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Sonneville R, Couffignal C, Sigaud F, Godard V, Audibert J, Contou D, Celier A, Djibre M, Schmidt J, Jaquet P, Mekontso Dessap A, Bourel C, Bellot R, Roy C, Lamara F, Essardy F, Timsit JF, Cornic R, Bouadma L. Restrictive use of Restraints and Delirium Duration in the Intensive Care Unit (R2D2-ICU): protocol for a French multicentre parallel-group open-label randomised controlled trial. BMJ Open 2024; 14:e083414. [PMID: 38631841 PMCID: PMC11029382 DOI: 10.1136/bmjopen-2023-083414] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Physical restraint (PR) is prescribed in patients receiving invasive mechanical ventilation in the intensive care unit (ICU) to avoid unplanned removal of medical devices. However, it is associated with an increased risk of delirium. We hypothesise that a restrictive use of PR, as compared with a systematic use, could reduce the duration of delirium in ICU patients receiving invasive mechanical ventilation. METHODS AND ANALYSIS The Restrictive use of Restraints and Delirium Duration in ICU (R2D2-ICU) study is a national multicentric, parallel-group, randomised (1:1) open-label, controlled, superiority trial, which will be conducted in 10 ICUs. A total of 422 adult patients requiring invasive mechanical ventilation for an expected duration of at least 48 hours and eligible for prescription of PR will be randomly allocated within 6 hours from intubation to either the restrictive PR use group or the systematic PR use group, until day 14, ICU discharge or death, whichever comes first. In both groups, PR will consist of the use of wrist straps. The primary endpoint will be delirium or coma-free days, defined as the number of days spent alive in the ICU without coma or delirium within the first 14 days after randomisation. Delirium will be assessed using the Confusion Assessment Method-ICU twice daily. Key secondary endpoints will encompass agitation episodes, opioid, propofol, benzodiazepine and antipsychotic drug exposure during the 14-day intervention period, along with a core outcome set of measures evaluated 90 days postrandomisation. ETHICS AND DISSEMINATION The R2D2-ICU study has been approved by the Comité de Protection des Personnes (CPP) ILE DE FRANCE III-PARIS (CPP19.09.06.37521) on June 10th, 2019). Participant recruitment started on 25 January 2021. Results will be published in international peer-reviewed medical journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT04273360.
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Affiliation(s)
- Romain Sonneville
- Médecine Intensive Réanimation, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
- INSERM UMR 1137, IAME, Université Paris Cité, Paris, France
| | - Camille Couffignal
- INSERM UMR 1137, IAME, Université Paris Cité, Paris, France
- Epidemiologie, Biostatistique, Recherche Clinique, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Florian Sigaud
- Médecine Intensive Réanimation, Grenoble University Hospital, La Tronche, France
| | - Virginie Godard
- Epidemiologie, Biostatistique, Recherche Clinique, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Juliette Audibert
- Service de Réanimation Polyvalente et USC, Hopital Louis Pasteur, Chartres, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Adam Celier
- Département R3S, Médecine Intensive Réanimation, Sorbonne Université Pitié-Salpêtrière Hospital, Paris, France
| | - Michel Djibre
- Médecine Intensive Réanimation, APHP, Hôpital Tenon, Paris, France
| | - Julien Schmidt
- Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Pierre Jaquet
- Médecine Intensive Réanimation, Hopital Delafontaine, Saint Denis, France
| | - Armand Mekontso Dessap
- Médecine Intensive Réanimation, APHP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Claire Bourel
- Médecine Intensive Réanimation, Centre hospitalo-universitaire, Lille, France
| | - Romane Bellot
- Epidemiologie, Biostatistique, Recherche Clinique, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Carine Roy
- Epidemiologie, Biostatistique, Recherche Clinique, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Fariza Lamara
- Médecine Intensive Réanimation, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Fatiha Essardy
- Médecine Intensive Réanimation, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Jean-François Timsit
- Médecine Intensive Réanimation, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
- INSERM UMR 1137, IAME, Université Paris Cité, Paris, France
| | - Renaud Cornic
- Epidemiologie, Biostatistique, Recherche Clinique, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
| | - Lila Bouadma
- Médecine Intensive Réanimation, APHP.Nord, Hôpital Bichat Claude Bernard, Paris, France
- INSERM UMR 1137, IAME, Université Paris Cité, Paris, France
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Samad M, Dallevet CA, Tandjaoui-Lambiotte Y, Bourgarit A, Jaquet P. Spectacular Improvement of Paradoxical Reaction in Tuberculosis after Tumor Necrosis Factor-Alpha Antagonist Therapy. Cureus 2023; 15:e50596. [PMID: 38222121 PMCID: PMC10788139 DOI: 10.7759/cureus.50596] [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] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
We report the case of a 42-year-old immunocompetent Indian patient presenting with miliary tuberculosis complicated by respiratory failure requiring intubation. Conventional quadritherapy was initiated for wild-type Mycobacterium tuberculosis. On day 29 of antibiotic treatment, persistent fever and neurological deterioration prompted the diagnosis of multiple brain and medullary tuberculomas, some surrounded by edema. Laboratory investigations ruled out meningitis and subtherapeutic drug concentrations. To enhance cerebrospinal fluid penetration, ethambutol was replaced with levofloxacin on day 30, and rifampicin doses were increased to 30 mg/kg. Dexamethasone was introduced on day 30 to address the paradoxical response to antituberculosis therapy, but neurological deterioration persisted, leading to hemiparesis and coma, with concurrent development of acute respiratory distress syndrome. As salvage therapy, an anti-tumor necrosis factor agent, infliximab (IFX), was administered on day 40. Rapid clinical improvement was observed, marked by awakening and subsequent weaning from respiratory ventilation just eight days after the first IFX infusion. The patient was discharged from the intensive care unit 10 days post-IFX initiation, with steroids discontinued one month after IFX introduction. Both antituberculosis treatment and IFX infusions (seven in total) were maintained for one year. Clinical and radiological evaluation at one year demonstrated complete clinical and radiological recovery.
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Affiliation(s)
- Myriam Samad
- Pulmonology & Infectious Diseases Department, Delafontaine Hospital, Saint-Denis, FRA
| | | | | | - Anne Bourgarit
- Internal Medicine, Jean Verdier Hospital AP-HP, Bondy, FRA
| | - Pierre Jaquet
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, FRA
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Tchoubou T, El-Hosni R, Dollat M, Jaquet P, Tournus C, Tandjaoui-Lambiotte Y, Da Silva D. Acute Respiratory Distress Syndrome due to Monkeypox Virus. Eur J Case Rep Intern Med 2023; 10:004126. [PMID: 37920221 PMCID: PMC10619529 DOI: 10.12890/2023_004126] [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: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
We report the first case of monkeypox virus (MPXV) associated acute respiratory distress syndrome (ARDS). A 34-year-old French woman with no medical history was admitted to the intensive care unit (ICU) for fever, altered mental status, hypotension and hypoxaemia. She presented with a diffuse skin rash with vesiculopustular lesions involving the four limbs and perineal ulcers with a skin swab positive for MPXV. On day 2, the patient presented moderate ARDS requiring invasive mechanical ventilation. She also had pleural empyema due to Streptococcus pyogenes. MPXV PCR was positive in the bronchoalveolar lavage, the pleural effusion and the blood. The patient was treated with tecovirimat. Despite the treatment, she had persistent viraemia for at least ten days. The patient condition rapidly improved; she was weaned from mechanical ventilation on day 18 despite the persistence of radiological lung opacities. She fully recovered and was discharged home on day 38 after admission. LEARNING POINTS This is the first case of monkeypox virus associated ARDS in a young woman with no medical historyBiological follow-up showed disseminated MPXV and persistent viraemiaTecovirimat was well tolerated.
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Affiliation(s)
- Tona Tchoubou
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - Rima El-Hosni
- Pulmonology and Infectious Diseases Department, Delafontaine Hospital, Saint-Denis, France
| | - Marion Dollat
- Infectious Diseases Department, Delafontaine Hospital, Saint-Denis, France
| | - Pierre Jaquet
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - Celine Tournus
- Microbiology Department, Delafontaine Hospital, Saint-Denis, France
| | - Yacine Tandjaoui-Lambiotte
- Pulmonology and Infectious Diseases Department, Delafontaine Hospital, Saint-Denis, France
- INSERM U1272 Hypoxia and the Lung, 93000; INSERM UMR 1137 IAME, Paris, France
| | - Daniel Da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
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Jaquet P, Couffignal C, Tardivon C, Godard V, Bellot R, Assouline B, Benghanem S, Da Silva D, Decavèle M, Dessajan J, Hermann B, Rambaud T, Voiriot G, Sonneville R. PupillOmetry for preDIction of DeliriUM in ICU (PODIUM): protocol for a prospective multicentre cohort study. BMJ Open 2023; 13:e072095. [PMID: 37438060 DOI: 10.1136/bmjopen-2023-072095] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Delirium is a severe complication that is associated with short-term adverse events, prolonged hospital stay and neurological sequelae in survivors. Automated pupillometry is an easy-to-use device that allows for accurate objective assessment of the pupillary light responses in comatose patients in the intensive care unit (ICU). Whether automated pupillometry might predict delirium in critically ill patients is not known. We hypothesise that automated pupillometry could predict the occurrence of delirium in critically ill patients without primary brain injury, requiring more than 48 hours of invasive mechanical ventilation in the ICU. METHODS AND ANALYSIS The PupillOmetry for preDIction of DeliriUM in ICU (PODIUM) study is a prospective cohort study, which will be conducted in eight French ICUs in the Paris area. We aim to recruit 213 adult patients requiring invasive mechanical ventilation for more than 48 hours. Automated pupillometry (Neurological Pupil Index; NPi-200, Neuroptics) will be assessed two times per day for 7 days. Delirium will be assessed using the Confusion Assessment Method in ICU two times per day over 14 days in non-comatose patients (Richmond Agitation and Sedation Scale ≥-3).The predictive performances of the seven automated pupillometry parameters (ie, pupillary diameter, variation of the pupillary diameter, pupillary constriction speed, pupillary dilatation speed, photomotor reflex latency, NPi and symmetry of pupillary responses) measured to detect the delirium occurrence within 14 days will be the main outcomes. Secondary outcomes will be the predictive performances of the seven automated pupillometry parameters to detect complications related to delirium, ICU length of stay, mortality, functional and cognitive outcomes at 90 days. ETHICS AND DISSEMINATION The PODIUM study has been approved by an independent ethics committee, the Comité de Protection des Personnes (CPP) OUEST IV-NANTES (CPP21.02.15.45239 32/21_3) on 06 April 2021). Participant recruitment started on 15 April 2022. Results will be published in international peer-reviewed medical journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT05248035; clinicaltrials.gov.
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Affiliation(s)
- Pierre Jaquet
- Intensive Care Unit, Delafontaine Hospital, Saint Denis, France
| | - Camille Couffignal
- Research Clinic, Epidemiology, Biostatistic Department Bichat hospital, DMU PRISME, Assistance Publique des Hôpitaux de Paris Nord, Groupe Hospitalier Universitaire Paris Cité, Paris, France
| | - Coralie Tardivon
- Research Clinic, Epidemiology, Biostatistic Department Bichat hospital, DMU PRISME, Assistance Publique des Hôpitaux de Paris Nord, Groupe Hospitalier Universitaire Paris Cité, Paris, France
| | - Virginie Godard
- Research Clinic, Epidemiology, Biostatistic Department Bichat hospital, DMU PRISME, Assistance Publique des Hôpitaux de Paris Nord, Groupe Hospitalier Universitaire Paris Cité, Paris, France
| | - Romane Bellot
- Research Clinic, Epidemiology, Biostatistic Department Bichat hospital, DMU PRISME, Assistance Publique des Hôpitaux de Paris Nord, Groupe Hospitalier Universitaire Paris Cité, Paris, France
| | - Benjamin Assouline
- Medical Intensive Care Unit, Département de Cardiologie, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Sarah Benghanem
- Medical Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Cochin University Hospital, Paris, France
- Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
| | - Daniel Da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint Denis, France
| | - Maxens Decavèle
- INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
- Medical Intensive Care Unit, Département R3S, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Julien Dessajan
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris Nord, Bichat Claude Bernard Hospital, Paris, France
| | - Bertrand Hermann
- Medical Intensive Care Unit, Assistance Publique - Hôpitaux de Paris Centre, Université Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
- INSERM UMR 1266 Institut de Psychiatrie et Neurosciences de Paris (IPNP), Université de Paris, Paris, Île-de-France, France
| | - Thomas Rambaud
- Medical Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Avicenne Hospital, Bobigny, France
| | - Guillaume Voiriot
- Medical Intensive Care Unit, Assistance Publique-Hopitaux de Paris, Tenon Hospital, Paris, France
- INSERM UMRS938, Sorbonne université, Centre de recherche Saint-Antoine, Paris, France
| | - Romain Sonneville
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris Nord, Bichat Claude Bernard Hospital, Paris, France
- INSERM UMR 1137, IAME, Université Paris Cité, Paris, France
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Jaquet P, Legouy C, Sonneville R. The authors reply. Crit Care Med 2023; 51:e103-e104. [PMID: 36928024 DOI: 10.1097/ccm.0000000000005794] [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] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Pierre Jaquet
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat - Claude Bernard, Paris, France
| | - Camille Legouy
- Médecine intensive-réanimation, CH Saint Anne, Paris, France
| | - Romain Sonneville
- Médecine intensive-réanimation, AP-HP, Hôpital Bichat - Claude Bernard, Paris, France
- Université de Paris, INSERM UMR1148, team 6, Paris, France
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6
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Jeantin L, Dupuis C, Vellieux G, Jaquet P, de Montmollin E, Timsit JF, Sonneville R. Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis. Ann Intensive Care 2023; 13:10. [PMID: 36821016 PMCID: PMC9950306 DOI: 10.1186/s13613-023-01110-3] [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: 11/04/2022] [Accepted: 02/12/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Electroencephalography (EEG) is recommended for the practical approach to the diagnosis and prognosis of encephalitis. We aimed to investigate the prognostic value of standard EEG (stdEEG) in adult patients with severe herpes simplex encephalitis. METHODS We performed a retrospective analysis of consecutive ICU patients with severe herpes simplex encephalitis in 38 French centers between 2006 and 2016. Patients with at least one stdEEG study performed at ICU admission were included. stdEEG findings were reviewed independently by two investigators. The association between stdEEG findings (i.e., background activity, lateralized periodic discharges, seizures/status epilepticus, and reactivity to painful/auditory stimuli) and poor functional outcome, defined by a score on the modified Rankin Scale (mRS) of 3 to 6 (moderate to severe disability or death) at 90 days, were investigated. RESULTS We included 214 patients with at least one available stdEEG study. The first stdEEG was performed after a median time of one (interquartile range (IQR) 0 to 2) day from ICU admission. At the time of recording, 138 (64.5%) patients were under invasive mechanical ventilation. Lateralized periodic discharges were recorded in 91 (42.5%) patients, seizures in 21 (9.8%) and status epilepticus in 16 (7.5%). In the whole population, reactivity to auditory/noxious stimuli was tested in 140/214 (65.4%) patients and was absent in 71/140 (33.2%) cases. In mechanically ventilated patients, stdEEG reactivity was tested in 91/138 (65.9%) subjects, and was absent in 53/91 (58.2%) cases. Absence of reactivity was the only independent stdEEG finding associated with poor functional outcome in the whole population (OR 2.80, 95% CI 1.19 to 6.58) and in the subgroup of mechanically ventilated patients (OR 4.99, 95% CI 1.6 to 15.59). Adjusted analyses for common clinical predictors of outcome and sedation at time of stdEEG revealed similar findings in the whole population (OR 2.03, 95% CI 1.18 to 3.49) and in mechanically ventilated patients (OR 2.62, 95% CI 1.25 to 5.50). CONCLUSIONS Absence of EEG reactivity to auditory/noxious stimuli is an independent marker of poor functional outcome in severe herpes simplex encephalitis.
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Affiliation(s)
- Lina Jeantin
- grid.5842.b0000 0001 2171 2558Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| | - Claire Dupuis
- grid.411163.00000 0004 0639 4151Department of Intensive Care Medicine, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Geoffroy Vellieux
- grid.462844.80000 0001 2308 1657Paris Brain Institute, ICM, Inserm, CNRS, Sorbonne Université, 75013 Paris, France ,grid.411439.a0000 0001 2150 9058Department of Neurophysiology, Pitie-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine, Delafontaine Hospital, Saint Denis, France
| | - Etienne de Montmollin
- grid.508487.60000 0004 7885 7602IAME, INSERM, UMR1137, Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877 Paris Cedex, France
| | - Jean-François Timsit
- grid.508487.60000 0004 7885 7602IAME, INSERM, UMR1137, Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877 Paris Cedex, France
| | - Romain Sonneville
- IAME, INSERM, UMR1137, Université Paris Cité, Paris, France. .,Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.
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Chommeloux J, Valentin S, Winiszewski H, Adda M, Pineton de Chambrun M, Moyon Q, Mathian A, Capellier G, Guervilly C, Levy B, Jaquet P, Sonneville R, Voiriot G, Demoule A, Boussouar S, Painvin B, Lebreton G, Combes A, Schmidt M. One-Year Mental and Physical Health Assessment in Survivors after Extracorporeal Membrane Oxygenation for COVID-19-related Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2023; 207:150-159. [PMID: 36150112 PMCID: PMC9893333 DOI: 10.1164/rccm.202206-1145oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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] [Indexed: 02/02/2023] Open
Abstract
Rationale: Long-term outcomes of patients with coronavirus disease (COVID-19)-related acute respiratory distress syndrome treated with extracorporeal membrane oxygenation (ECMO) are unknown. Objectives: To assess physical examination, pulmonary function tests, anxiety, depression, post-traumatic stress disorder and quality of life at 6 and 12 months after ECMO onset. Methods: Multicenter, prospective study in patients who received ECMO for COVID-19 acute respiratory distress syndrome from March to June 2020 and survived hospital discharge. Measurements and Main Results: Of 80 eligible patients, 62 were enrolled in seven French ICUs. ECMO and invasive mechanical ventilation duration were 18 (11-25) and 36 (27-62) days, respectively. All were alive, but only 19/50 (38%) returned to work and 13/42 (31%) had recovered a normal sex drive at 1 year. Pulmonary function tests were almost normal at 6 months, except for DlCO, which was still impaired at 12 months. Mental health, role-emotional, and role-physical were the most impaired domain compared with patients receiving ECMO who did not have COVID-19. One year after ICU admission, 19/43 (44%) patients had significant anxiety, 18/43 (42%) had depression symptoms, and 21/50 (42%) were at risk for post-traumatic stress disorders. Conclusions: Despite the partial recovery of the lung function tests at 1 year, the physical and psychological function of this population remains impaired. Based on the comparison with long-term follow-up of patients receiving ECMO who did not have COVID-19, poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation.
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Affiliation(s)
- Juliette Chommeloux
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| | - Simon Valentin
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France;,Faculté de Médecine, INSERM U1116, Vandoeuvre-les-Nancy, France;,Université de Lorraine, Nancy, France
| | | | - Mélanie Adda
- Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique Hopitaux de Marseille Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France
| | - Marc Pineton de Chambrun
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| | - Quentin Moyon
- Medical Intensive Care Unit and,Sorbonne Universite, AP-HP, Groupement Hospitalier Pitié–Salpêtrière, Service de Medecine Interne 2, Inserm UMRS, Paris, France
| | - Alexis Mathian
- Sorbonne Universite, AP-HP, Groupement Hospitalier Pitié–Salpêtrière, Service de Medecine Interne 2, Inserm UMRS, Paris, France
| | - Gilles Capellier
- Medical Intensive Care Unit, University Hospital, Besancon, France
| | - Christophe Guervilly
- Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique Hopitaux de Marseille Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France
| | - Bruno Levy
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France;,Faculté de Médecine, INSERM U1116, Vandoeuvre-les-Nancy, France;,Université de Lorraine, Nancy, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA) UMRS_938 INSERM, Assistance Publique-Hôpitaux de Paris, Service de médecine intensive réanimation, Hôpital Tenon, Paris, France
| | - Alexandre Demoule
- Sorbonne Universite, Groupe Hospitalier Universitaire Pitié–Salpêtrière, Service de Medecine Intensive et Reanimation (Departement R3S), UMRS-1158 Neurophysiologie Respiratoire Experimentale et Clinique, Paris, France
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Pitié–Salpêtrière Hospital, AP-HP, ICAN Institute of Cardiometabolism and Nutrition, INSERM, Sorbonne University, Paris, France; and
| | - Benoit Painvin
- Réanimation Médicale, Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Rennes, France
| | - Guillaume Lebreton
- Thoracic and Cardiovascular Department, Assistance Publique–Hôpitaux de Paris (AP-HP), Pitié–Salpêtrière Hospital, Paris, France
| | - Alain Combes
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| | - Matthieu Schmidt
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
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8
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Rambaud T, de Montmollin E, Jaquet P, Gaudemer A, Mariotte E, Abid S, Para M, Cimadevilla C, Iung B, Duval X, Wolff M, Bouadma L, Timsit JF, Sonneville R. Cerebrovascular complications and outcomes of critically ill adult patients with infective endocarditis. Ann Intensive Care 2022; 12:119. [PMID: 36583809 PMCID: PMC9803797 DOI: 10.1186/s13613-022-01086-6] [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: 08/25/2022] [Accepted: 11/24/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neurological complications are associated with poor outcome in patients with infective endocarditis (IE). Although guidelines recommend systematic brain imaging in the evaluation of IE patients, the association between early brain imaging findings and outcomes has never been evaluated in critically ill patients. We aimed to assess the association of CT-defined neurological complications with functional outcomes of critically ill IE patients. METHODS This retrospective cohort study included consecutive patients with severe, left-sided IE hospitalized in the medical ICU of a tertiary care hospital. Patients with no baseline brain CT were excluded. Baseline CT-scans were classified in five mutually exclusive categories (normal, moderate-to-severe ischemic stroke, minor ischemic stroke, intracranial hemorrhage, other abnormal CT). The primary endpoint was 1-year favorable outcome, defined by a modified Rankin Scale score of 0-3. RESULTS Between 06/01/2011 and 07/31/2018, 156 patients were included. Among them, 87/156 (56%) had a CT-defined neurological complication, including moderate-to-severe ischemic stroke (n = 33/156, 21%), intracranial hemorrhage (n = 24/156, 15%), minor ischemic stroke (n = 29/156, 19%), other (n = 3/156, 2%). At one year, 69 (45%) patients had a favorable outcome. Factors negatively associated with favorable outcome in multivariable analysis were moderate-to-severe ischemic stroke (OR 0.37, 95%CI 0.14 - 0.95) and age (OR 0.94, 95%CI 0.91-0.97). By contrast, the score on the Glasgow Coma Scale was positively associated with favorable outcome (per 1-point increment, OR 1.23, 95%CI 1.08-1.42). Sensitivity analyses conducted in operated patients revealed similar findings. Compared to normal CT, only moderate-to-severe ischemic stroke was associated with more frequent post-operative neurological complications (n = 8/23 (35%) vs n = 1/46 (2%), p < 0.01). CONCLUSION Moderate-to-severe ischemic stroke had an independent negative impact on 1-year functional outcome in critically ill IE patients; whereas other complications, including intracranial hemorrhage, had no such impact.
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Affiliation(s)
- Thomas Rambaud
- grid.508487.60000 0004 7885 7602Université Paris-Cité, INSERM UMR1148, Team 6, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France ,grid.413780.90000 0000 8715 2621Département de Réanimation Médico-Chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Etienne de Montmollin
- grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, INSERM UMR1137, IAME, 75018 Paris, France
| | - Pierre Jaquet
- grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France
| | - Augustin Gaudemer
- grid.411119.d0000 0000 8588 831XDepartment of Radiology, AP-HP, Hôpital Bichat-Claude Bernard, 75018 Paris, France
| | - Eric Mariotte
- grid.413328.f0000 0001 2300 6614Department of Intensive Care Medicine, AP-HP, Hôpital Saint-Louis, 75010 Paris, France
| | - Sonia Abid
- grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France ,grid.413328.f0000 0001 2300 6614Surgical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
| | - Marylou Para
- grid.411119.d0000 0000 8588 831XDepartment of Cardiac Surgery, AP-HP, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - Claire Cimadevilla
- grid.411119.d0000 0000 8588 831XDepartment of Cardiac Surgery, AP-HP, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - Bernard Iung
- grid.411119.d0000 0000 8588 831XDepartment of Cardiology, AP-HP, Hôpital Bichat - Claude Bernard, 75018 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris-Cité , INSERM UMR1148, Paris, France
| | - Xavier Duval
- grid.411119.d0000 0000 8588 831XDepartment of Infectious Diseases, AP-HP, Hôpital Bichat-Claude Bernard, 75018 Paris, France
| | - Michel Wolff
- GHU Paris Psychiatrie
& Neurosciences, Paris, France
| | - Lila Bouadma
- grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, INSERM UMR1137, IAME, 75018 Paris, France
| | - Jean-François Timsit
- grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, INSERM UMR1137, IAME, 75018 Paris, France
| | - Romain Sonneville
- grid.411119.d0000 0000 8588 831XDepartment of Intensive Care Medicine, AP-HP. Nord, Hôpital Bichat - Claude Bernard, Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, INSERM UMR1137, IAME, 75018 Paris, France
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9
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Egea A, Dupuis C, de Montmollin E, Wicky PH, Patrier J, Jaquet P, Lefèvre L, Sinnah F, Marzouk M, Sonneville R, Bouadma L, Souweine B, Timsit JF. Augmented renal clearance in the ICU: estimation, incidence, risk factors and consequences-a retrospective observational study. Ann Intensive Care 2022; 12:88. [PMID: 36156744 PMCID: PMC9510087 DOI: 10.1186/s13613-022-01058-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/28/2021] [Accepted: 08/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Augmented renal clearance (ARC) remains poorly evaluated in ICU. The objective of this study is to provide a full description of ARC in ICU including prevalence, evolution profile, risk factors and outcomes. Methods This was a retrospective, single-center, observational study. All the patients older than 18 years admitted for the first time in Medical ICU, Bichat, University Hospital, APHP, France, between January 1, 2017, and November 31, 2020 and included into the Outcomerea database with an ICU length of stay longer than 72 h were included. Patients with chronic kidney disease were excluded. Glomerular filtration rate was estimated each day during ICU stay using the measured creatinine renal clearance (CrCl). Augmented renal clearance (ARC) was defined as a 24 h CrCl greater than 130 ml/min/m2. Results 312 patients were included, with a median age of 62.7 years [51.4; 71.8], 106(31.9%) had chronic cardiovascular disease. The main reason for admission was acute respiratory failure (184(59%)) and 196(62.8%) patients had SARS-COV2. The median value for SAPS II score was 32[24; 42.5]; 146(44%) and 154(46.4%) patients were under vasopressors and invasive mechanical ventilation, respectively. The overall prevalence of ARC was 24.6% with a peak prevalence on Day 5 of ICU stay. The risk factors for the occurrence of ARC were young age and absence of cardiovascular comorbidities. The persistence of ARC during more than 10% of the time spent in ICU was significantly associated with a lower risk of death at Day 30. Conclusion ARC is a frequent phenomenon in the ICU with an increased incidence during the first week of ICU stay. Further studies are needed to assess its impact on patient prognosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01058-w.
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Affiliation(s)
- Alexandre Egea
- Service d'Anesthésie Réanimation, CHU Saint Antoine, APHP, Paris, France
| | - Claire Dupuis
- Service de Médecine Intensive et Réanimation, CHU Clermont Ferrand, CHU Hôpital Gabriel-Montpied, 58 Rue Montalembert, 63000, Clermont Ferrand, France.
| | - Etienne de Montmollin
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,IAME UMR 1137, Université de Paris, 75018, Paris, France
| | - Paul-Henry Wicky
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Juliette Patrier
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Pierre Jaquet
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Lucie Lefèvre
- Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Sorbonne Université Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Fabrice Sinnah
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France
| | - Mehdi Marzouk
- Réanimation Polyvalente/Surveillance Continue, Hôpitaux Publics de l'Artois, Lens, France
| | - Romain Sonneville
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,Université de Paris, UMR1148, Team 6, 75018, Paris, France
| | - Lila Bouadma
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,IAME UMR 1137, Université de Paris, 75018, Paris, France
| | - Bertrand Souweine
- Service de Médecine Intensive et Réanimation, CHU Clermont Ferrand, CHU Hôpital Gabriel-Montpied, 58 Rue Montalembert, 63000, Clermont Ferrand, France
| | - Jean-François Timsit
- Medical and Infectious Intensive Care Unit, CHU Bichat-Claude, APHP, Paris, France.,IAME UMR 1137, Université de Paris, 75018, Paris, France
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10
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Jaquet P, Legouy C, Le Fevre L, Grinea A, Sinnah F, Franchineau G, Patrier J, Marzouk M, Wicky PH, Alexis Geoffroy P, Arnoult F, Vledouts S, de Montmollin E, Bouadma L, Timsit JF, Sharshar T, Sonneville R. Neurologic Outcomes of Survivors of COVID-19-Associated Acute Respiratory Distress Syndrome Requiring Intubation. Crit Care Med 2022; 50:e674-e682. [PMID: 35132020 PMCID: PMC9275804 DOI: 10.1097/ccm.0000000000005500] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU. DESIGN A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020). SETTING Two academic hospital ICUs, Paris, France. PATIENTS Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge. INTERVENTIONS Follow-up by face-to-face neurologic consultation. MEASURES AND MAIN RESULTS The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome. CONCLUSIONS COVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.
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Affiliation(s)
- Pierre Jaquet
- UFR de médecine, Université de Paris, Paris, France
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Camille Legouy
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Lucie Le Fevre
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Fabrice Sinnah
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Guillaume Franchineau
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Juliette Patrier
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Mehdi Marzouk
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Paul-Henri Wicky
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Pierre Alexis Geoffroy
- Department of Psychiatry and Addictive Medicine, AP-HP, Hospital Bichat - Claude Bernard, 75018 Paris, France
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Florence Arnoult
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, AP-HP Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Serafima Vledouts
- Neurophysiologie clinique, service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Etienne de Montmollin
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Lila Bouadma
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Jean-François Timsit
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Tarek Sharshar
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Romain Sonneville
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
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11
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Sonneville R, Jaquet P, Vellieux G, de Montmollin E, Visseaux B. Intensive care management of patients with viral encephalitis. Rev Neurol (Paris) 2021; 178:48-56. [PMID: 34973832 DOI: 10.1016/j.neurol.2021.12.002] [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: 10/08/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Viral encephalitis is a severe syndrome that can lead to encephalopathy, seizures, focal deficits, and neurological sequelae and death. It is mainly caused by neurotropic herpes viruses (i.e., HSV and VZV), although other pathogens may be observed in specific geographic regions or conditions. Recent advances in neuroimaging and molecular biology (PCR, metagenomics) allow for faster and more accurate etiological diagnoses, although their benefits need to be confirmed to provide guidelines for their use and interpretation. Despite intravenous acyclovir therapy and supportive care, outcomes remain poor in about two-thirds of herpes encephalitis patients requiring ICU admission. Randomized clinical trials focusing on symptomatic measures (i.e. early ICU admission, fever control, and treatment of seizures/status epilepticus) or adjunctive immunomodulatory therapies (i.e. steroids, intravenous immunoglobulins) to improve neurologic outcomes have not been conducted in the ICU setting. Large prospective multicenter studies combining clinical, electrophysiological, and neuroimaging data are needed to improve current knowledge on care pathways, long-term outcomes, and prognostication.
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Affiliation(s)
- R Sonneville
- Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France.
| | - P Jaquet
- AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - G Vellieux
- AP-HP, department of Physiology, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - E de Montmollin
- Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; Université de Paris, INSERM UMR1137, team 6, 75018 Paris, France
| | - B Visseaux
- Université de Paris, INSERM UMR1137, team 6, 75018 Paris, France; AP-HP, department of virology, Hôpital Bichat - Claude Bernard, 75018 Paris, France
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12
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Meyer A, Buetti N, Houhou-Fidouh N, Patrier J, Abdel-Nabey M, Jaquet P, Presente S, Girard T, Sayagh F, Ruckly S, Wicky PH, de Montmollin E, Bouadma L, Sonneville R, Descamps D, Timsit JF. HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients. Crit Care 2021; 25:417. [PMID: 34872611 PMCID: PMC8647503 DOI: 10.1186/s13054-021-03843-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 08/24/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). METHODS We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. RESULTS Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16-3.62; p = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06-5.39, p = 0.037), but not of ICU-BSI. CONCLUSIONS HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.
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Affiliation(s)
- Antoine Meyer
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Niccolò Buetti
- INSERM, IAME, University of Paris, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre on Patient Safety, Service PCI, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Nadhira Houhou-Fidouh
- Virology Department, GH APHP.Nord, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| | - Juliette Patrier
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Moustafa Abdel-Nabey
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Pierre Jaquet
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Simona Presente
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Tiphaine Girard
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Faiza Sayagh
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Stephane Ruckly
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Paul-Henri Wicky
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Etienne de Montmollin
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Lila Bouadma
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
| | - Romain Sonneville
- Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France.,INSERM, UMR1148, Université de Paris, 75018, Paris, France
| | - Diane Descamps
- Virology Department, GH APHP.Nord, Université de Paris, IAME INSERM UMR1137, Bichat-Claude Bernard University Hospital, 75018, Paris, France
| | - Jean-Francois Timsit
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, APHP, Bichat University Hospital, Paris, France
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13
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau 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D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Ghanem M, Homps-Legrand M, Garnier M, Morer L, Goletto T, Frija-Masson J, Wicky PH, Jaquet P, Bancal C, Hurtado-Nedelec M, de Chaisemartin L, Jaillet M, Mailleux A, Quesnel C, Poté N, Debray MP, de Montmollin E, Neukirch C, Borie R, Taillé C, Crestani B. Blood fibrocytes are associated with severity and prognosis in COVID-19 pneumonia. Am J Physiol Lung Cell Mol Physiol 2021; 321:L847-L858. [PMID: 34496650 PMCID: PMC8562948 DOI: 10.1152/ajplung.00105.2021] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Increased blood fibrocytes are associated with a poor prognosis in fibrotic lung diseases. We aimed to determine whether the percentage of circulating fibrocytes could be predictive of severity and prognosis during coronavirus disease 2019 (COVID-19) pneumonia. Blood fibrocytes were quantified by flow cytometry as CD45+/CD15-/CD34+/collagen-1+ cells in patients hospitalized for COVID-19 pneumonia. In a subgroup of patients admitted in an intensive care unit (ICU), fibrocytes were quantified in blood and bronchoalveolar lavage (BAL). Serum amyloid P (SAP), transforming growth factor-β1 (TGF-β1), CXCL12, CCL2, and FGF2 concentrations were measured. We included 57 patients in the hospitalized group (median age = 59 yr [23-87]) and 16 individuals as healthy controls. The median percentage of circulating fibrocytes was higher in the patients compared with the controls (3.6% [0.2-9.2] vs. 2.1% [0.9-5.1], P = 0.04). Blood fibrocyte count was lower in the six patients who died compared with the survivors (1.6% [0.2-4.4] vs. 3.7% [0.6-9.2], P = 0.02). Initial fibrocyte count was higher in patients showing a complete lung computed tomography (CT) resolution at 3 mo. Circulating fibrocyte count was decreased in the ICU group (0.8% [0.1-2.0]), whereas BAL fibrocyte count was 6.7% (2.2-15.4). Serum SAP and TGF-β1 concentrations were increased in hospitalized patients. SAP was also increased in ICU patients. CXCL12 and CCL2 were increased in ICU patients and negatively correlated with circulating fibrocyte count. We conclude that circulating fibrocytes were increased in patients hospitalized for COVID-19 pneumonia, and a lower fibrocyte count was associated with an increased risk of death and a slower resolution of lung CT opacities.
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Affiliation(s)
- Mada Ghanem
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Méline Homps-Legrand
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France
| | - Marc Garnier
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,Sorbonne Université, APHP, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, Paris, France
| | - Lise Morer
- APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Tiphaine Goletto
- APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | | | - Paul-Henri Wicky
- APHP, Service de Réanimation Médicale et Infectieuse, Hôpital Bichat, Paris, France
| | - Pierre Jaquet
- APHP, Service de Réanimation Médicale et Infectieuse, Hôpital Bichat, Paris, France
| | - Catherine Bancal
- APHP, Laboratoire d'Explorations Fonctionnelles, Hôpital Bichat, Paris, France
| | | | - Luc de Chaisemartin
- Université Paris-Sud, Université Paris-Saclay, APHP, Laboratoire d'immunologie, Hôpital Bichat, Paris, France, Inserm, Châtenay-Malabry, France
| | - Madeleine Jaillet
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France
| | - Arnaud Mailleux
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France
| | - Christophe Quesnel
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,Sorbonne Université, APHP, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Tenon, Paris, France
| | - Nicolas Poté
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service d'Anatomie et Cytologie pathologique, Hôpital Bichat, Paris, France
| | - Marie-Pierre Debray
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service de Radiologie, Hôpital Bichat, Paris, France
| | | | - Catherine Neukirch
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Raphael Borie
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Camille Taillé
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Bruno Crestani
- Laboratoire d'excellence INFLAMEX, Université de Paris, Inserm, U1152, Paris, France.,APHP, Service de Pneumologie A, Centre de référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
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Sarton B, Jaquet P, Belkacemi D, de Montmollin E, Bonneville F, Sazio C, Frérou A, Conrad M, Daubin D, Chabanne R, Argaud L, Dailler F, Brulé N, Lerolle N, Maestraggi Q, Marechal J, Bailly P, Razazi K, Mateos F, Guidet B, Levrat A, Susset V, Lautrette A, Mira JP, El Kalioubie A, Robert A, Massri A, Albucher JF, Olivot JM, Conil JM, Boudma L, Timsit JF, Sonneville R, Silva S. Assessment of Magnetic Resonance Imaging Changes and Functional Outcomes Among Adults With Severe Herpes Simplex Encephalitis. JAMA Netw Open 2021; 4:e2114328. [PMID: 34313743 PMCID: PMC8317014 DOI: 10.1001/jamanetworkopen.2021.14328] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 01/09/2023] Open
Abstract
Importance Current guidelines recommend brain magnetic resonance imaging (MRI) for clinical management of patients with severe herpes simplex encephalitis (HSE). However, the prognostic value of brain imaging has not been demonstrated in this setting. Objective To investigate the association between early brain MRI data and functional outcomes of patients with HSE at 90 days after intensive care unit (ICU) admission. Design, Setting, and Participants This multicenter cohort study was conducted in 34 ICUs in France from 2007 to 2019 and recruited all patients who received a clinical diagnosis of encephalitis and exhibited cerebrospinal fluid positivity for herpes simplex virus DNA in the polymerase chain reaction analysis. Data analysis was performed from January to April 2020. Exposures All patients underwent a standard brain MRI during the first 30 days after ICU admission. Main Outcomes and Measures MRI acquisitions were analyzed by radiologists blinded to patients' outcomes, using a predefined score. Multivariable logistic regression and supervised hierarchical classifiers methods were used to identify factors associated with poor outcome at 90 days, defined by a score of 3 to 6 (indicating moderate-to-severe disability or death) on the Modified Rankin Scale. Results Overall, 138 patients (median [interquartile range {IQR}] age, 62.6 [54.0-72.0] years; 75 men [54.3%]) with an admission median (IQR) Glasgow Coma Scale score of 9 (6-12) were studied. The median (IQR) delay between ICU admission and MRI was 1 (1-7) days. At 90 days, 95 patients (68.8%) had a poor outcome, including 16 deaths (11.6%). The presence of fluid-attenuated inversion recovery MRI signal abnormalities in more than 3 brain lobes (odds ratio [OR], 25.71; 95% CI, 1.21-554.42), age older than 60 years (OR, 7.62; 95% CI, 2.02-28.91), and the presence of diffusion-weighted MRI signal abnormalities in the left thalamus (OR, 6.90; 95% CI, 1.12-43.00) were independently associated with poor outcome. Machine learning models identified bilateral diffusion abnormalities as an additional factor associated with poor outcome (34 of 39 patients [87.2%] with bilateral abnormalities had poor outcomes) and confirmed the functional burden of left thalamic lesions, particularly in older patients (all 11 patients aged >60 years had left thalamic lesions). Conclusions and Relevance These findings suggest that in adult patients with HSE requiring ICU admission, extensive MRI changes in the brain are independently associated with poor functional outcome at 90 days. Thalamic diffusion signal changes were frequently observed and were associated with poor prognosis, mainly in older patients.
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Affiliation(s)
- Benjamine Sarton
- Critical Care Unit, University Hospital of Purpan, Toulouse, France
- Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Paris, France
| | - Djida Belkacemi
- Department of Neuroradiology, University Hospital of Purpan, Toulouse, France
| | - Etienne de Montmollin
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Paris, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
- Department of Neuroradiology, University Hospital of Purpan, Toulouse, France
| | - Charline Sazio
- Critical Care Unit, University Hospital of Pellegrin, Bordeaux, France
| | - Aurelien Frérou
- Critical Care Unit, University Hospital of Rennes, Rennes, France
| | - Marie Conrad
- Critical Care Unit, Regional and University Hospital of Nancy, Nancy France
| | - Delphine Daubin
- Critical Care Unit, University Hospital of Montpellier, Montpellier, France
| | - Russell Chabanne
- Critical Care Unit, University Hospital Gabriel Montpied, Clermont Ferrand, France
| | - Laurent Argaud
- Critical Care Unit, University Hospital Edouard Herriot, Hospices Civils of Lyon, Lyon, France
| | - Frédéric Dailler
- Neurological Critical Care Unit, Hospital Pierre Wertheimer, Hospices Civils of Lyon, Lyon, France
| | - Noëlle Brulé
- Critical Care Unit, University Hospital of Nantes, Nantes, France
| | - Nicolas Lerolle
- Critical Care Unit, University Hospital of Angers, Angers, France
| | - Quentin Maestraggi
- Critical Care Unit, University Hospital Hautepierre of Strasbourg, Strasbourg, France
| | - Julien Marechal
- Critical Care Unit, University Hospital La Miletrie, Poitiers, France
| | - Pierre Bailly
- Critical Care Unit, Regional University Hospital La Cavale Blanche, Brest, France
| | - Keyvan Razazi
- Critical Care Unit, University Hospital of Henri Mondor, Créteil, France
| | - Francois Mateos
- Critical Care Unit, Regional Hospital of Saint Brieuc, Saint Brieuc, France
| | - Bertrand Guidet
- Critical Care Unit, University Hospital of Saint Antoine, Paris, France
| | - Albrice Levrat
- Critical Care Unit, University Hospital of Annecy Genevois, Epagny Metz-Tessy, France
| | - Vincent Susset
- Critical Care Unit, Regional Hospital of Chambery, Chambery, France
| | - Alexandre Lautrette
- Critical Care Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Paul Mira
- Critical Care Unit, University Hospital Cochin, Paris, France
| | | | | | | | - Jean François Albucher
- Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
- Department of Neurology, University Hospital of Purpan, Toulouse, France
| | - Jean Marc Olivot
- Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
- Department of Neurology, University Hospital of Purpan, Toulouse, France
| | - Jean Marie Conil
- Critical Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Lila Boudma
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Paris, France
- Laboratory for Vascular Translational Science, Sorbonne Paris Cité, Unité Mixte de Recherche 1148, Institut National de la Santé et de la Recherche Médicale, Paris Diderot University, Paris, France
| | - Stein Silva
- Critical Care Unit, University Hospital of Purpan, Toulouse, France
- Toulouse NeuroImaging Center, Unité Mixte de Recherche 1214, Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Toulouse, France
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Touchard C, Cartailler J, Vellieux G, de Montmollin E, Jaquet P, Wanono R, Reuter J, Para M, Bouadma L, Timsit JF, d'Ortho MP, Kubis N, Rouvel Tallec A, Sonneville R. Simplified frontal EEG in adults under veno-arterial extracorporeal membrane oxygenation. Ann Intensive Care 2021; 11:76. [PMID: 33987690 PMCID: PMC8119573 DOI: 10.1186/s13613-021-00854-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background EEG-based prognostication studies in intensive care units often rely on a standard 21-electrode montage (stdEEG) requiring substantial human, technical, and financial resources. We here evaluate whether a simplified 4-frontal electrode montage (4-frontEEG) can detect EEG patterns associated with poor outcomes in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods We conducted a reanalysis of EEG data from a prospective cohort on 118 adult patients under VA-ECMO, in whom EEG was performed on admission to intensive care. EEG patterns of interest included background rhythm, discontinuity, reactivity, and the Synek’s score. They were all reassessed by an intensivist on a 4-frontEEG montage, whose analysis was then compared to an expert’s interpretation made on stdEEG recordings. The main outcome measure was the degree of correlation between 4-frontEEG and stdEEG montages to identify EEG patterns of interest. The performance of the Synek scores calculated on 4-frontEEG and stdEEG montage to predict outcomes (i.e., 28-day mortality and 90-day Rankin score \documentclass[12pt]{minimal}
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\begin{document}$${\ge {4}}$$\end{document}≥4) was investigated in a secondary exploratory analysis. Results The detection of EEG patterns using 4-frontEEG was statistically similar to that of stdEEG for background rhythm (Spearman rank test, ρ = 0.66, p < 0.001), discontinuity (Cohen’s kappa, \documentclass[12pt]{minimal}
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\begin{document}$$\kappa$$\end{document}κ = 0.955), reactivity (\documentclass[12pt]{minimal}
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\begin{document}$$\kappa$$\end{document}κ = 0.739) and the Synek’s score (ρ = 0.794, p < 0.001). Using the Synek classification, we found similar performances between 4-frontEEG and stdEEG montages in predicting 28-day mortality (AUC 4-frontEEG 0.71, AUC stdEEG 0.68) and for 90-day poor neurologic outcome (AUC 4-frontEEG 0.71, AUC stdEEG 0.66). An exploratory analysis confirmed that the Synek scores determined by 4 or 21 electrodes were independently associated with 28-day mortality and poor 90-day functional outcome. Conclusion In adult patients under VA-ECMO, a simplified 4-frontal electrode EEG montage interpreted by an intensivist, detected common EEG patterns associated with poor outcomes, with a performance similar to that of a standard EEG montage interpreted by expert neurophysiologists. This simplified montage could be implemented as part of a multimodal evaluation for bedside prognostication. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00854-0.
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Affiliation(s)
- Cyril Touchard
- Department of Anesthesiology and Intensive Care, APHP, Lariboisière-Saint Louis Hospitals, 75010, Paris, France
| | - Jérôme Cartailler
- Department of Anesthesiology and Intensive Care, APHP, Lariboisière-Saint Louis Hospitals, 75010, Paris, France.,Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, 75019, Paris, France.,Department of Clinical Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Etienne de Montmollin
- Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Ruben Wanono
- Université de Paris, NeuroDiderot, Inserm, 75019, Paris, France.,Department of Clinical Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Jean Reuter
- Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Marie-Pia d'Ortho
- Department of Clinical Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Nathalie Kubis
- Laboratory for Vascular Translational Science, INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.,Department of Clinical Physiology, APHP, Lariboisière - Saint Louis hospitals, DMU DREAM, 75010, Paris, France
| | - Anny Rouvel Tallec
- Université de Paris, NeuroDiderot, Inserm, 75019, Paris, France.,Department of Clinical Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Romain Sonneville
- Laboratory for Vascular Translational Science, INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France. .,Department of Intensive Care Medicine and Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France.
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Vellieux G, Sonneville R, Vledouts S, Jaquet P, Rouvel-Tallec A, d’Ortho MP. COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature. Front Physiol 2021; 11:622466. [PMID: 33679425 PMCID: PMC7933549 DOI: 10.3389/fphys.2020.622466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the end of year 2019 and is currently responsive for coronavirus infectious disease 2019 (COVID-19). The first reports considered COVID-19 as a respiratory tract disease responsible for pneumonia, but numerous studies rapidly emerged to warn the medical community of COVID-19-associated neurological manifestations, including encephalopathy at the acute phase and other postinfectious manifestations. Using standard visual analysis or spectral analysis, recent studies reported electroencephalographic (EEG) findings of COVID-19 patients with various neurological symptoms. Most EEG recordings were normal or revealed non-specific abnormalities, such as focal or generalized slowing, interictal epileptic figures, seizures, or status epilepticus. Interestingly, novel EEG abnormalities over frontal areas were also described at the acute phase. Underlying mechanisms leading to brain injury in COVID-19 are still unknown and matters of debate. These frontal EEG abnormalities could emphasize the hypothesis whereby SARS-CoV-2 enters the central nervous system (CNS) through olfactory structures and then spreads in CNS via frontal lobes. This hypothesis is reinforced by the presence of anosmia in a significant proportion of COVID-19 patients and by neuroimaging studies confirming orbitofrontal abnormalities. COVID-19 represents a new viral disease characterized by not only respiratory symptoms but also a systemic invasion associated with extra-respiratory signs. Neurological symptoms must be the focus of our attention, and functional brain evaluation with EEG is crucial, in combination with anatomical and functional brain imaging, to better understand its pathophysiology. Evolution of symptoms together with EEG patterns at the distance of the acute episode should also be scrutinized.
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Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Sérafima Vledouts
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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18
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Vellieux G, Jaquet P, Grinea A, Para M, Rouvel-Tallec A, Sonneville R. Continuous EEG findings in COVID-19 patients under extracorporeal membrane oxygenation. Clin Neurophysiol 2021; 132:839-840. [PMID: 33636600 PMCID: PMC7963103 DOI: 10.1016/j.clinph.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie Clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Pierre Jaquet
- Médecine Intensive - Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine Intensive - Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Marylou Para
- Chirurgie Cardiaque, APHP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France; Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie Clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Romain Sonneville
- Médecine Intensive - Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France; Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France.
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Magalhaes E, Reuter J, Wanono R, Bouadma L, Jaquet P, Tanaka S, Sinnah F, Ruckly S, Dupuis C, de Montmollin E, Para M, Braham W, Pisani A, d'Ortho MP, Rouvel-Tallec A, Timsit JF, Sonneville R. Correction to: Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation. Neurocrit Care 2020; 33:867. [PMID: 33033960 DOI: 10.1007/s12028-020-01098-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eric Magalhaes
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Jean Reuter
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France
| | - Ruben Wanono
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Sébastien Tanaka
- Department of Anesthesiology and Intensive Care, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
- INSERM 1188, DéTROI, Reunion Island University, Saint-Denis de la Réunion, France
| | - Fabrice Sinnah
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | | | - Claire Dupuis
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Etienne de Montmollin
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Wael Braham
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Angelo Pisani
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Marie-Pia d'Ortho
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Anny Rouvel-Tallec
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
- UMR 1137, IAME, Université de Paris, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.
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Blum A, Gillet R, Rauch A, Urbaneja A, Biouichi H, Dodin G, Germain E, Lombard C, Jaquet P, Louis M, Simon L, Gondim Teixeira P. 3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future. Diagn Interv Imaging 2020; 101:693-705. [PMID: 33036947 DOI: 10.1016/j.diii.2020.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 08/04/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022]
Abstract
Three-dimensional (3D) imaging and post processing are common tasks used daily in many disciplines. The purpose of this article is to review the new postprocessing tools available. Although 3D imaging can be applied to all anatomical regions and used with all imaging techniques, its most varied and relevant applications are found with computed tomography (CT) data in musculoskeletal imaging. These new applications include global illumination rendering (GIR), unfolded rib reformations, subtracted CT angiography for bone analysis, dynamic studies, temporal subtraction and image fusion. In all of these tasks, registration and segmentation are two basic processes that affect the quality of the results. GIR simulates the complete interaction of photons with the scanned object, providing photorealistic volume rendering. Reformations to unfold the rib cage allow more accurate and faster diagnosis of rib lesions. Dynamic CT can be applied to cinematic joint evaluations a well as to perfusion and angiographic studies. Finally, more traditional techniques, such as minimum intensity projection, might find new applications for bone evaluation with the advent of ultra-high-resolution CT scanners. These tools can be used synergistically to provide morphologic, topographic and functional information and increase the versatility of CT.
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Affiliation(s)
- A Blum
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France; Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, 54511 Vandœuvre-lès-Nancy, France.
| | - R Gillet
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - A Rauch
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - A Urbaneja
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - H Biouichi
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - G Dodin
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - E Germain
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - C Lombard
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - P Jaquet
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - M Louis
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - L Simon
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - P Gondim Teixeira
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France; Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, 54511 Vandœuvre-lès-Nancy, France
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21
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Lê MP, Jaquet P, Patrier J, Wicky PH, Le Hingrat Q, Veyrier M, Kauv J, Sonneville R, Visseaux B, Laouénan C, Bouadma L, Descamps D, de Montmollin E, Peytavin G, Timsit JF. Pharmacokinetics of lopinavir/ritonavir oral solution to treat COVID-19 in mechanically ventilated ICU patients. J Antimicrob Chemother 2020; 75:2657-2660. [PMID: 32688374 PMCID: PMC7454557 DOI: 10.1093/jac/dkaa261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background The combination lopinavir/ritonavir is recommended to treat HIV-infected patients at the dose regimen of 400/100 mg q12h, oral route. The usual lopinavir trough plasma concentrations are 3000–8000 ng/mL. A trend towards a 28 day mortality reduction was observed in COVID-19-infected patients treated with lopinavir/ritonavir. Objectives To assess the plasma concentrations of lopinavir and ritonavir in patients with severe COVID-19 infection and receiving lopinavir/ritonavir. Patients and methods Mechanically ventilated patients with COVID-19 infection included in the French COVID-19 cohort and treated with lopinavir/ritonavir were included. Lopinavir/ritonavir combination was administered using the usual adult HIV dose regimen (400/100 mg q12h, oral solution through a nasogastric tube). A half-dose reduction to 400/100 mg q24h was proposed if lopinavir Ctrough was >8000 ng/mL, the upper limit considered as toxic and reported in HIV-infected patients. Lopinavir and ritonavir pharmacokinetic parameters were determined after an intensive pharmacokinetic analysis. Biological markers of inflammation and liver/kidney function were monitored. Results Plasma concentrations of lopinavir and ritonavir were first assessed in eight patients treated with lopinavir/ritonavir. Median (IQR) lopinavir Ctrough reached 27 908 ng/mL (15 928–32 627). After the dose reduction to 400/100 mg q24h, lopinavir/ritonavir pharmacokinetic parameters were assessed in nine patients. Lopinavir Ctrough decreased to 22 974 ng/mL (21 394–32 735). Conclusions In mechanically ventilated patients with severe COVID-19 infections, the oral administration of lopinavir/ritonavir elicited plasma exposure of lopinavir more than 6-fold the upper usual expected range. However, it remains difficult to safely recommend its dose reduction without compromising the benefit of the antiviral strategy, and careful pharmacokinetic and toxicity monitoring are needed.
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Affiliation(s)
- Minh Patrick Lê
- AP-HP, Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, 75018 Paris, France.,INSERM, UMRS-1144, Université de Paris, 75006 Paris, France
| | - Pierre Jaquet
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France
| | - Juliette Patrier
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France
| | - Paul-Henri Wicky
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France
| | - Quentin Le Hingrat
- AP-HP, Bichat Claude Bernard Hospital, Virology Department, 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Marc Veyrier
- AP-HP, Bichat Claude Bernard Hospital, Pharmacy Department, 75018 Paris, France
| | - Juliette Kauv
- AP-HP, Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, 75018 Paris, France
| | - Romain Sonneville
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Benoit Visseaux
- AP-HP, Bichat Claude Bernard Hospital, Virology Department, 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Cédric Laouénan
- IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France.,AP-HP, Bichat Claude Bernard Hospital, Department of Epidemiology, Biostatistics and Clinical Research, CIC-EC 1425, 75018 Paris, France
| | - Lila Bouadma
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Diane Descamps
- AP-HP, Bichat Claude Bernard Hospital, Virology Department, 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Etienne de Montmollin
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Gilles Peytavin
- AP-HP, Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), 75018 Paris, France.,IAME, INSERM, UMRS1137, Université de Paris, 75018 Paris, France
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Calligaris C, Marois C, Jaquet P, Viala K, Weiss N, Demeret S, Rohaut B. Botulisme ou polyradiculonévrite aiguë : à propos d’un cas. Rev Neurol (Paris) 2020. [DOI: 10.1016/j.neurol.2020.01.104] [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] [Indexed: 10/23/2022]
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23
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von Seckendorff AF, Marois C, Jaquet P, Morin A, Bernard J, Cohen L, Demeret S. Analyse en IRM cérébrale fonctionnelle de l’effet paradoxal du Zolpidem dans un syndrome catatonique associé à une encéphalite à anticorps anti-NMDA récepteur. Rev Neurol (Paris) 2020. [DOI: 10.1016/j.neurol.2020.01.134] [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] [Indexed: 10/23/2022]
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Magalhaes E, Reuter J, Wanono R, Bouadma L, Jaquet P, Tanaka S, Sinnah F, Ruckly S, Dupuis C, de Montmollin E, Para M, Braham W, Pisani A, d'Ortho MP, Rouvel-Tallec A, Timsit JF, Sonneville R. Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation. Neurocrit Care 2020; 33:688-694. [PMID: 32789602 DOI: 10.1007/s12028-020-01066-3] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND/OBJECTIVES Tools for prognostication of neurologic outcome of adult patients under venoarterial ECMO (VA-ECMO) have not been thoroughly investigated. We aimed to determine whether early standard electroencephalography (stdEEG) can be used for prognostication in adults under VA-ECMO. METHODS Prospective single-center observational study conducted in two intensive care units of a university hospital, Paris, France. Early stdEEG was performed on consecutive adult patients treated with VA-ECMO for refractory cardiogenic shock or refractory cardiac arrest. The association between stdEEG findings and unfavorable outcome was investigated. The primary endpoint was 28-day mortality. The secondary endpoint was severe disability or death at 90 days, defined by a score of 4-6 on the modified Rankin scale. RESULTS A total of 122 patients were included, of whom 35 (29%) received cardiopulmonary resuscitation before VA-ECMO cannulation. Main stdEEG findings included low background frequency ≤ 4 Hz (n = 27, 22%) and background abnormalities, i.e., a discontinuous (n = 20, 17%) and/or an unreactive background (n = 12, 10%). Background abnormalities displayed better performances for prediction of unfavorable outcomes, as compared to clinical parameters at time of recording. An unreactive stdEEG background in combination with a background frequency ≤ 4 Hz had a false positive rate of 0% for prediction of unfavorable outcome at 28 days and 90 days, with sensitivities of 8% and 6%, respectively. After adjustment for confounders, a lower background frequency was independently associated with unfavorable outcome at 28 days (adjusted odds ratio per 1-Hz increment, 95% CI 0.71, 0.52-0.97), whereas no such independent association was observed at 90 days. CONCLUSION Standard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable outcomes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improving management of care and prognostication.
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Affiliation(s)
- Eric Magalhaes
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Jean Reuter
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France
| | - Ruben Wanono
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Pierre Jaquet
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | - Sébastien Tanaka
- Department of Anesthesiology and Intensive Care, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France.,INSERM 1188, DéTROI, Reunion Island University, Saint-Denis de la Réunion, France
| | - Fabrice Sinnah
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France
| | | | - Claire Dupuis
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Etienne de Montmollin
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Wael Braham
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Angelo Pisani
- Department of Cardiac Surgery, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Marie-Pia d'Ortho
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Anny Rouvel-Tallec
- Department of Physiology, AP-HP, Bichat-Claude Bernard Hospital, 75018, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France.,UMR 1137, IAME, Université de Paris, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris Cedex, France. .,INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.
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25
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Vellieux G, Rouvel-Tallec A, Jaquet P, Grinea A, Sonneville R, d'Ortho MP. COVID-19 associated encephalopathy: Is there a specific EEG pattern? Clin Neurophysiol 2020; 131:1928-1930. [PMID: 32615526 PMCID: PMC7311351 DOI: 10.1016/j.clinph.2020.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France.
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Pierre Jaquet
- Médecine intensive-réanimation, AP-HP, Bichat-Claude Bernard Hospital, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine intensive-réanimation, AP-HP, Bichat-Claude Bernard Hospital, F-75018 Paris, France
| | - Romain Sonneville
- Médecine intensive-réanimation, AP-HP, Bichat-Claude Bernard Hospital, F-75018 Paris, France; Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
| | - Marie-Pia d'Ortho
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France; Neurophysiologie clinique, Service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
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Hauw F, Dinkelacker V, Jaquet P, Vespignani H, Grégoire C, Perrin M, Engrand N. Herpes simplex encephalitis: A new type of "ICU-acquired infection"? Heliyon 2020; 6:e03667. [PMID: 32258496 PMCID: PMC7113434 DOI: 10.1016/j.heliyon.2020.e03667] [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: 12/29/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Although it is a well-known disease, the occurrence of Herpes simplex encephalitis (HSE) during a hospital stay may render the diagnosis particularly challenging. The objective of this report is to alert clinicians about the diagnostic pitfalls arising from hospital-developed HSE. Materials and methods Clinical observation of one patient. Case report An 87-year-old male was admitted to the Intensive Care Unit (ICU) because of respiratory failure due to an exacerbation of myasthenia gravis. After corticoids and azathioprine treatment, his clinical condition improved, allowing weaning from mechanical ventilation. One month after admission, while still hospitalized in the ICU, the patient developed fever and confusion. In the context of confounding factors, HSE was not suspected before a convulsive status epilepticus occurred, resulting in a significant delay in treatment. Diagnosis was confirmed by PCR-analysis in the cerebrospinal fluid. Serological status confirmed reactivation of prior herpes simplex infection. The patient died one week after the onset of confusion. Conclusions Hospital-“acquired” HSE must be suspected in case of new neurologic symptoms associated with fever, even in ICU-hospitalized patients. The diagnosis is made even more difficult by nonspecific symptoms due to previous diseases, leading to an even more severe prognosis in those vulnerable patients.
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Affiliation(s)
- Fabien Hauw
- Neuro-Intensive Care Unit, Fondation Rothschild, 29 rue Manin, 75019 Paris, France
| | - Vera Dinkelacker
- Department of Neurology, Fondation Rothschild, 29 rue Manin, 75019 Paris, France
| | - Pierre Jaquet
- Intensive Care Unit, Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris 47-85 Bd de l'Hôpital 75013 Paris, France
| | - Hervé Vespignani
- Serenity Medical Services - NeuroPhy, ICM-iPEPS, 47-85 Bd de l'Hôpital, 75013 Paris, France1http://www.serenitymedicalservices.com
| | - Charles Grégoire
- Neuro-Intensive Care Unit, Fondation Rothschild, 29 rue Manin, 75019 Paris, France
| | - Mathilde Perrin
- Neuro-Intensive Care Unit, Fondation Rothschild, 29 rue Manin, 75019 Paris, France
| | - Nicolas Engrand
- Neuro-Intensive Care Unit, Fondation Rothschild, 29 rue Manin, 75019 Paris, France
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27
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Jaquet P, de Montmollin E, Dupuis C, Sazio C, Conrad M, Susset V, Demeret S, Tadie JM, Argaud L, Barbier F, Sarton B, Chabane R, Daubin D, Brulé N, Lerolle N, Alves M, Da Silva D, Kalioubi AE, Silva S, Bailly P, Wolff M, Bouadma L, Timsit JF, Sonneville R. Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study. Intensive Care Med 2019; 45:1103-1111. [PMID: 31292686 DOI: 10.1007/s00134-019-05684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/16/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.
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Affiliation(s)
- P Jaquet
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - E de Montmollin
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - C Dupuis
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - C Sazio
- Medical Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - M Conrad
- Medical Intensive Care Unit, Central Hospital, Nancy University Hospitals, Nancy, France
| | - V Susset
- Polyvalent Intensive Care Unit, Chambery Hospital, Chambery, France
| | - S Demeret
- Neurologic Intensive Care Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - J M Tadie
- Medical Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - L Argaud
- Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France
| | - F Barbier
- Medical Intensive Care Unit, La Source Hospital, Orléans, France
| | - B Sarton
- Intensive Care Unit, Purpan University Hospital, Toulouse, France
| | - R Chabane
- Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - D Daubin
- Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - N Brulé
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - N Lerolle
- Medical Intensive Care Unit, CHU Angers, Angers University Hospital, Angers, France
| | - M Alves
- Polyvalent Intensive Care Unit, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France
| | - D Da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - A El Kalioubi
- Medical Intensive Care Unit, Roger Salengro University Hospital, Lille, France
| | - S Silva
- Intensive Care Unit, Purpan University Hospital, Toulouse, France
| | - P Bailly
- Medical Intensive Care Unit, La Cavale Blanche University Hospital, Brest, France
| | - M Wolff
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - L Bouadma
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - J F Timsit
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.,UMR 1137, IAME, Paris Diderot University, Paris, France
| | - R Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France. .,UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.
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Teixeira P, Jaquet P, Bakour O, Jacquot A, Molé D, Sirveaux F, Blum A. CT arthrography of the intra-articular long head of biceps tendon: Diagnostic performance outside the labral-bicipital complex. Diagn Interv Imaging 2019; 100:437-444. [DOI: 10.1016/j.diii.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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Freiherr von Seckendorff A, Marois C, Jaquet P, Weiss N, Demeret S. Une encéphalite à LGI1 atypique dissimulée. Rev Neurol (Paris) 2019. [DOI: 10.1016/j.neurol.2019.01.377] [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] [Indexed: 10/27/2022]
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Saveanu A, Jaquet P, Brue T, Barlier A. Relevance of coexpression of somatostatin and dopamine D2 receptors in pituitary adenomas. Mol Cell Endocrinol 2008; 286:206-13. [PMID: 18241980 DOI: 10.1016/j.mce.2007.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [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] [Received: 06/11/2007] [Revised: 12/10/2007] [Accepted: 12/12/2007] [Indexed: 02/06/2023]
Abstract
Dopamine and somatostatin are both involved in the negative control of normal pituitary cells. Dopamine subtype 2 receptor (D2DR) and somatostatin receptor (sst) agonists, mainly directed to sst2, are used in the treatment of pituitary adenomas. Nevertheless, a majority of corticotroph and gonadotroph adenomas and a third of somatotroph adenomas are still not sufficiently controlled by these treatments. D2DR and sst1, 2, 3 and 5 are present in most pituitary adenomas. These receptors may interact by heterodimerization as shown for sst1-sst5, sst5-D2DR, sst2-sst3 and sst2-D2DR suggesting possible additive effects. D2DR and sst2 agonist cotreatment showed limited additivity on GH secretion in acromegaly. Moreover, new chimeric compounds with sst2, D2DR and sst5 affinity have shown an increased control of secretion and/or proliferation of different types of pituitary adenomas in cell culture. Together with the multi-sst ligand drugs recently developed, these dopamine-somatostatin ligands represent a new opportunity in the combinatory treatment of pituitary adenomas.
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Affiliation(s)
- A Saveanu
- Laboratory Interactions Cellulaires Neuroendocriniennes, UMR 6544 CNRS, Institut Fédératif Jean Roche, Faculté de Médecine Nord, Université de la Méditerranée, Marseille, France.
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Abstract
CONTEXT Although transsphenoidal surgery remains the first-line treatment in Cushing's disease (CD), recurrence is observed in about 20% of cases. Adjunctive treatments each have specific drawbacks. Despite its inhibitory effects on steroidogenesis, the antifungal drug ketoconazole was only evaluated in series with few patients and/or short-term follow-up. OBJECTIVE Analysis of long-term hormonal effects and tolerance of ketoconazole in CD. DESIGN A total of 38 patients were retrospectively studied with a mean follow-up of 23 months (6-72). SETTING All patients were treated at the same Department of Endocrinology in Marseille, France. PATIENTS The 38 patients with CD, of whom 17 had previous transsphenoidal surgery. INTERVENTION Ketoconazole was begun at 200-400 mg/day and titrated up to 1200 mg/day until biochemical remission. MAIN OUTCOME MEASURES Patients were considered controlled if 24-h urinary free cortisol was normalized. RESULTS Five patients stopped ketoconazole during the first week because of clinical or biological intolerance. On an intention to treat basis, 45% of the patients were controlled as were 51% of those treated long term. Initial hormonal levels were not statistically different between patients controlled or uncontrolled. Ketoconazole was similarly efficacious as a primary or postoperative treatment. Among 15 patients without visible adenoma at initial evaluation, subsequent follow-up allowed identification of the lesion in five cases. No adrenal insufficiency was observed. Adverse effects were rare in patients treated long term. CONCLUSIONS Ketoconazole is a safe and efficacious treatment in CD, particularly in patients for whom surgery is contraindicated, or delayed because of the absence of image of adenoma on magnetic resonance imaging.
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Affiliation(s)
- F Castinetti
- Department of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille and Faculté de Médecine, Université de la Méditerranée, 264 rue St Pierre, Cedex 5, 13385 Marseille, France
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Castinetti F, Morange I, Dufour H, Jaquet P, Conte-Devolx B, Girard N, Brue T. Desmopressin test during petrosal sinus sampling: a valuable tool to discriminate pituitary or ectopic ACTH-dependent Cushing's syndrome. Eur J Endocrinol 2007; 157:271-7. [PMID: 17766708 DOI: 10.1530/eje-07-0215] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [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: 11/08/2022]
Abstract
UNLABELLED Corticotropin-releasing hormone (CRH)-stimulated petrosal sinus sampling is currently the gold standard method for the differential diagnosis between pituitary and ectopic ACTH-dependent Cushing's syndrome. Our objective was to determine sensitivity and specificity of desmopressin test during petrosal sinus sampling. PATIENTS AND METHODS Forty-three patients had petrosal sinus sampling because of the lack of visible adenoma on magnetic resonance imaging (MRI) and/or because of discordant cortisol response to high-dose dexamethasone suppression test. ACTH sampling was performed in an antecubital vein, right and left petrosal sinuses, then at each location 5 and 10 min after injection of desmopressin. Diagnosis was based on the ACTH ratio between petrosal sinus and humeral vein ACTH after desmopressin test. Diagnosis was confirmed after surgery. A receiver operating characteristics curve was used to determine optimal sensitivity and specificity. RESULTS Thirty-six patients had Cushing's disease (CD) and seven had ectopic ACTH secretion. A ratio > 2 after desmopressin was found in 35 of the 36 cases of CD (sensitivity: 95%). A ratio < or = 2 was found in the seven patients with ectopic ACTH secretion (specificity: 100%). Sinus sampling was ineffective in determining the left or right localization of the adenoma (sensitivity = 50%). No major adverse effects were observed during or after the procedure. CONCLUSION Desmopressin test during petrosal sinus sampling is a safe and effective diagnostic procedure in ACTH-dependent Cushing's syndrome. It thus represents a valuable alternative to CRH.
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Affiliation(s)
- F Castinetti
- Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille, Marseille, France
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Jan M, Dufour H, Brue T, Jaquet P. Prolactinoma surgery. Annales d'Endocrinologie 2007; 68:118-9. [PMID: 17512893 DOI: 10.1016/j.ando.2007.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 01/20/2007] [Accepted: 03/19/2007] [Indexed: 10/22/2022]
Abstract
Surgery is generally used as second-line treatment in prolactinomas. For microprolactinomas, it may be indicated in cases of resistance or intolerance to dopamine agonists or where patients prefer definitive cure to lifelong drug treatment. In highly trained hands, selective adenomectomy results in normalization of prolactin levels in 75-90% of cases with little morbidity and no mortality. However, subsequent relapse is possible in up to 20% of cases. In macroprolactinoma, a definitive cure is unlikely due to the frequency of invasive tumor extension. A transsphenoidal or, less frequently, a transfrontal surgical approach is necessary in patients resistant to or intolerant of medical treatment, and also in rare cases such as pituitary apoplexy or cerebrospinal fluid rhinorrhea.
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Affiliation(s)
- M Jan
- Department of Neurosurgery, Bretonneau Regional University Teaching Hospital, 2 Bd Tonnellé, 37044 Tours cedex, France
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Castinetti F, Nagai M, Dufour H, Kuhn JM, Morange I, Jaquet P, Conte-Devolx B, Regis J, Brue T. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease. Eur J Endocrinol 2007; 156:91-8. [PMID: 17218730 DOI: 10.1530/eje.1.02323] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [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: 11/08/2022]
Abstract
OBJECTIVE Though transsphenoidal surgery remains the first-line treatment of Cushing's disease, recurrence occurs frequently. Conventional radiotherapy and anticortisolic drugs both have adverse effects. Stereotactic radiosurgery needs to be evaluated more precisely. The aim of this study was to determine long-term hormonal effects and tolerance of gamma knife (GK) radiosurgery in Cushing's disease. DESIGN Forty patients with Cushing's disease treated by GK were prospectively studied over a decade, with a mean follow-up of 54.7 months. Eleven of them were treated with GK as a primary treatment. METHODS Radiosurgery was performed at the Department of Functional Neurosurgery of Marseille, France, using the Leksell Gamma Unit B and C models. Median margin dose was 29.5 Gy. Patients were considered in remission if they had normalized 24-h free urinary cortisol and suppression of plasma cortisol after low-dose dexamethasone suppression test. RESULTS Seventeen patients (42.5%) were in remission after a mean of 22 months (range 12-48 months). The two groups did not differ in terms of initial hormonal levels. Target volume was significantly higher in uncured than in remission group (909.8 vs 443 mm(3), P = 0.038). We found a significant difference between patients who were on or off anticortisolic drugs at the time of GK (20 vs 48% patients in remission respectively, P = 0.02). CONCLUSION With 42% of patients in remission after a median follow-up of 54 months, GK stereotactic radiosurgery, especially as an adjunctive treatment to surgery, may represent an alternative to other therapeutic options in view of their adverse effects.
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Affiliation(s)
- F Castinetti
- Federation of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Hôpital de la Timone, Centre Hospitalier Universitaire de Marseille and Faculté de Médecine, Université de la Méditerranée, 264 rue St Pierre, cedex 5, 13385 Marseille, France
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Caudie C, Kaygisiz F, Jaquet P, Petiot P, Gonnaud PM, Antoine JC, Vial C. [Diagnostic value of autoantibodies to MAG by ELISA Bühlmann in 117 immune-mediated peripheral neuropathies associated with monoclonal IgM to SGPG/SGLPG]. Ann Biol Clin (Paris) 2006; 64:353-9. [PMID: 16829480] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 05/20/2006] [Indexed: 05/10/2023]
Abstract
The neuropathies associated with monoclonal IgM gammopathy reacted with glycoconjugated targets on a very antigenic epitope on the sulfated glucuronic glycolipids corresponding to SGPG and SGLPG (sulfoglucuronyl paragloboside and sulfoglucuronyl lactosaminyl paragloboside), myelin-associated glycoprotein (MAG) and sulfatide. Sometimes monoclonal IgM binds to a broad spectrum of gangliosides. The detection of targets of autoantibodies has considerable importance in the diagnosis and management of patients. It is not known whether the results of antibody tests are equally sensitive and specific for identification of involved auto-antigens. In this study we evaluated the results obtained using IgM reactivity against MAG by enzyme-linked immunosorbent assay (ELISA Bühlmann) with IgM reactivity against SGPG/SGLPG obtained by overlay thin-layer chromatography. We selected 117 patients with anti-SGPG/SGLPG monoclonal gammopathy and peripheral neuropathy and a control group of 102 peripheral neuropathies with 24 having IgM high titres of monoclonal IgM anti-ganglioside antibodies. The anti-MAG sensitivity was 0.97, specificity was 0.86. There is a crossreactivity between 8 (57%) monoclonal IgM antibodies anti-MAG and anti-ganglioside GM1 and 2 (28%) anti-disialylated gangliosides. These results indicate that in clinical practice, anti-MAG ELISA is useful for eliminating anti-MAG neuropathy, as well as for positive diagnosis for titres upper than 10,000 BTU. It is also alpha good test to appreciate clinical improvement after Rituximab treatment.
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Affiliation(s)
- C Caudie
- Fédération de Biologie, Service d'Immunologie et Neuro-Immunologie, Hôpital Neurologique, Lyon Bron.
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Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R, Ghigo E, Ho K, Jaquet P, Kleinberg D, Lamberts S, Laws E, Lombardi G, Sheppard MC, Thorner M, Vance ML, Wass JAH, Giustina A. Consensus statement: medical management of acromegaly. Eur J Endocrinol 2005; 153:737-40. [PMID: 16322377 DOI: 10.1530/eje.1.02036] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [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: 11/08/2022]
Abstract
In November 2003, the Pituitary Society and the European Neuroendocrine Association sponsored a consensus workshop in Seville to address challenging issues in the medical management of acromegaly. Participants comprised 70 endocrinologists and neurosurgeons with international expertise in managing patients with acromegaly. All participants participated in the workshop proceedings, and the final document written by the scientific committee reflects the consensus opinion of the interactive deliberations. The meeting was supported by an unrestricted educational grant from Ipsen. No pharmaceutical representatives participated in the program planning or in the scientific deliberations.
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Affiliation(s)
- S Melmed
- Cedar-Sinai Research Institute, UCLA School of Medicine, Los Angeles, USA
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Jaquet P, Gunz G, Saveanu A, Dufour H, Taylor J, Dong J, Kim S, Moreau JP, Enjalbert A, Culler MD. Efficacy of chimeric molecules directed towards multiple somatostatin and dopamine receptors on inhibition of GH and prolactin secretion from GH-secreting pituitary adenomas classified as partially responsive to somatostatin analog therapy. Eur J Endocrinol 2005; 153:135-41. [PMID: 15994755 DOI: 10.1530/eje.1.01950] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [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: 11/08/2022]
Abstract
OBJECTIVE This study compared the potency of a somatostatin receptor (sstr)2-sstr5 analog, BIM-23244, of an sstr2-dopamine D2 receptor (sstr2-DAD2) molecule, BIM-23A387 and of new somatostatin-dopamine chimeric molecules with differing, enhanced affinities for sstr2, sstr5 and DAD2, BIM-23A758, BIM-23A760 and BIM-23A761, to suppress GH and prolactin (PRL) from 18 human GH adenomas that are partially responsive to octreotide or lanreotide. MATERIALS AND METHODS The sstr2, sstr5 and DAD2 mRNA levels were determined by RT-PCR. The effect of drugs was tested in cell cultures at various concentrations. RESULTS In all tumors, the sstr2, sstr5 and DAD2 mRNA levels were coexpressed (mean levels+/-s.e.m. 0.4+/-0.1, 5.3+/-1.9 and 2.0+/-0.4 copy/copy beta-glucuronidase). In 13 tumors, the maximal suppression of GH secretion produced by BIM-23A387 (30+/-3%) and BIM-23244 (28+/-3%) was greater than that produced by octreotide (23+/-3%). In six out of 13 tumors, BIM-23A758, BIM-23A760 and BIM- 23A761 produced greater maximal suppression of GH secretion than octreotide (33+/-5, 38+/-2 and 41+/-2 vs 24+/-2%). Their EC(50) values were 10, 2 and 4 pmol/l. BIM-23A761 was more effective than BIM-23A387 in GH suppression (41+/-2 vs 32+/-4%). The new chimeric molecules produced maximal PRL suppression greater than octreotide (62+/-8 to 74+/-5 vs 46+/-11%). CONCLUSIONS Novel dopamine-somatostatin chimeric molecules with differing, enhanced activity at sstr2, sstr5 and DAD2, consistently produced significatly greater suppression of GH and PRL than either octreotide or single-receptor-interacting ligands in tumors from patients classified as only partially responsive to octreotide therapy. The higher efficacy of the chimeric compounds was, at least partially, linked to their high affinity for sstr2 (IC50 1-10 pmol/l). The other mechanisms by which such molecules produce an enhanced inhibition of GH remain to be elucidated.
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Affiliation(s)
- P Jaquet
- Interactions Cellulaires Neuroendocriniennes, UMR6544, Centre National de la Recherche Scientifique, Institut Fédératif Jean Roche, Faculté de Médecine Nord, Boulevard Pierre Dramard, 13916 Marseille Cedex 20, France.
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Jaquet P, Gunz G, Saveanu A, Barlier A, Dufour H, Taylor J, Dong J, Kim S, Moreau JP, Culler MD. BIM-23A760, a chimeric molecule directed towards somatostatin and dopamine receptors, vs universal somatostatin receptors ligands in GH-secreting pituitary adenomas partial responders to octreotide. J Endocrinol Invest 2005; 28:21-7. [PMID: 16625841] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
We report the comparative efficacy of a somatostatin receptor 1 and 5 subtypes (SSTR2 and SSTR5), and dopamine D2 (DAD2) compound, BIM-23A760, in suppressing GH secretion, in cell culture from human GH-secreting tumors, from patients partially responsive to long-term treatments with octreotide or lanreotide. In 18 tumors tested, the SSTR2, SSTR5, and DAD2 mRNAs were coexpressed. The SSTR2-selective analog, BIM-23197, the SSTR5-selective analog, BIM-23268, and the dopamine (DA) analog, BIM-53097, produced a mean maximal suppression of GH secretion (24 +/- 3, 20 +/- 3, and 20 +/- 3%, respectively) that was similar to that obtained with octreotide (23 +/- 3%). Nevertheless, based on individual responses, 60% of the tumors were mostly sensitive to the SSTR2 analog while 19 and 21% of the tumors were mainly responsive to the SSTR5 analog and to the DA analog, respectively. Among a series of new chimeric compounds that bind the SSTR2, SSTR5, and DAD2 receptors with variable affinities, BIM-23A760 produced greater maximal suppression of GH secretion than octreotide (38 +/- 2 vs 24 +/- 2%; p<0.03). The EC50 for BIM-23A760 was 2 pmol/l. In the presence of sulpride, the dose response inhibition of GH secretion by the trihybrid molecule, BIM-23A760, was partially reversed. The trihybrid produced also a maximal suppression of PRL greater than octreotide (74 +/- 5 vs 46 +/- 11%). When SSTRs pan inhibitors such as BIM-23A779 (binding affinity for SSTR1, SSTR2, SSTR3, SSTR5, respectively: 2.5, 0.3, 0.6, 0.6 nmol/l) or SOM230 were tested for their suppressive effects on GH secretion, they were less potent than the previous dopastatin hybrid molecule. After a brief exposure to a SSTR2-selective analog, BIM-23197, or to a DA analog, BIM-53097, the maximal GH suppression was achieved during 12 h. Under exposure to BIM-23A760, in the same conditions, maximal suppression of GH secretion lasted for 24 h. Such a longer biological effect, yet not explained, probably participates in the higher efficacy of BIM-23A760. The higher efficacy of BIM-23A760 is, at least partially, linked to its high affinity for the SSTR2 receptor subtype (IC50: 3 pmol/l). As compared to the dopastatin compound, the lower efficacy of the universal somatostatin ligands in the inhibition of GH secretion of GH-secreting tumors argues for the use of drugs targeted, according to specific receptors expression and functionality which may vary among the various classes of tumors.
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Affiliation(s)
- P Jaquet
- Interactions Cellulaires Neuroendocriniennes, UMR6544, Centre National de la Recherche Scientifique, Institut Fédératif Jean Roche, Faculté de Médecine Nord, Marseille, France.
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Jaquet P, Saveanu A, Barlier A. New SRIF analogs in the control of human pituitary adenomas: perspectives. J Endocrinol Invest 2005; 28:14-8. [PMID: 16114269] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
SRIF receptor (sst) subtypes expressed on the different neuroendocrine tumors are the basis for treatment of such tumors with SRIF analogues. Although the drugs of reference, octreotide and lanreotide, are widely used in the treatment of acromegaly, their long-term administration allows an effective control of both GH hypersecretion and IGF-I levels in about 60% of the patients. This variable sensitivity is related to a significant loss of the sst subtype 2 (sst2) in the octreotide partial responder acromegalic patients. Such a decrease is rescued, in these tumors, by an overexpression of the sst5. Further, all GH-secreting adenomas coexpress the D2 dopamine receptor, which also mediates the inhibitory effect of dopamine agonists on GH secretion in acromegalic tumors. Such specific profiles of receptor expression in this class of neuroendocrine tumors led to the development of new ligand molecules directed towards sst2 + sst5 receptors, sst1 + sst2 + sst3 + sst5 receptors, or sst2 + dopamine D2 receptors. These bi- or multivalents ligands proved, in cell culture studies, more effective than their single components for inhibiting GH and PRL secretion. This review covers the data recently issued using such hybrid or chimeric compounds. The mechanism(s) by which such ligands may act are yet unknown. One possible explanation of their increased potency could be through their ability to induce oligodimerization of the receptors at the cell membrane level, and modify, in a ligands-specific manner, the subsequent trafficking and recycling of the receptors. New details from the literature are reviewed, supporting the importance of such ligands into the agonist-dependant control of G-protein-coupled receptors oligomerization.
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Affiliation(s)
- P Jaquet
- Université de la Méditerranée, Institut Jean Roche, Faculté de Médecine Nord, Marseille, France.
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Abstract
The first part of this contribution reviews the current knowledge about endocrine and neuromodulatory actions of somatostatin. These biological actions are exerted according to endocrine, paracrine and autocrine modes of action and involve five distinct types of membrane receptors belonging to the 'super-family' of G-protein-coupled receptors. A new concept concerning a juxtacrine mode of action has recently been introduced to refer to the intervention of cytokines and growth factors in direct, cell-to-cell communication. The evidence in favor of juxtacrine actions of somatostatin will be presented in the second part of this review and illustrated by our own results on macrophage-lymphocyte T interactions in the immune system and spermatogonia-Sertoli cell interactions in mammalian testis. Another phenomenon such as ligand-induced somatostatin receptor homo- and hetero-dimerization resulting in 'poly'-receptors (with characteristics different from those of each of the two receptors forming the complex) is also at the origin of a novel mode of somatostatin action. The latter will be illustrated by the data obtained on human pituitary adenomas with somatostatin analogs specific for either 'poly'-receptor or relevant individual receptors. The arguments in favor of the analogous mode of actions among different families of chemical messengers such as peptides, cytokines and growth factors are discussed in the concluding section. The emerging unifying concepts on such functional analogies might provide a useful basis for the development of synthetic analogs not only for bioactive peptides but also for other types of chemical messengers.
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Affiliation(s)
- S Krantic
- Interactions Cellulaires Neuroendocriniennes, Unité Mixte de Recherche (UMR 6544), Centre National de Recherche Scientifique (CNRS)/Université de la Mediterranée, 13916 Marseille, France.
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Giustina A, Casanueva FF, Cavagnini F, Chanson P, Clemmons D, Frohman LA, Gaillard R, Ho K, Jaquet P, Kleinberg DL, Lamberts SWJ, Lombardi G, Sheppard M, Strasburger CJ, Vance ML, Wass JAH, Melmed S. Diagnosis and treatment of acromegaly complications. J Endocrinol Invest 2003; 26:1242-7. [PMID: 15055479 DOI: 10.1007/bf03349164] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [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: 12/16/2022]
Abstract
The Pituitary Society in conjunction with the European Neuroendocrine Association held a consensus workshop to develop guidelines for diagnosis and treatment of the co-morbid complications of acromegaly. Fifty nine pituitary specialists (endocrinologists, neurosurgeons and cardiologists) assessed the current published literature on acromegaly complications in light of recent advances in maintaining tight therapeutic control of GH hypersecretion. The impact of elevated GH levels on cardiovascular disease, hypertension, diabetes, sleep apnea, colon polyps, bone disease, reproductive disorders, and neuropsychologic complications were considered. Guidelines are proposed for effective management of these complications in the context of overall acromegaly control. When appropriate, requirements for prospective evidence-based studies and surveillance database development are enunciated. Effective management of co-morbid acromegaly complications will lead to improved morbidity and mortality in acromegaly.
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Saveanu A, Gunz G, Dufour H, Enjalbert A, Culler MD, Jaquet P. Distribution and functionality of the somatostatin receptor subtypes in acromegaly. J Endocrinol Invest 2003; 26:4-7. [PMID: 15233203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- A Saveanu
- Interactions Cellulaires Neuroendocriniennes, UMR6544-CNRS-Université de la Méditerranée, Institut Fédératif Jean Roche, Faculté de Médecine Nord, Marseille, France
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Saveanu A, Lavaque E, Gunz G, Barlier A, Kim S, Taylor JE, Culler MD, Enjalbert A, Jaquet P. Demonstration of enhanced potency of a chimeric somatostatin-dopamine molecule, BIM-23A387, in suppressing growth hormone and prolactin secretion from human pituitary somatotroph adenoma cells. J Clin Endocrinol Metab 2002; 87:5545-52. [PMID: 12466351 DOI: 10.1210/jc.2002-020934] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [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: 02/12/2023]
Abstract
In acromegaly, the combination of somatostatin (SS) and dopamine (DA) agonists has been shown to enhance suppression of GH secretion. In the present study, a new chimeric molecule, BIM-23A387, which selectively binds to the SS subtype 2 receptor (sst(2); K(i) = 0.10 nM) and to the DA D2 receptor (D2DR; K(i) = 22.1 nM) was tested in cultures prepared from 11 human GH-secreting tumors for its ability to suppress GH and prolactin (PRL) secretion. The chimeric compound was compared with individual sst(2) and D2DR agonists of comparable activity at the individual receptors. All tumors expressed both sst(2) and D2DR mRNAs (0.8 +/- 0.2 and 4.7 +/- 0.7 copy/copy beta-glucuronidase mRNA, respectively). In cell cultures from seven octreotide-sensitive tumors, the maximal inhibition of GH release induced by the individual sst(2) and D2DR analogs and by BIM-23A387 was similar. However, the mean EC(50) for GH suppression by BIM-23A387 (0.2 pM) was 50 times lower than that of the individual sst(2) and D2DR analogs, either used individually or combined. Similar data were obtained in four tumors that were only partially responsive to octreotide. The inhibition of GH release by BIM-23A387 was only partially reversed by the D2R2 antagonist, sulpiride, or by the sst(2) antagonist, BIM-23454. Only when both antagonists were combined was the GH suppressive effect of BIM-23A387 totally reversed. Finally, BIM-23A387 produced a mean 73 +/- 6% inhibition of PRL in six mixed GH plus PRL tumors. These data demonstrate an enhanced potency of the chimeric molecule, BIM-23A387, in suppressing GH and PRL secretion from acromegalic tumors, which cannot be explained merely on the basis of binding affinity for SS and/or DA receptors.
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Affiliation(s)
- A Saveanu
- Interactions Cellulaires Neuroendocriniennes, Unité Mixte de Recherche 6544, Centre National de la Recherche Scientifique, Institut Fédératif Jean Roche, Faculté de Médecine Nord, 13916 Marseille Cedex 20, France
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Jaquet P. [New developments in somatostatin analogs and their receptors]. Ann Endocrinol (Paris) 2002; 63:2S3-4. [PMID: 12037500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Vallette-Kasic S, Barlier A, Teinturier C, Diaz A, Manavela M, Berthezène F, Bouchard P, Chaussain JL, Brauner R, Pellegrini-Bouiller I, Jaquet P, Enjalbert A, Brue T. PROP1 gene screening in patients with multiple pituitary hormone deficiency reveals two sites of hypermutability and a high incidence of corticotroph deficiency. J Clin Endocrinol Metab 2001; 86:4529-35. [PMID: 11549703 DOI: 10.1210/jcem.86.9.7811] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 02/12/2023]
Abstract
Alterations of the gene encoding the pituitary transcription factor PROP1 were associated with congenital forms of multiple pituitary hormone deficiencies in several families. Among 23 patients with multiple pituitary hormone deficiencies screened for a PROP1 gene abnormality, nine belonging to eight unrelated families had homozygous PROP1 gene defects. All mutations were located in exon 2 and affected only two different sites: a homozygous AG deletion at codons 99/100/101 (n = 5); homozygous point mutations affecting codon 73: R73C (n = 2) or R73H (n = 1), and a R73C/R99X double-heterozygous mutation (n = 1). R73H and R99X were never described. All patients were born to unaffected parents, and consanguinity was documented in two patients. They had complete GH, LH-FSH, and TSH deficiencies and normal basal levels of PRL. Delayed ACTH deficiency was diagnosed in four of nine patients. At magnetic resonance imaging the anterior pituitary was hypoplastic in seven patients and hyperplastic in two. This study found two novel mutations (R73H and R99X) and underlines the high incidence of PROP1 gene alterations in patients with multiple pituitary hormone deficiencies. A corticotroph deficiency was frequently observed in association with GH, TSH, and gonadotropin deficiencies and should be carefully sought during follow-up.
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Affiliation(s)
- S Vallette-Kasic
- Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Timone, Marseille, France 13385
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Saveanu A, Morange-Ramos I, Gunz G, Dufour H, Enjalbert A, Jaquet P. A luteinizing hormone-, alpha-subunit- and prolactin-secreting pituitary adenoma responsive to somatostatin analogs: in vivo and in vitro studies. Eur J Endocrinol 2001; 145:35-41. [PMID: 11415850 DOI: 10.1530/eje.0.1450035] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/08/2022]
Abstract
OBJECTIVE Evaluation of the efficiency of somatostatin analogues in the treatment of a mixed luteinizing hormone (LH)-, alpha-subunit-, prolactin (PRL)-secreting pituitary adenoma. DESIGN A 30-year-old woman, with amenorrhaea-galactorrhaea, presented with a pituitary macroadenoma. The endocrine evaluation showed high plasma levels of PRL, LH, and alpha-subunit inhibited by 65%, 65% and 33% respectively under octreotide test (200 microg, s.c.). Long-term treatment with slow release (SR) lanreotide (30 mg/10 days, i.m.) restored menstrual cycles and normalized PRL values. Due to persisting supranormal levels of LH and alpha-subunit, and to the absence of tumoral shrinkage, the adenoma was resected by the transsphenoidal route. METHODS In vitro characterization of the somatostatin receptor subtypes (SSTR) expression and functionality. Real-time polymerase chain reaction was performed to quantify the expression of SSTR mRNAs and functionality of the SSTRs was assessed in cell culture studies with various concentrations of native somatostatin (SRIF-14) and of analogues preferential for SSTR2 or SSTR5. RESULTS This adenoma presented with high levels of SSTR2, SSTR3 and SSTR5 mRNAs, as compared with a series of gonadotroph adenomas. In cell culture studies, PRL, LH and alpha-subunit were inhibited by 60%, 47% and 33% respectively by SRIF-14 at a concentration of 10 nmol/l. The SSTR2 (BIM-23197, lanreotide) and SSTR5 (BIM-23268) preferential analogues both produced a partial 21-38% inhibition of PRL, LH, and alpha-subunit release. DISCUSSION In this plurihormonal-secreting adenoma, the high efficacy of somatostatin analogues to inhibit PRL, LH and alpha-subunit secretion in vivo may be explained by the unusually high level of expression and by the functionality of both SSTR2 and SSTR5 receptor subtypes.
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Affiliation(s)
- A Saveanu
- Interactions Cellulaires Neuroendocriniennes, UMR6544, Centre National de la Recherche Scientifique, Institut Fédératif Jean Roche, Faculté de Médecine Nord, Boulevard Pierre Dramard, Marseille, France
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Saveanu A, Gunz G, Dufour H, Caron P, Fina F, Ouafik L, Culler MD, Moreau JP, Enjalbert A, Jaquet P. Bim-23244, a somatostatin receptor subtype 2- and 5-selective analog with enhanced efficacy in suppressing growth hormone (GH) from octreotide-resistant human GH-secreting adenomas. J Clin Endocrinol Metab 2001; 86:140-5. [PMID: 11231991 DOI: 10.1210/jcem.86.1.7099] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [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: 11/19/2022]
Abstract
Although both somatostatin receptor subtype 2 (SSTR2) and SSTR5 messenger ribonucleic acid (mRNA) are consistently expressed in GH-secreting adenomas, SSTR2 has been believed to be the key modulator of somatostatin-mediated inhibition of GH release. The somatostatin agonists currently in clinical use, octreotide and lanreotide, are directed mainly to SSTR2 (IC(50) 12- to 18-fold higher than for SSTR5). Recently, however, it was demonstrated that an SSTR5 preferential agonist, BIM-23268, not only suppressed PRL release from prolactinomas and mixed GH-PRL adenomas, but also inhibited GH release in about half of GH adenomas. In addition, the SSTR5-preferring analog showed a slight additive effect when used in combination with SSTR2 preferential drugs at submaximal concentrations in octreotide partially sensitive adenomas. In the present study we quantified SSTR2 and SSTR5 mRNA expression and the GH-suppressive effects of somatostatin-14; octreotide; a SSTR2-preferential compound, BIM-23197; a SSTR5-preferential compound, BIM-23268; and a new SSTR2- and SSTR5-bispecific compound, BIM-23244, in GH-secreting tumors classified as either full responders to octreotide (n = 5) or partially sensitive to octreotide (n = 5). The octreotide-sensitive GH secretory adenomas presented with a high level of both SSTR2 and SSTR5 mRNA expression [222 +/- 61 and 327 +/- 136 pg/pg glyceraldehyde-3-phosphate dehydrogenase (GAPDH), respectively]. In these tumors the suppression of GH release was similarly achieved at picomolar ranges by octreotide, BIM-23197, and BIM-23244 (EC(50) = 25 +/- 15, 3 +/- 2, and 3 +/- 3 pmol/L, respectively). The compounds preferential for only SSTR5 were unable to inhibit GH release in such tumors. Among the octreotide partially responsive tumors, SSTR2 mRNA expression was 9-fold lower than in the octreotide-sensitive tumors (25 +/- 12 vs. 222 +/- 61 pg/pg GAPDH; P < 0.015), whereas SSTR5 mRNA expression was approximately 7-fold higher than in the octreotide-sensitive tumors (2271 +/- 1197 pg/pg GAPDH). In these octreotide partially responsive tumors, the SSTR5-preferential compound, BIM-23268, and the SSTR2- and SSTR5-bispecific compound, BIM-23244, were quite effective in suppressing GH secretion (EC(50) = 25 +/- 13 and 50 +/- 31 pmol/L, respectively). Similarly, BIM-23244, was able to suppress by 51 +/- 5% PRL release from five mixed GH- and PRL-secreting adenomas. These data indicate that due to heterogeneous expression of SSTR2 and SSTR5 receptor subtypes, in GH-secreting tumors, a bispecific analog, such as BIM-23244, that can activate both receptors could achieve better control of GH hypersecretion in a larger number of acromegalic patients.
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Affiliation(s)
- A Saveanu
- Interactions Cellulaires Neuroendocriniennes, Unité Mixte de Recherche 6544, Centre National de la Recherche Scientifique, 13916 Marseilles, France
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Vallette-Kasic S, Dufour H, Mugnier M, Trouillas J, Valdes-Socin H, Caron P, Morange S, Girard N, Grisoli F, Jaquet P, Brue T. Markers of tumor invasion are major predictive factors for the long-term outcome of corticotroph microadenomas treated by transsphenoidal adenomectomy. Eur J Endocrinol 2000; 143:761-8. [PMID: 11124859 DOI: 10.1530/eje.0.1430761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
OBJECTIVE To assess the postsurgical outcome of patients with corticotroph microadenomas and to define predictors of the long-term outcome, with special emphasis on markers of tumor extension. DESIGN Prospective study of 53 corticotroph microadenomas treated by enlarged adenomectomy. Patients followed for at least 2 years were classified into two groups: those in long-term remission and uncured patients (immediate failures and recurrences). Pre-, per- and postoperative parameters were analyzed as predictors of the long-term outcome. METHODS Baseline hormone assessments were performed preoperatively, 8 days after surgery and every 6-12 months thereafter. Pituitary magnetic resonance imaging (MRI) allowed analysis of possible tumor extension to adjacent structures. Apparent completeness of the surgical removal was determined, and fragments labeled either 'tumor' or 'surrounding pituitary tissue' were submitted to serial sectioning. RESULTS Immediate control of hypercortisolism was achieved in 43/53 patients (81%). However, later recurrences were observed in five patients (9%). Preoperative MRI showed tumor extension into adjacent structures with good specificity (91%) for prediction of surgical failure. Evidence of local invasion at surgery was also significantly predictive of the long-term outcome. A corticotroph adenoma was found at histological examination in 96% of the patients, and 26% had irregular limits, a feature significantly correlated with a poor outcome. Immediate postoperative plasma cortisol did not allow discrimination between long-term remissions and recurrences. CONCLUSION Surgical failure was best predicted by signs of tumor 'invasiveness' at MRI, confirmed by peroperative examination and histology.
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Affiliation(s)
- S Vallette-Kasic
- Department of Endocrinology, Centre Hospitalier Universitaire (CHU) Timone, Marseille, France
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Caron P, Tabarin A, Cogne M, Chanson P, Jaquet P. Variable growth hormone profiles following withdrawal of long-term 30mg slow-release lanreotide treatment in acromegalic patients: clinical implications. Eur J Endocrinol 2000; 142:565-71. [PMID: 10822218 DOI: 10.1530/eje.0.1420565] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/08/2022]
Abstract
OBJECTIVE Intramuscular injections of 30mg slow-release (SR) lanreotide (every 10 to 14 days) are an effective treatment in acromegalic patients. Because of an ongoing need to assess the efficacy and the tolerance of a new formulation of a depot preparation of lanreotide, we have evaluated prospectively GH profiles following withdrawal of 30mg slow-release lanreotide in a cohort of acromegalic patients. PATIENTS Fifty-one acromegalic patients, controlled during long-term 30mg SR lanreotide treatment (GH: 1.44 +/- 0.64 microgram/l, IGF-I: 316 +/- 145ng/ml) (mean +/- s.d.), were studied following the withdrawal of the drug. MEASUREMENTS Mean GH (half-hour samples, 0800-1200h), IGF-I and lanreotide levels were evaluated 14, 28, and 42 days following the last 30mg SR lanreotide injection. RESULTS Mean GH levels remained below 2.5 microgram/l in 32 patients (group 1) twenty-eight days following SR lanreotide withdrawal. In these patients, mean GH and IGF-I levels had increased from 1.2 +/- 0.6 to 1.7 +/- 0.5 microgram/l (P < 0001), and from 283 +/- 138 to 359 +/- 168ng/ml (P < 0.001) respectively. In the 19 other patients (group 2), mean GH concentrations had risen above 2.5 microgram/l at 28 days following SR lanreotide withdrawal. Mean GH and IGF-I levels had increased from 1.9 +/- 0.4 to 5.1 +/- 2.8 microgram/l (P < 0.001), and from 371 +/- 143 to 568 +/- 206ng/ml (P < 0.001) respectively. Patients of groups 1 and 2 were comparable with regard to age, sex, tumoral status, mean GH levels before somatostatin analogue treatment, and previous treatments such as radiotherapy and duration of somatostatin analogue therapy, but 75% of group 1 patients underwent surgery compared with 37% of group 2 patients (P < 0.01). Twenty-eight days following SR lanreotide withdrawal, mean lanreotide levels in group 1 and group 2 had decreased from 1.6 +/- 0.7 to 0.6 +/- 0.3ng/ml (P < 0.001), and from 2.7 +/- 2.0 to 0.7 +/- 0.7ng/ml (P < 0.001) respectively. A negative correlation was observed between the lanreotide levels and GH and IGF-I concentrations in the two groups of patients, but the inhibition of GH/IGF-I concentrations by lanreotide levels was higher in group 1 patients than in those of group 2. Six patients of group 1 were treated with 30mg SR lanreotide injected at monthly intervals. During monthly follow-up, mean GH levels increased above 2.5 microgram/l in 2 patients. After 12 months follow-up, mean GH and IGF-I levels from 4 other patients were similar to those obtained with previous therapeutic sequence (i.e. intramuscular injections every 14 days). CONCLUSION The degree of responsiveness to lanreotide and the duration of somatotroph suppression following lanreotide withdrawal are variable in acromegalic patients controlled during long-term 30mg SR lanreotide treatment. In patients displaying high sensitivity to lanreotide, the interval between i.m. 30mg SR lanreotide injections can be increased to one month, thus reducing the cost of the therapy, without altering its efficacy upon GH/IGF-I control.
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Affiliation(s)
- P Caron
- Department of Endocrinology, CHU Rangueil, Toulouse, France.
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Jaquet P, Saveanu A, Gunz G, Fina F, Zamora AJ, Grino M, Culler MD, Moreau JP, Enjalbert A, Ouafik LH. Human somatostatin receptor subtypes in acromegaly: distinct patterns of messenger ribonucleic acid expression and hormone suppression identify different tumoral phenotypes. J Clin Endocrinol Metab 2000; 85:781-92. [PMID: 10690891 DOI: 10.1210/jcem.85.2.6338] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/19/2022]
Abstract
Recently, studies using somatostatin (SRIF) analogs preferential for either the SRIF receptor 2 (SSTR2) or the SSTR5 subtype demonstrated a variable suppression of GH and PRL release from GH-secreting human adenomas. These data suggested the concept of SSTR subtype specificity in such tumors. In the present study the quantitative expression of messenger ribonucleic acid (mRNA) for the 5 SSTR subtypes and the inhibitory effects of SRIF14; SRIF28; octreotide; the SSTR2-preferential analog, BIM-23197; and the SSTR5-preferential analog, BIM-23268, on GH and PRL secretion were analyzed in cells cultured from 15 acromegalic tumors. RT-PCR analysis revealed a consistent pattern of SSTR2 and SSTR5 mRNA expression. SSTR5 mRNA was expressed at a higher level (1052 +/- 405 pg/pg glyceraldehyde-3-phosphate dehydrogenase) than SSTR2 mRNA (100 +/- 30 pg/pg glyceraldehyde-3-phosphate dehydrogenase). However, only SSTR2 mRNA expression correlated with the degree of GH inhibition induced by SRIF14, SRIF28, and BIM-23197. The SSTR5-preferential compound inhibited GH release in only 7 of 15 cases. In cells cultured from the 10 mixed adenomas that secreted both GH and PRL, RT-PCR analysis revealed a consistent coexpression of SSTR5, SSTR2, and SSTR1 mRNA. In all cases SRIF14, SRIF28, and the SSTR5-preferential analog, BIM-23268, significantly suppressed PRL secretion, with a mean maximal inhibition of 48 +/- 4%. In contrast, the SSTR2-preferential analogs, BIM-23197 and octreotide, were effective in suppressing PRL in only 6 of 10 cases. In cells cultured from adenomas taken from patients partially responsive to the SRIF analog, octreotide, partial additivity in suppressing both GH and PRL secretion was observed when the SSTR2- and SSTR5-preferring analogs, BIM-23197 and BIM-23268, were tested in combination. Our data show a highly variable ratio of the SSTR2 and SSTR5 transcripts, according to tumors. The SSTR2-preferring compound consistently inhibits GH release, whereas the SSTR5-preferring compound is the main inhibitor of PRL secretion. When both drugs are combined, the partial additivity observed in mixed GH- plus PRL-secreting adenomas may be of interest in the therapeutic approach of such tumors.
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Affiliation(s)
- P Jaquet
- Interactions Cellulaires Neuroendocrines, UMR 6544, Centre National de la Recherche Scientifique, Institut Fédératif Jean Roche, Faculté de Médecine Nord, Marseille, France.
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