. CanLivJ 2021; 4:391-400. [DOI: 10.3138/canlivj-2021-0022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with chronic liver disease (CLD) and liver transplant (LT) recipients remains a concern. The aim of this study was to report the impact of coronavirus disease 2019 (COVID-19) infection among patients at the tertiary health care centre Centre hospitalier de l’Université de Montréal (CHUM) during the first wave of the SARS-CoV-2 pandemic. METHODS: This real-world, retrospective cohort included all patients admitted to our liver unit and/or seen as an outpatient with CLD with or without cirrhosis and/or LT recipients who tested positive to SARS-CoV-2 infection. Cases were considered positive as defined by the detection of SARS-CoV-2 by reverse-transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. RESULTS: Between April 1 and July 31, 2020, 5,637 were admitted to our liver unit and/or seen as outpatient. Among them, 42 were positive for SARS-CoV-2. Twenty-two patients had CLD without cirrhosis while 16 patients had cirrhosis at the time of the infection (13, 2, and 1 with Child–Pugh A, B, and C scores, respectively). Four were LT recipients. Overall, 15 of 42 patients (35.7%) were hospitalized; among them, 7 of 42 (16.7%) required respiratory support and 4 of 42 (9.5%) were transferred to the intensive care unit. Only 4 of 42 (9.5%) patients died: 2 with CLD without cirrhosis and 2 with CLD with cirrhosis. Overall survival was 90.5%. CONCLUSION: This real-world study demonstrates an unexpectedly low prevalence and low mortality in the context of SARS-CoV-2 infection among patients with CLD with or without cirrhosis and LT recipients.
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Affiliation(s)
- Isaac Ruiz
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Geneviève Huard
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Claire Fournier
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Julien Bissonnette
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Hélène Castel
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jeanne-Marie Giard
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jean-Pierre Villeneuve
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daphna Fenyves
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Denis Marleau
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Bernard Willems
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniel Corsilli
- Intensive Care Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Florence Correal
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Victor Ferreira
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Dominic Martel
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alexandre Mathieu
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Catherine Vincent
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Marc Bilodeau
- Liver Unit, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
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Chakravarti A, Butler-Laporte G, Carrier FM, Bilodeau M, Huard G, Corsilli D, Savard P, Luong ML. Targeted caspofungin prophylaxis for invasive aspergillosis in high-risk liver transplant recipients, a single-center experience. Transpl Infect Dis 2021; 23:e13568. [PMID: 33450126 DOI: 10.1111/tid.13568] [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: 09/06/2020] [Revised: 11/04/2020] [Accepted: 01/03/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Invasive aspergillosis (IA) is a rare but highly lethal complication after orthotopic liver transplantation (OLT). Targeted antifungal prophylaxis has been proposed as a strategy to prevent IA among orthotopic liver transplant recipient (OLTr), but limited data are available to support its efficacy. METHOD We conducted a single-center, retrospective, before and after cohort study, comparing IA incidences among OLTr who did not receive antifungal prophylaxis after transplantation (cohort 1) to OLTr who received targeted antifungal prophylaxis after liver transplantation (cohort 2). Patients in cohort 2 received caspofungin prophylaxis if they presented one of the following risk factors: retransplantation, acute liver failure, dialysis, or Aspergillus colonization prior to transplantation. The primary outcome was IA at 90 days after transplantation. RESULTS A total of 391 OLTr were included in the study; 181 patients in the cohort 1 (no prophylaxis) and 210 patients in the cohort 2 (targeted prophylaxis). Among patients in cohort 2, 19% (40/ 210) were considered at high risk for IA and 85% (34/40) of those received caspofungin prophylaxis. The incidence of IA at 90 days was 3.3% (6/ 181) and 0.5% (1/ 210), in cohort 1 and 2, respectively (OR 0.14; 95%CI 0.01-0.83; P = .03). Ninety-day mortality was similar among the two cohorts (3.9% (7/181) and 2.4% (5/210) in cohort 1 and 2, respectively (OR 0.61; 95% 0.18-1.93; P = .40)). The 90-day mortality among the OLTs with IA was 71% (5/7). CONCLUSION Targeted caspofungin prophylaxis was associated with lower rate of IA.
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Affiliation(s)
- Arpita Chakravarti
- Division of Infectious Disease, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Guillaume Butler-Laporte
- Division of Infectious Disease, Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Francois Martin Carrier
- Department of Anesthesiology, University of Montreal Hospital Center, Montreal, QC, Canada.,Division of Critical Care, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Marc Bilodeau
- Division of Hepatology, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Genevieve Huard
- Division of Hepatology, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Daniel Corsilli
- Division of Critical Care, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada.,Division of Hepatology, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Patrice Savard
- Division of Infectious Disease, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Me-Linh Luong
- Division of Infectious Disease, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada
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Lévesque V, Millaire É, Corsilli D, Rioux-Massé B, Carrier FM. Severe immune thrombocytopenic purpura in critical COVID-19. Int J Hematol 2020; 112:746-750. [PMID: 32613314 PMCID: PMC7327458 DOI: 10.1007/s12185-020-02931-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/01/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 is a new disease with many undescribed clinical manifestations. We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient. A patient presented a severe episode of immune thrombocytopenia (< 10 × 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high-dose dexamethasone to observe an increase in platelet count. COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.
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Affiliation(s)
- Valérie Lévesque
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Émilie Millaire
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Daniel Corsilli
- Department of Medicine - Critical Care Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada
| | - Benjamin Rioux-Massé
- Department of Medicine - Hematology Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada
| | - François-Martin Carrier
- Department of Medicine - Critical Care Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada. .,Department of Medicine - Hematology Division, Centre hospitalier de I'Université de Montréal, Montréal, Canada. .,Department of Anesthesiology, Centre hospitalier de I'Université de Montréal, Montréal, Canada. .,Carrefour de I'Innovation, Centre de recherche du Centre hospitalier de I'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, H2X 0A9, Canada.
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Ambaraghassi G, Cardinal H, Corsilli D, Fortin C, Fortin MC, Martel-Laferrière V, Malaise J, Pâquet MR, Rouleau D. First Canadian Case Report of Kidney Transplantation From an HIV-Positive Donor to an HIV-Positive Recipient. Can J Kidney Health Dis 2017; 4:2054358117695792. [PMID: 28321326 PMCID: PMC5347410 DOI: 10.1177/2054358117695792] [Citation(s) in RCA: 14] [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: 08/24/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Kidney transplantation has become standard of care for carefully selected patients living with human immunodeficiency virus (HIV) and end-stage renal disease (ESRD) in the highly active antiretroviral therapy (HAART) era. American and European prospective cohort studies have reported similar patient and graft survival compared with HIV-negative kidney transplant recipients. Despite an increased rate of acute rejection, partially due to drug interactions, HIV immunovirologic parameter generally remains under control during immunosuppression. A few cases of kidney transplantation between HIV-infected patients were done in South Africa and showed favorable results. No cases of kidney transplantation from an HIV-positive donor in Canada have previously been reported. PRESENTING CONCERNS OF THE PATIENT A 60-year-old Canadian man with HIV infection presented in 2007 with symptoms compatible with acute renal failure secondary to IgA nephropathy. Chronic kidney disease resulted after the acute episode. DIAGNOSES Hemodialysis was started in 2012. The patient was referred for a kidney transplantation evaluation. INTERVENTIONS The patient underwent kidney transplantation from an HIV-positive donor in January 2016. The recipient's antiretroviral regimen consisted of abacavir, lamivudine, and dolutegravir. No drug interactions have been reported between these antiretrovirals and the maintenance immunosuppressive regimen used. OUTCOMES The outcome at 7 months post transplantation was excellent, with good graft function and adequate control of HIV replication, in the absence of opportunistic infections at a time when immunosuppression is at its highest intensity. No acute rejection was reported. An episode of bacteremic graft pyelonephritis due to Enterococcus faecalis was successfully treated after transplantation. NOVEL FINDING With careful selection of patient, kidney transplantation between HIV-infected patients is a viable option. The use of antiretroviral drugs free of interactions simplified the dosing and management of the immunosuppressive drugs.
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Affiliation(s)
- Georges Ambaraghassi
- Département de Microbiologie médicale et Infectiologie, Hôpital Maisonneuve-Rosemont, Québec, Canada
| | - Héloïse Cardinal
- Département de Néphrologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Daniel Corsilli
- Département des Soins intensifs, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Claude Fortin
- Département de Microbiologie médicale et Infectiologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Marie-Chantal Fortin
- Département de Néphrologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Valérie Martel-Laferrière
- Département de Microbiologie médicale et Infectiologie, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Jacques Malaise
- Département de Chirurgie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Michel R Pâquet
- Département de Néphrologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Danielle Rouleau
- Département de Microbiologie médicale et Infectiologie, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Québec, Canada
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Albert M, Corsilli D, Williamson DR, Brosseau M, Bellemare P, Delisle S, Nguyen AQN, Varin F. Comparison of inhaled milrinone, nitric oxide and prostacyclin in acute respiratory distress syndrome. World J Crit Care Med 2017; 6:74-78. [PMID: 28224110 PMCID: PMC5295172 DOI: 10.5492/wjccm.v6.i1.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/03/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of inhaled milrinone in acute respiratory distress syndrome (ARDS).
METHODS Open-label prospective cross-over pilot study where fifteen adult patients with hypoxemic failure meeting standard ARDS criteria and monitored with a pulmonary artery catheter were recruited in an academic 24-bed medico-surgical intensive care unit. Random sequential administration of iNO (20 ppm) or nebulized epoprostenol (10 μg/mL) was done in all patients. Thereafter, inhaled milrinone (1 mg/mL) alone followed by inhaled milrinone in association with inhaled nitric oxide (iNO) was administered. A jet nebulization device synchronized with the mechanical ventilation was use to administrate the epoprostenol and the milrinone. Hemodynamic measurements and partial pressure of arterial oxygen (PaO2) were recorded before and after each inhaled therapy administration.
RESULTS The majority of ARDS were of pulmonary cause (n = 13) and pneumonia (n = 7) was the leading underlying initial disease. Other pulmonary causes of ARDS were: Post cardiopulmonary bypass (n = 2), smoke inhalation injury (n = 1), thoracic trauma and pulmonary contusions (n = 2) and aspiration (n = 1). Two patients had an extra pulmonary cause of ARDS: A polytrauma patient and an intra-abdominal abscess Inhaled nitric oxide, epoprostenol, inhaled milrinone and the combination of inhaled milrinone and iNO had no impact on systemic hemodynamics. No significant adverse events related to study medications were observed. The median increase of PaO2 from baseline was 8.8 mmHg [interquartile range (IQR) = 16.3], 6.0 mmHg (IQR = 18.4), 6 mmHg (IQR = 15.8) and 9.2 mmHg (IQR = 20.2) respectively with iNO, epoprostenol, inhaled milrinone, and iNO added to milrinone. Only iNO and the combination of inhaled milrinone and iNO had a statistically significant effect on PaO2.
CONCLUSION When comparing the effects of inhaled NO, milrinone and epoprostenol, only NO significantly improved oxygenation. Inhaled milrinone appeared safe but failed to improve oxygenation in ARDS.
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Slack AJ, Auzinger G, Willars C, Dew T, Musto R, Corsilli D, Sherwood R, Wendon JA, Bernal W. Ammonia clearance with haemofiltration in adults with liver disease. Liver Int 2014; 34:42-8. [PMID: 23786538 DOI: 10.1111/liv.12221] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [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: 03/18/2013] [Accepted: 05/11/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Ammonia is recognized as a toxin central to complications of liver failure. Hyperammonaemia has important clinical consequences, but optimal means to reduce circulating levels are uncertain. In patients with liver disease, continuous renal replacement therapy (CRRT) with haemofiltration (HF) is often required to treat concurrent kidney injury, but its effects upon ammonia levels are poorly characterized. To evaluate the effect of HF at different treatment intensities on ammonia clearance (AC) and arterial ammonia concentration. METHODS Prospective study of adult patients with liver failure and arterial ammonia >100 μmol/L requiring CRRT using veno-venous HF. Arterial ammonia concentration and AC measured at 1 and 24 h after initiation of low (35 ml/kg/h) or high (90 ml/kg/h) filtration volume. RESULTS Twenty-four patients (10 acute liver failure, 10 chronic liver disease and 4 following liver resection) were studied. Clearance of urea and ammonia solutes correlated closely (r = 0.819, P = 0.007). Ammonia clearance correlated closely with ultrafiltration rate (r = 0.86, P < 0.001). At 1 h, AC was 39 (34-54) ml/min (low volume) vs 85 (62-105) ml/min (high volume) CRRT, (P < 0.001) and at 24 h 44 (34-63) vs 105 (82-109) ml/min, (P = 0.01). Overall, a 22% reduction in median arterial ammonia concentration was observed over 24 h of HF from 156 (137-176) to 122 (85-133) μmol/L, (P ≤ 0.0001). CONCLUSION Clinically significant ammonia clearance can be achieved in adult patients with hyperammonaemia utilizing continuous VVHF. Ammonia clearance is closely correlated with ultrafiltration rate. HF was associated with a fall in arterial ammonia concentration.
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Affiliation(s)
- Andrew J Slack
- Institute of Liver Studies, King's College Hospital Foundation Trust, London, UK
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