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Maisons V, Duval A, Mesnard L, Frimat M, Fakhouri F, Grangé S, Servais A, Cartery C, Fauchier L, Coppo P, Titeca-Beauport D, Fage N, Delmas Y, Quérard AH, Seret G, Bobot M, Le Quintrec M, Ville S, von Tokarski F, Chauvet S, Wynckel A, Martins M, Schurder J, Barbet C, Sautenet B, Gatault P, Caillard S, Vuiblet V, Halimi JM. Assessment of epidemiology and outcomes of adult patients with kidney-limited thrombotic microangiopathies. Kidney Int 2024; 105:1100-1112. [PMID: 38431217 DOI: 10.1016/j.kint.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Thrombotic microangiopathies (TMA) are usually associated with hematological features (RH-TMA). The epidemiology of TMA limited to kidneys (RL-TMA) is unclear Therefore, patients with TMA and native kidney biopsies were identified during 2009-2022 in 20 French hospitals and results evaluated. RL-TMA was present in 341/757 (45%) patients and associated with lower creatinine levels (median 184 vs 346 μmol/L) than RH-TMA. RL-TMA resulted from virtually all identified causes, more frequently from anti-VEGF treatment and hematological malignancies but less frequently from shigatoxin-associated hemolytic uremic syndrome (HUS), systemic sclerosis, gemcitabine and bacterial infection, and even less frequently when three or more causes/triggers were combined (RL-TMA: 5%; RH-TMA: 12%). RL-TMA was associated with significantly lower major cardiovascular events (10% vs 20%), kidney replacement therapy (23% vs 43%) and death (12% vs 20%) than RH-TMA during follow-up (median 28 months). Atypical HUS (aHUS) was found in 326 patients (RL-TMA: 43%, RH-TMA: 44%). Among the 69 patients with proven complement-mediated aHUS, eculizumab (anti-C5 therapy) was used in 43 (62%) (RL-TMA: 35%; RH-TMA: 71%). Among the 257 other patients with aHUS, including 51% with RL-TMA, eculizumab was used in 29 but with unclear effects of this treatment. Thus, RL-TMA represents a very high proportion of patients with TMA and results from virtually all known causes of TMA and includes 25% of patients with complement-mediated aHUS. Adverse outcomes of RL-TMA are lower compared to RH-TMA but remain significant. Anti-C5 therapy was rarely used in RL-TMA, even in proven complement-mediated aHUS, and its effects remain to be assessed.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie, CHU de Tours, Tours, France; U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France
| | - Anna Duval
- Service de Néphrologie, CHU de Strasbourg, Strasbourg, France
| | | | - Marie Frimat
- Service de Néphrologie, CHU de Lille, Lille, France
| | - Fadi Fakhouri
- Service de Néphrologie, CHU Vaudois, Lausanne, Switzerland
| | | | - Aude Servais
- Service de Néphrologie, APHP Hopital Necker, Paris, France
| | - Claire Cartery
- Service de Néphrologie, CH de Valenciennes, Valenciennes, France
| | | | - Paul Coppo
- Service d'Hématologie, Centre de référence pour les microangiopathies thrombotiques (CNR-MAT), APHP Hopital Saint-Antoine, Paris, France
| | | | - Nicolas Fage
- Service de Néphrologie, Département de médecine intensive reanimation-médecine hyperbare, CHU d'Angers, Angers, France
| | - Yahsou Delmas
- Service de Néphrologie, CHU de Bordeaux, Bordeaux, France
| | | | - Guillaume Seret
- Service de Néphrologie, Pole Santé Sud Echo Le Mans, Le Mans, France
| | - Mickaël Bobot
- Service de Néphrologie, CHU de Marseille; Aix, Marseille Université, INSERM 1263, INRAE 1260, C2VN, CERIMED, Marseille, France
| | | | - Simon Ville
- Service de Néphrologie, CHU de Nantes, Nantes, France
| | | | - Sophie Chauvet
- Service de Néphrologie, APHP Hopital Européen Georges Pompidou, Paris, France
| | | | - Manon Martins
- Service de Néphrologie, CHU de Rennes, Rennes, France
| | - Juliet Schurder
- Service de Néphrologie, CH de Saint-Malo, Saint-Malo, France
| | | | | | - Philippe Gatault
- Service de Néphrologie, CHU de Tours, U1327, INSERM, ISCHEMIA, Université de Tours, Tours, France
| | - Sophie Caillard
- U1246, INSERM, SPHERE, Université de Tours, Université de Nantes, Tours, Nantes, France
| | - Vincent Vuiblet
- Service de Pathologie, Institut d'Intelligence Artificielle en Santé, CHU de Reims et Université de Reims Champagne Ardenne, Reims, France
| | - Jean-Michel Halimi
- Service de Néphrologie, CHU de Tours, U1327, INSERM, ISCHEMIA, Université de Tours, Tours, France.
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Joseph A, Harel S, Mesnard L, Rafat C, Knapp S, Rumpler A, Philipponnet C, Barba C, Rebibou JM, Buob D, Hertig A, Vargaftig J, Halimi JM, Arnulf B, Bretaud AS, Joly B, Grangé S, Coppo P. Carfilzomib-associated thrombotic microangiopathy: clinical features and outcomes. Nephrol Dial Transplant 2024:gfae096. [PMID: 38658194 DOI: 10.1093/ndt/gfae096] [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] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS Carfilzomib, a new proteasome inhibitor indicated for patients with relapsed/refractory myeloma, has been associated with cases of thrombotic microangiopathy (CFZ-TMA). The role of variants in the complement alternative pathway and therapeutic potential of complement blockade with eculizumab remain to be determined. METHODS We report 37 cases of CFZ-TMA recorded in the French reference center for TMA with their clinical characteristics, genetic analysis and outcome according to treatments. RESULTS A trigger was identified in more than half of cases, including 8 influenza and 5 SARS-CoV-2 cases. All patients presented with acute kidney injury (AKI) (KDIGO stage 3 in 31 (84%) patients) while neurological (n=13, 36%) and cardiac damage (n=7, 19%) were less frequent. ADAMTS13 and complement activity were normal (n= 28 and 18 patients tested) and no pathogenic variant in the alternative complement pathway was found in 7 patients tested.TMA resolved in most (n=34, 94%) patients but 12 (44%) still displayed stage 3 AKI at discharge. Nineteen (51%) patients were treated with therapeutic plasma exchange, 14 (38%) patients received corticosteroids and 18 (50%) were treated with eculizumab. However none of these treatments demonstrated a significant impact on outcomes. CONCLUSION This study is the largest case series of CFZ-TMA since its approval in 2012. Patients present with severe AKI and experience frequent sequelae. Complement variants and blockade therapy do not seem to play a role in the pathophysiology and prognosis of the disease.
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Affiliation(s)
- Adrien Joseph
- Service de Médecine intensive réanimation, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Stéphanie Harel
- Service d'immuno-hématologie, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Laurent Mesnard
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
- UMR_S1155, INSERM, Sorbonne Université, Paris, France
| | - Cédric Rafat
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Soins Intensifs Néphrologiques et Rein Aigu, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Silène Knapp
- Service d'immuno-hématologie, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne Rumpler
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'hématologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Carole Philipponnet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie, dialyse et transplantation, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Christophe Barba
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie et Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Jean-Michel Rebibou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
| | - David Buob
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'anatomo-pathologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Alexandre Hertig
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de néphrologie, Hôpital Foch, Suresnes, France
| | - Jacques Vargaftig
- Service d'hématologie, Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
| | - Jean-Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie-hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau ; Hôpital Clocheville, Centre Hospitalier Universitaire de Tours, Tours, France et EA4245 T2i, Hôpital Trousseau, CHRU de Tours, Université de Tours, Tours, France
| | - Bertrand Arnulf
- Service d'immuno-hématologie, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Anne-Sophie Bretaud
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Bérangère Joly
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'Hématologie Biologique, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service de Néphrologie, dialyse et transplantation, Centre Hospitalier Universitaire de Rouen, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), Assistance Publique des Hôpitaux de Paris, Paris, France
- Service d'Hématologie, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
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Girault C, Bubenheim M, Boyer D, Declercq PL, Schnell G, Gouin P, Michot JB, Carpentier D, Grangé S, Béduneau G, Tamion F. ROX index performance to predict high-flow nasal oxygen outcome in Covid-19 related hypoxemic acute respiratory failure. Ann Intensive Care 2024; 14:13. [PMID: 38236356 PMCID: PMC10796865 DOI: 10.1186/s13613-023-01226-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Given the pathophysiology of hypoxemia in patients with Covid-19 acute respiratory failure (ARF), it seemed necessary to evaluate whether ROX index (ratio SpO2/FiO2 to respiratory rate) could accurately predict intubation or death in these patients initially treated by high-flow nasal oxygenation (HFNO). We aimed, therefore, to assess the accuracy of ROX index to discriminate between HFNO failure (sensitivity) and HFNO success (specificity). METHODS We designed a multicentre retrospective cohort study including consecutive patients with Covid-19 ARF. In addition to its accuracy, we assessed the usefulness of ROX index to predict HFNO failure (intubation or death) via logistic regression. RESULTS Among 218 ARF patients screened, 99 were first treated with HFNO, including 49 HFNO failures (46 intubations, 3 deaths before intubation). At HFNO initiation (H0), ROX index sensitivity was 63% (95%CI 48-77%) and specificity 76% (95%CI 62-87%) using Youden's index. With 4.88 as ROX index cut-off at H12, sensitivity was 29% (95%CI 14-48%) and specificity 90% (95%CI 78-97%). Youden's index yielded 8.73 as ROX index cut-off at H12, with 87% sensitivity (95%CI 70-96%) and 45% specificity (95%CI 31-60%). ROX index at H0 was associated with HFNO failure (p = 0.0005) in univariate analysis. Multivariate analysis showed that SAPS II (p = 0.0003) and radiographic extension of pulmonary injuries (p = 0.0263), rather than ROX index, were predictive of HFNO failure. CONCLUSIONS ROX index cut-off values seem population-specific and the ROX index appears to have a technically acceptable but clinically low capability to discriminate between HFNO failures and successes in Covid-19 ARF patients. In addition, SAPS II and pulmonary injuries at ICU admission appear more useful than ROX index to predict the risk of intubation.
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Affiliation(s)
- Christophe Girault
- Medical Intensive Care Unit, CHU Rouen, Normandie University, UNIROUEN, UR 3830, 76000, Rouen, France.
- Service de Médecine Intensive Et Réanimation, Hôpital Charles Nicolle, Centre Hospitalier Universitaire-Hôpitaux de Rouen, 37, Boulevard Gambetta, 76000, Cedex, France.
| | - Michael Bubenheim
- Department of Clinical Research and Innovation, CHU Rouen, 76000, Rouen, France
| | - Déborah Boyer
- Medical Intensive Care Unit, CHU Rouen, 76000, Rouen, France
| | | | - Guillaume Schnell
- Medical and Surgical Intensive Care Unit, Le Havre Hospital, 76600, Le Havre, France
| | - Philippe Gouin
- Department of Anesthesiology and Critical Care, CHU Rouen, 76000, Rouen, France
| | - Jean-Baptiste Michot
- Medical and Surgical Intensive Care Unit, Elbeuf Hospital, 76500, Elbeuf, France
| | | | - Steven Grangé
- Medical Intensive Care Unit, CHU Rouen, 76000, Rouen, France
| | - Gaëtan Béduneau
- Medical Intensive Care Unit, CHU Rouen, Normandie University, UNIROUEN, UR 3830, 76000, Rouen, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, CHU Rouen, Normandie University, UNIROUEN, Inserm, U1096, F-76000, Rouen, France
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4
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Zafrani L, Canet E, Walter-Petrich A, Joly-Laffargue B, Veyradier A, Faguer S, Bigé N, Calvet L, Mayaux J, Grangé S, Rafat C, Poulain C, Klouche K, Perez P, Pène F, Pichereau C, Duceau B, Mariotte E, Chevret S, Azoulay E. Magnesium sulphate in patients with thrombotic thrombocytopenic purpura (MAGMAT): a randomised, double-blind, superiority trial. Intensive Care Med 2023; 49:1293-1304. [PMID: 37867165 DOI: 10.1007/s00134-023-07178-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate supplementation on TTP recovery. METHODS In this multicenter, randomised, double-blind, controlled, superiority study, we enrolled adults with a clinical diagnosis of TTP. Patients were randomly allocated to receive magnesium sulphate (6 g intravenously followed by a continuous infusion of 6 g/24 h for 3 days) or placebo, in addition to the standard treatment. The primary outcome was the median time to platelet normalisation (defined as a platelet count ≥ 150 G/L). Efficacy and safety were assessed by intention-to-treat. RESULTS Overall, we enrolled 74 participants, including one who withdrew his/her consent. Seventy-three patients were further analyzed, 35 (48%) allocated to magnesium sulphate and 38 (52%) to placebo. The median time to platelet normalisation was 4 days (95% confidence interval [CI], 3-4) in the magnesium sulphate group and 4 days (95% CI 3-5) in the placebo group. The cause-specific hazard ratio of response was 0.93 (95% CI 0.58-1.48, p = 0.75). The number of patients with ≥ 1 serious adverse reactions was similar in the two groups. By day 90, four patients in the magnesium sulphate group and two patients in the placebo group had died (p = 0.42). The most frequent adverse event was low blood pressure occurring in 34% in the magnesium sulphate group and 29% in the placebo group (p = 0.80). CONCLUSION Among patients with TTP, the addition of magnesium sulphate to the standard of care did not result in a significant improvement in time to platelet normalisation.
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Affiliation(s)
- Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France.
- INSERM U944, Saint-Louis Research Institute, University of Paris Cité, Paris, France.
| | - Emmanuel Canet
- Department of Medical Intensive Care Unit, Nantes University Hospital, Nantes University, Nantes, France
| | - Anouk Walter-Petrich
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, INSERM S 717, Paris, France
| | - Bérangère Joly-Laffargue
- Service d'Hématologie Biologique, Lariboisière Hospital and EA3518, Institut de Recherche Saint-Louis, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie Biologique, Lariboisière Hospital and EA3518, Institut de Recherche Saint-Louis, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, National Reference Center for Rare Kidney Diseases, University Hospital of Toulouse, INSERM UMR 1297 (I2MC), Toulouse, France
| | - Naïke Bigé
- Department of Medical Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Laure Calvet
- Department of Medical Intensive Care Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Mayaux
- Department of Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Steven Grangé
- Department of Nephrology, Rouen University Hospital, Rouen, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Coralie Poulain
- Department of Nephrology Internal Medicine Dialysis Transplantation, Amiens University Medical Center, F-80054, Amiens, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie University Hospital, Montpellier, France
| | - Pierre Perez
- Medical Intensive Care Unit, Brabois Hospital, Vandoeuvre Les Nancy, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, University of Paris Cité, Cochin Institute, INSERM U1016, CNRS UMR8104, Paris, France
| | - Claire Pichereau
- Department of Intensive Care Unit, Poissy Saint Germain en Laye Hospital, Poissy, France
| | - Baptiste Duceau
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Eric Mariotte
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, INSERM S 717, Paris, France
| | - Elie Azoulay
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
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Largeau B, Thoreau B, Grangé S, Jonville-Béra AP, Halimi JM. Thrombotic microangiopathy associated with anticancer and immune system targeting drugs: New insights from real-world data using the WHO pharmacovigilance database. J Intern Med 2023; 294:665-678. [PMID: 37538031 DOI: 10.1111/joim.13703] [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: 08/05/2023]
Abstract
BACKGROUND The worldwide development of immune system targeting/anticancer drugs has revolutionized immuno-oncology, but their implication in thrombotic microangiopathy syndromes (TMA) is increasingly suspected. Using real-world data, the aim of this study was to identify drugs associated with TMA reporting and to describe the evolution of TMA reporting over time with a focus on these drugs. METHODS A global disproportionality study was performed using the individual case safety reports (ICSRs) extracted from the World Health Organization (WHO) pharmacovigilance database (VigiBase) from its inception (1968) to April 30, 2022. RESULTS Of the 31,251,040 ICSRs, 6946 cases of suspected drug-induced TMA were included from 55 countries. The outcome was fatal in 18.2% of cases. A total of 72 immune system targeting/anticancer drugs were associated with significant overreporting, including 17 drugs with a potential new safety concern for TMA. Although the rate of TMA reporting per million of ICSRs has remained fairly stable, an absolute increase in reported cases of suspected drug-induced TMA has been observed over the last decade. The pattern of drugs reported in TMA has evolved with a substantial increase in the proportion of cases involving immune system-targeting drugs/anticancer drugs from 47.3% (205/433) in the period 1992-2001 to 80.7% (3819/4730) in the period 2012-2021. CONCLUSION Several recently marketed immune system targeting/anticancer drugs have been identified as potential new drugs associated with TMA, which will require confirmatory studies. The number of drugs associated with TMA reporting markedly increased within the past 10 years, primarily due to innovative anticancer drugs.
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Affiliation(s)
- Bérenger Largeau
- Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Benjamin Thoreau
- Service de Médecine Interne-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Steven Grangé
- Centre National de Référence pour les microangiopathies thrombotiques, Hôpital Saint-Antoine, Université de la Sorbonne, AP-HP, Paris, France
- Service de Néphrologie, Hôpital Bois-Guillaume, CHU Rouen, Rouen, France
| | - Annie-Pierre Jonville-Béra
- Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Jean-Michel Halimi
- Centre National de Référence pour les microangiopathies thrombotiques, Hôpital Saint-Antoine, Université de la Sorbonne, AP-HP, Paris, France
- Service de Néphrologie, Hôpital Bretonneau, CHU Tours, Tours, France
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6
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Neuman L, Joseph A, Bouzid R, Lescroart M, Mariotte E, Ederhy S, Tuffet S, Baudel JL, Benhamou Y, Galicier L, Grangé S, Provôt F, Neel A, Pène F, Delmas Y, Presne C, Poullin P, Wynckel A, Perez P, Barbet C, Halimi JM, Chatelet V, Rebibou JM, Ojeda-Uribe M, Vigneau C, Mesnard L, Veyradier A, Azoulay E, Coppo P, Chabriat H. Predictors of acute ischemic cerebral lesions in immune-mediated thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. J Neurol 2023; 270:5023-5033. [PMID: 37392208 DOI: 10.1007/s00415-023-11830-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND The immune form of thrombotic thrombocytopenic purpura (iTTP) and the hemolytic and uremic syndrome (HUS) are two major forms of thrombotic microangiopathy (TMA). Their treatment has been recently greatly improved. In this new era, both the prevalence and predictors of cerebral lesions occurring during the acute phase of these severe conditions remain poorly known. AIM The prevalence and predictors of cerebral lesions appearing during the acute phase of iTTP and Shiga toxin-producing Escherichia coli-HUS or atypical HUS were evaluated in a prospective multicenter study. METHODS Univariate analysis was performed to report the main differences between patients with iTTP and those with HUS or between patients with acute cerebral lesions and the others. Multivariable logistic regression analysis was used to identify the potential predictors of these lesions. RESULTS Among 73 TMA cases (mean age 46.9 ± 16 years (range 21-87 years) with iTTP (n = 57) or HUS (n = 16), one-third presented with acute ischemic cerebral lesions on magnetic resonance imagery (MRI); two individuals also had hemorrhagic lesions. One in ten patients had acute ischemic lesions without any neurological symptom. The neurological manifestations did not differ between iTTP and HUS. In multivariable analysis, three factors predicted the occurrence of acute ischemic lesions on cerebral MRI: (1) the presence of old infarcts on cerebral MRI, (2) the level of blood pulse pressure, (3) the diagnosis of iTTP. CONCLUSION At the acute phase of iTTP or HUS, both symptomatic and covert ischemic lesions are detected in one third of cases on MRI. Diagnosis of iTTP and the presence of old infarcts on MRI are associated with the occurrence of such acute lesions as well as increased blood pulse pressure, that may represent a potential target to further improve the therapeutic management of these conditions.
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Affiliation(s)
- Lisa Neuman
- Centre NeuroVasculaire Translationnel, Centre de Référence CERVCO, Département de Neurologie, Hôpital Lariboisière, GHU AP-HP Nord, Université de Paris, Paris, France
| | - Adrien Joseph
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Raïda Bouzid
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
| | - Mickael Lescroart
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Eric Mariotte
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Stéphane Ederhy
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Department of Cardiology, Saint-Antoine Hospital, GRC N° 27, Sorbonne Université, AP-HP, 75012, Paris, France
| | - Sophie Tuffet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Department of Clinical Pharmacology, Clinical Research Platform of East of Paris (Unité de Recherche Clinique (URCEST), Centre de Recherche Clinique (CRCEST), Centre de Ressources Biologiques (CRB.APHP-SU), Hôpital Saint Antoine, AP-HP, Paris, France
| | - Jean-Luc Baudel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, 184 Rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Département de Médecine Interne, Hôpital Universitaire de Rouen, Université de Normandie, Rouen, France
- Service de Réanimation Médicale, CHU Charles Nicolle, Rouen, France
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'Immunologie Clinique, CHU Saint-Louis, Université de Paris, Paris, France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Médicale, CHU Charles Nicolle, Rouen, France
| | - François Provôt
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Albert-Calmette, Lille, France
| | - Antoine Neel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Médicale, CHU Hôtel-Dieu, Nantes, France
| | - Frédéric Pène
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de médecine intensive-réanimationHôpital Cochin, APHP Centre &, Université de Paris, Paris, France
| | - Yahsou Delmas
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, CHU de Bordeaux, Bordeaux, France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Nord, Amiens, France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'hémaphérèse et d'autotransfusion, Hôpital la Conception, Marseille, France
| | - Alain Wynckel
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, Hôpital Maison Blanche, Reims, France
| | - Pierre Perez
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Réanimation Polyvalente, CHU de Nancy, Nancy, France
| | - Christelle Barbet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpitaux Bretonneau et Clocheville, Tours, France
| | - Jean-Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpitaux Bretonneau et Clocheville, Tours, France
| | - Valérie Chatelet
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Université, Caen, France
| | - Jean-Michel Rebibou
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service de Néphrologie, CHU de Dijon, Dijon, France
| | - Mario Ojeda-Uribe
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Service d'Hématologie et de Thérapie Cellulaire, Groupe Hospitalier Region Mulhouse-Sud-Alsace (GHRMSA), Mulhouse, France
| | - Cécile Vigneau
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Inserm, EHESP, Irset (Institut de Recherche en SantéEnvironnement et Travail)-UMR_S 1085, Université de Rennes, CHU Rennes, 35000, Rennes, France
| | - Laurent Mesnard
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Biochimie, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France
- Médecine Intensive Réanimation, Hôpital Saint Louis, AP-HP, Paris, France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP, Paris, France.
- Service d'Hématologie, Centre National de Référence des Microangiopathies Thrombotiques, AP-HP.6 and Sorbonne-Université, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138, Paris, France.
| | - Hugues Chabriat
- Centre NeuroVasculaire Translationnel, Centre de Référence CERVCO, Département de Neurologie, Hôpital Lariboisière, GHU AP-HP Nord, Université de Paris, Paris, France
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7
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Gaillet A, Bay P, Péju E, Ait-Oufella H, Azoulay E, Benchabane N, Cerf C, Cohen Y, de Prost N, Faguer S, Geri G, Grangé S, Kahn JE, Kreitmann L, Larcher R, Lefèvre G, Mabrouki A, Mekonsto-Dessap A, Panel K, Pène F, Pineton de Chambrun M, Quenot JP, Tandjaoui-Lambiotte Y, Timsit JF, Vieillard-Baron A, Dargent A, Herault A, Groh M. Correction: Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit. Intensive Care Med 2023; 49:611. [PMID: 37042964 DOI: 10.1007/s00134-023-07059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Antoine Gaillet
- Department of Internal Medicine, Foch Hospital, Suresnes, France.
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France.
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France.
| | - Pierre Bay
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Edwige Péju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Nacime Benchabane
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Charles Cerf
- Medical Intensive Care Unit, Foch Hospital, Suresnes, France
| | - Yves Cohen
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
| | - Nicolas de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre de Référence Des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Louis Kreitmann
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Asma Mabrouki
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Armand Mekonsto-Dessap
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Kewin Panel
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Pineton de Chambrun
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Yacine Tandjaoui-Lambiotte
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
- INSERM U1272 Hypoxia and Lung, Bobigny, France
| | - Jean-Francois Timsit
- Medical Intensive Care Unit, Université Paris Diderot/Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Auguste Dargent
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Antoine Herault
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- CHU Lille, Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Lille, France
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8
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Gaillet A, Bay P, Péju E, Ait-Oufella H, Azoulay E, Benchabane N, Cerf C, Cohen Y, de Prost N, Faguer S, Geri G, Grangé S, Kahn JE, Kreitmann L, Larcher R, Lefèvre G, Mabrouki A, Mekonsto-Dessap A, Panel K, Pène F, Pineton de Chambrun M, Quenot JP, Tandjaoui-Lambiotte Y, Timsit JF, Vieillard-Baron A, Dargent A, Herault A, Groh M. Epidemiology, clinical presentation, and outcomes of 620 patients with eosinophilia in the intensive care unit. Intensive Care Med 2023; 49:291-301. [PMID: 36723637 DOI: 10.1007/s00134-022-06967-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Although eosinophil-induced manifestations can be life-threatening, studies focusing on the epidemiology and clinical manifestations of eosinophilia in the intensive care unit (ICU) are lacking. METHODS A retrospective, national, multicenter (14 centers) cohort study over 6 years of adult patients who presented with eosinophilia ≥ 1 × 109/L on two blood samples performed from the day before admission to the last day of an ICU stay. RESULTS 620 patients (0.9% of all ICU hospitalizations) were included: 40% with early eosinophilia (within the first 24 h of ICU admission, ICU-Eo1 group) and 56% with delayed (> 24 h after ICU admission, ICU-Eo2 group) eosinophilia. In ICU-Eo1, eosinophilia was mostly due to respiratory (14.9%) and hematological (25.8%) conditions, frequently symptomatic (58.1%, mainly respiratory and cardiovascular manifestations) requiring systemic corticosteroids in 32.2% of cases. In ICU-Eo2, eosinophil-related organ involvement was rare (25%), and eosinophilia was mostly drug-induced (46.8%). Survival rates at day 60 (D60) after ICU admission were 21.4% and 17.2% (p = 0.219) in ICU-Eo1 and ICU-Eo2 patients, respectively. For ICU-Eo1 patients, in multivariate analysis, risk factors for death at D60 were current immunosuppressant therapy at ICU admission, eosinophilia of onco-hematological origin and the use of vasopressors at ICU admission, whereas older age and the use of vasopressors or mechanical ventilation at the onset of eosinophilia were associated with a poorer prognosis for ICU-Eo2 patients. CONCLUSION Eosinophilia ≥ 1 × 109/L is not uncommon in the ICU. According to the timing of eosinophilia, two subsets of patients requiring different etiological workups and management can be distinguished.
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Affiliation(s)
- Antoine Gaillet
- Department of Internal Medicine, Foch Hospital, Suresnes, France.
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France.
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France.
| | - Pierre Bay
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Edwige Péju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Nacime Benchabane
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Charles Cerf
- Medical Intensive Care Unit, Foch Hospital, Suresnes, France
| | - Yves Cohen
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
| | - Nicolas de Prost
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre de Référence Des Maladies Rénales Rares, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Louis Kreitmann
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Asma Mabrouki
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Armand Mekonsto-Dessap
- Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 Rue Gustave Eiffel, 94010, Créteil Cedex, France
| | - Kewin Panel
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Marc Pineton de Chambrun
- Medical Intensive Care Unit, Cardiological Institute, APHP Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Yacine Tandjaoui-Lambiotte
- Medical Intensive Care Unit, CHU Avicenne, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 93000, Bobigny, France
- INSERM U1272 Hypoxia and Lung, Bobigny, France
| | - Jean-Francois Timsit
- Medical Intensive Care Unit, Université Paris Diderot/Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Auguste Dargent
- Medical Intensive Care Unit, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Antoine Herault
- Medical Intensive Care Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76031, Rouen Cedex, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, Suresnes, France
- National Reference Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, 40, Rue Worth, 92151, Suresnes Cedex, France
- CHU Lille, Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, University of Lille, Lille, France
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9
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Popoff B, Occhiali É, Grangé S, Bergis A, Carpentier D, Tamion F, Veber B, Clavier T. Trends in major intensive care medicine journals: A machine learning approach. J Crit Care 2022; 72:154163. [PMID: 36209696 DOI: 10.1016/j.jcrc.2022.154163] [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: 07/04/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Intensive care medicine (ICM) has the particularity of being a multidisciplinary specialty and its literature reflects this multidisciplinarity. However, the proportion of each field in this literature and its trend dynamics are not known. The objective of this study was to analyze the ICM literature, extract latent topics and search for the presence of research trends. MATERIAL AND METHODS Abstracts of original articles from the top ICM journals, from their inception until December 31st, 2019, were included. This corpus was fed into a structural topic modeling algorithm to extract latent semantic topics. The temporal distribution was then analyzed and the presence of trends was searched by Mann-Kendall trends tests. RESULTS Finally, 49,276 articles from 10 journals were included. After topic modeling analysis and experts' feedback, 124 research topics were selected and labeled. Topics were categorized into 19 categories, the most represented being respiratory, fundamental and neurological research. Increasing trends were observed for research on mechanical ventilation and decreasing trends for cardiopulmonary resuscitation. CONCLUSIONS This study reviewed all articles from major ICM journals in a comprehensive way. It provides a better understanding of ICM research landscape by analyzing the temporal evolution of latent research topics in the ICM literature.
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Affiliation(s)
- Benjamin Popoff
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
| | - Émilie Occhiali
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Alexandre Bergis
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
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10
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Azoulay LD, Pineton de Chambrun M, Larcher R, Pène F, Argaud L, Mayaux J, Jamme M, Coudroy R, Mathian A, Gibelin A, Azoulay E, Tandjaoui-Lambiotte Y, Dargent A, Beloncle F, Raphalen JH, Troger A, de Prost N, Devaquet J, Contou D, Gaugain S, Trouiller P, Grangé S, Ledochowski S, Lemarie J, Faguer S, Degos V, Moyon Q, Luyt CE, Kerneis M, Combes A, Amoura Z. Prevalence, characteristics and outcome of cardiac manifestations in critically-ill antiphospholipid syndrome patients. J Autoimmun 2022; 133:102908. [PMID: 36126365 DOI: 10.1016/j.jaut.2022.102908] [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: 07/18/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 12/13/2022]
Abstract
AIMS Antiphospholipid syndrome (APS) is a rare autoimmune disease defined by thrombotic events occurring in patients with persistent antiphospholipid antibodies. Cardiac manifestations in critically-ill APS patients are poorly investigated. We conducted a study to assess the prevalence, the characteristics and the prognosis of cardiac manifestations in thrombotic APS patients admitted to intensive care unit (ICU). METHODS AND RESULTS A French, national, multicentre, retrospective study, conducted, from January 2000 to September 2018, including all APS patients admitted to 24 participating centres' ICUs with any new thrombotic (arterial, venous or microvascular) manifestation. Cardiac manifestations were defined as any new cardiac abnormalities relying on clinical examination, cardiac biomarkers, echocardiography, cardiac magnetic resonance (CMR) and coronarography. One hundred and thirty-six patients (female 72%) were included. Mean age at ICU admission was 46 ± 15years. Cardiac manifestations were present in 71 patients (53%). In patients with cardiac involvement, median left ventricular ejection fraction (LVEF) was 40% [28-55], troponin was elevated in 93% patients, coronary angiogram (n = 19, 27%) disclosing a coronary obstruction in 21%. CMR (n = 21) was abnormal in all cases, with late gadolinium enhancement in 62% of cases. Cardiac manifestations were associated with a non-significant increase of mortality (32% vs. 19%, p = 0.08). After 1-year follow-up, median LVEF was 57% [44-60] in patients with cardiac involvement. CONCLUSION Cardiac involvement is frequent in critically-ill thrombotic APS patients and may be associated to more severe outcome. Increased awareness on this rare cause of myocardial infarction with or without obstructive coronary artery is urgently needed.
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Affiliation(s)
- Lévi-Dan Azoulay
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Hôpital La Pitié-Salpêtrière, Paris, France.
| | - Romaric Larcher
- Service de Médecine Intensive-Réanimation, Hôpital Lapeyronie, Centre Hospitalier Universitaire (CHU) de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Frédéric Pène
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, APHP & Université Paris Descartes, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Julien Mayaux
- AP-HP, Hôpital La Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation Médicale, Département R3S, Sorbonne Université, INSERM UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Matthieu Jamme
- Sorbonne Université, AP-HP, Hôpital Tenon, Service d'Urgences Néphrologiques et de Transplantation Rénale, Paris, France
| | - Remi Coudroy
- Service de Médecine Intensive-Réanimation, INSERM CIC1402, Groupe ALIVE, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Aude Gibelin
- Service de Médecine intensive réanimation, Hôpital Tenon, AP-HP, Faculté de médecine Sorbonne Université, Paris, France
| | - Elie Azoulay
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Auguste Dargent
- Service de Médecine Intensive-Réanimation, CHU Dijon, INSERM UMR 1231 LabEx Lipstic, Dijon, France
| | - François Beloncle
- Département de Médecine Intensive-Réanimation et Médecine Hyperbare, CHU d'Angers, Université d'Angers, Angers, France
| | - Jean-Herlé Raphalen
- Service d'Anesthésie et de Réanimation, Hôpital Necker, Université Paris Descartes, AP-HP, Paris, France
| | - Antoine Troger
- Service de Médecine Intensive-Réanimation, Hôpital Européen George-Pompidou, Université Paris Descartes, AP-HP, Paris, France
| | - Nicolas de Prost
- Service de Médecine Intensive-Réanimation, CHU Henri-Mondor, AP-HP, Créteil, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor-Dupouy, Argenteuil, France
| | - Samuel Gaugain
- Département d'Anesthésie et Réanimation, Hôpital Saint-Louis-Lariboisière, Université Paris Diderot, AP-HP, Paris, France
| | - Pierre Trouiller
- Service de Réanimation Polyvalente et Unité de Surveillance Continue, Hôpital Antoine-Béclère, Hôpitaux Universitaires Paris-Sud, AP-HP, Clamart, France
| | - Steven Grangé
- Service de Néphrologie, Hôpital Charles-Nicolle, CHU de Rouen, Rouen, France
| | - Stanislas Ledochowski
- Service de Réanimation Polyvalente, Médipôle Lyon-Villeurbanne, Ramsay Santé, France
| | - Jérémie Lemarie
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, Nancy, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Unité de Réanimation, Centre de Référence des Maladies Rénales Rares, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Vincent Degos
- Service de Réanimation Neurochirurgicale, Sorbonne Université, Hôpital La Pitié-Salpêtrière, APHP, Paris, France
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, ACTION Study Group, Département de Cardiologie, Paris, France
| | - Alain Combes
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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11
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Joseph A, Eloit M, Azoulay E, Kaplanski G, Provot F, Presne C, Wynckel A, Grangé S, Rondeau É, Pène F, Delmas Y, Lautrette A, Barbet C, Mousson C, Coindre J, Perez P, Jamme M, Augusto J, Poullin P, Jacobs F, El Karoui K, Vigneau C, Ulrich M, Kanouni T, Le Quintrec M, Hamidou M, Ville S, Charvet‐Rumpler A, Ojeda‐Uribe M, Godmer P, Fremeaux‐Bacchi V, Veyradier A, Halimi J, Coppo P. Immune‐mediated thrombotic thrombocytopenic purpura prognosis is affected by blood pressure. Res Pract Thromb Haemost 2022; 6:e12702. [PMID: 35599703 PMCID: PMC9115975 DOI: 10.1002/rth2.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background The prevalence, prognostic role, and diagnostic value of blood pressure in immune-mediated thrombotic thrombocytopenic purpura (iTTP) and other thrombotic microangiopathies (TMAs) remain unclear. Methods Using a national cohort of iTTP (n = 368), Shigatoxin-induced hemolytic uremic syndrome (n = 86), atypical hemolytic uremic syndrome (n = 84), and hypertension-related thrombotic microangiopathy (n = 25), we sought to compare the cohort's blood pressure profile to assess its impact on prognosis and diagnostic performances. Results Patients with iTTP had lower blood pressure than patients with other TMAs, systolic (130 [interquartile range (IQR) 118-143] vs 161 [IQR 142-180] mmHg) and diastolic (76 [IQR 69-83] vs 92 [IQR 79-105] mmHg, both p < 0.001). The best threshold for iTTP diagnosis corresponded to a systolic blood pressure <150 mmHg. iTTP patients presenting with hypertension had a significantly poorer survival (hazard ratio 1.80, 95% confidence interval 1.07-3.04), and this effect remained significant after multivariable adjustment (hazard ratio = 1.14, 95% confidence interval 1.00-1.30). Addition of a blood pressure criterion modestly improved the French clinical score to predict a severe A disintegrin and metalloprotease with thrombospondin type 1 deficiency in patients with an intermediate score (i.e., either platelet count <30 × 109/L or serum creatinine <200 µM). Conclusions Elevated blood pressure at admission affects the prognosis of iTTP patients and may help discriminate them from other TMA patients. Particular attention should be paid to blood pressure and its management in these patients.
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Affiliation(s)
- Adrien Joseph
- INSERM, U1138, INSERM, Équipe 11 labellisée Ligue Nationale Contre le Cancer, Centre de Recherche des Cordeliers Paris France
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Médecine intensive réanimation Hôpital Saint Louis AP‐HP Paris France
| | - Martin Eloit
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie et Thérapie Cellulaire CHRU de Tours Tours France
| | - Elie Azoulay
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Médecine intensive réanimation Hôpital Saint Louis AP‐HP Paris France
| | - Gilles Kaplanski
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Interne Hôpital la Conception Marseille France
| | - François Provot
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Albert‐Calmette Lille France
| | - Claire Presne
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Nord Amiens France
| | - Alain Wynckel
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Maison Blanche Reims France
| | - Steven Grangé
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Médicale CHU Charles Nicolle Rouen France
| | - Éric Rondeau
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Urgences Néphrologiques et Transplantation Rénale Hôpital Tenon Paris France
| | - Frédéric Pène
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Intensive–Réanimation Hôpital Cochin APHP Centre & Université de Paris Paris France
| | - Yahsou Delmas
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Bordeaux Bordeaux France
| | - Alexandre Lautrette
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Médicale Hôpital Gabriel Montpied Clermont‐Ferrand France
| | - Christelle Barbet
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie‐hypertension, Dialyses, Transplantation Rénale Hôpitaux Bretonneau et Clocheville Tours France
| | - Christiane Mousson
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Dijon Dijon France
| | - Jean‐Philippe Coindre
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CH Le Mans Le Mans France
| | - Pierre Perez
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Polyvalente CHU de Nancy Nancy France
| | - Matthieu Jamme
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Centre Hospitalier Intercommunal Poissy Saint‐Germain Poissy France
| | - Jean‐François Augusto
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Dialyse et Transplantation CHU Larrey Angers France
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’hémaphérèse et d’autotransfusion Hôpital la Conception Marseille France
| | - Frédéric Jacobs
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Réanimation Médicale Hôpital Antoine Béclère Clamart France
| | - Khalil El Karoui
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie et Transplantation rénale Groupe Hospitalier Henri‐Mondor Créteil France
| | - Cécile Vigneau
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)–UMR_S 1085 Rennes France
| | - Marc Ulrich
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie Hôpital Jean Bernard Valenciennes France
| | - Tarik Kanouni
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Unité d’Hémaphérèse Service d’Hématologie CHU de Montpellier Montpellier France
| | - Moglie Le Quintrec
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Montpellier Montpellier France
| | - Mohamed Hamidou
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Interne CHU de Nantes Nantes France
| | - Simon Ville
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie CHU de Nantes Nantes France
| | - Anne Charvet‐Rumpler
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz Besançon France
| | - Mario Ojeda‐Uribe
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie et de Thérapie Cellulaire Groupe Hospitalier Region Mulhouse‐Sud‐Alsace (GHRMSA) Mulhouse France
| | - Pascal Godmer
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Médecine Interne Centre Hospitalier Bretagne Atlantique de Vannes Vannes France
| | - Véronique Fremeaux‐Bacchi
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Immunologie Biologique Hôpital Européen Georges Pompidou, AP‐HP Paris France
| | - Agnès Veyradier
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie Biologique Hôpital Lariboisière, AP‐HP Paris France
| | - Jean‐Michel Halimi
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service de Néphrologie‐hypertension, Dialyses, Transplantation Rénale Hôpitaux Bretonneau et Clocheville Tours France
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques (CNR‐MAT) AP‐HP Paris France
- Service d’Hématologie Hôpital Saint‐Antoine AP‐HP Paris France
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12
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Artaud-Macari E, Bubenheim M, Le Bouar G, Carpentier D, Grangé S, Boyer D, Béduneau G, Misset B, Cuvelier A, Tamion F, Girault C. High-flow oxygen therapy versus noninvasive ventilation: a randomised physiological crossover study of alveolar recruitment in acute respiratory failure. ERJ Open Res 2021; 7:00373-2021. [PMID: 34912882 PMCID: PMC8666576 DOI: 10.1183/23120541.00373-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 11/05/2022] Open
Abstract
High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxaemic acute respiratory failure (ARF) patients, while the value of noninvasive ventilation (NIV) remains debated. The primary end-point was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary end-points compared regional EELI, lung volumes (global and regional tidal volume variation (VT)), respiratory parameters, haemodynamic tolerance, dyspnoea and patient comfort between HFNC and NIV, relative to face mask (FM). A prospective randomised crossover physiological study was conducted in patients with hypoxaemic ARF due to pneumonia. They received alternately HFNC, NIV and FM. 16 patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95% CI 857–2646) and 826 (95% CI 399.5–2361), respectively. Global and regional VT increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher pulse oxygen saturation/inspired oxygen fraction ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnoea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1), but was lower with NIV (p=0.001). This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF. In contrast with HFNC, NIV increased lung volumes, which may contribute to overdistension and its potentially deleterious effect in these patients. This study found a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF, but NIV also increases lung volumes, which may give rise to overdistension, reinforcing the concept of patient self-inflicted lung injuryhttps://bit.ly/3iRcZDJ
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Affiliation(s)
- Elise Artaud-Macari
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| | - Michael Bubenheim
- Rouen University Hospital, Dept of Clinical Research and Innovation, F-76000, Rouen, France
| | - Gurvan Le Bouar
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, F-76000, Rouen, France
| | - Dorothée Carpentier
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France
| | - Steven Grangé
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France
| | - Déborah Boyer
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France
| | - Gaëtan Béduneau
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| | - Benoit Misset
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Dept of Intensive Care, Liège University Hospital, Liège, Belgium
| | - Antoine Cuvelier
- Rouen University Hospital, Pulmonary, Thoracic Oncology and Respiratory Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
| | - Fabienne Tamion
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, IRIB, Inserm U 1096, Rouen University Hospital, F-76000, Rouen, France
| | - Christophe Girault
- Rouen University Hospital, Medical Intensive Care Unit, F-76000, Rouen, France.,Normandie Université, UNIROUEN, EA3830, Rouen University Hospital, F-76000, Rouen, France
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13
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Martis N, Jamme M, Bagnis-Isnard C, Pouteil-Noble C, Presne C, Vigneau C, Grangé S, Burtey S, Coindre JP, Wynckel A, Hamidou MA, Kanouni T, Azoulay E, Hié M, Chauveau D, Veyradier A, Rondeau E, Coppo P. Systemic autoimmune disorders associated with thrombotic microangiopathy: A cross-sectional analysis from the French National TMA registry: Systemic autoimmune disease-associated TMA. Eur J Intern Med 2021; 93:78-86. [PMID: 34175183 DOI: 10.1016/j.ejim.2021.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
CONTEXT The management of systemic auto-immune diseases (SAID) -associated thrombotic microangiopathies (TMA) [SAID-TMA] remains debated. OBJECTIVES To provide a demographic, clinical and therapeutic picture of SAID-TMA. METHODS A cross-sectional analysis was conducted on adult patients presenting with SAID and TMA from the French National TMA Registry over a 20-year period. Clinical features were extracted and compared to those from a historical cohort of atypical haemolytic and uremic syndrome (aHUS) patients. RESULTS Forty-one patients with SAID-TMA were compared to 78 patients with aHUS from a historical cohort. Connective tissue diseases (CTD) were systemic lupus erythematosus (n=18), primary Sjögren's syndrome (n=7), systemic sclerosis (n=11), mixed CTD (n=2) and 2 cases of vasculitides, including 7 overlapping forms and 8 cases of primary antiphospholipid syndromes (APLS). Patients with SAID-TMA generally had pre-existing chronic kidney failure (OR= 3.17, 95%CI: 1.204 to 7.923; p= 0.016) compared to aHUS patients, though creatinine levels were significantly lower (216 [IQR, 108-334] µmol/L vs. 368 [IQR, 170-722] µmol/L; p= 0.002). Patients were less likely to recover if renal replacement therapy was needed at onset (OR= 0.07; 0.02 to 0.34; p <0.0005). Two patients died. Thirty patients responded to immunosuppressive treatment and complete remission was achieved in 25 cases. By contrast, therapeutic plasma exchange (TPE) did not have an early effect on TMA features at Day-7 nor Day-15 (p >0.05). CONCLUSION The management of SAID-TMA implies an early initiation of immunosuppressive drugs for flares of the associated SAID, whereas TPE seem ineffective. KEY MESSAGES.
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Affiliation(s)
- Nihal Martis
- Internal Medicine Department, University Hospital of Nice; Côte d'Azur University, Nice, France; French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France.
| | - Matthieu Jamme
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, C.H. Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | | | - Claire Pouteil-Noble
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Édouard Herriot Hospital, Lyon, France
| | - Claire Presne
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Sud, Amiens, France
| | - Cécile Vigneau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; University of Rennes, University Hospital of Rennes - Inserm, EHESP, Institut de recherche en santé, Environnement et Travail - UMR_S 1085, F-35000 Rennes, France
| | - Steven Grangé
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Intensive Care Unit, C.H.U Rouen, Rouen, France
| | - Stéphane Burtey
- Nephrology Department, C.H.U. de la Conception, Marseille, France
| | | | - Alain Wynckel
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology Department, Hôpital Maison Blanche, Reims Cedex, France
| | - Mohamed A Hamidou
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Hôtel Dieu Hospital, Nantes, France
| | - Tarik Kanouni
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Therapeutic Apheresis Department, C.H.U de Montpellier, Montpellier, France
| | - Elie Azoulay
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | - Miguel Hié
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Internal Medicine Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Chauveau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Rangueil Hospital, Toulouse, France
| | - Agnès Veyradier
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haemostasis Department, Lariboisière Hospital, Paris, France
| | - Eric Rondeau
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Nephrology and Kidney transplant Unit, Tenon Hospital, Paris, France
| | - Paul Coppo
- French Reference Centre for Thrombotic Microangiopathies, Saint-Antoine Hospital, Paris, France; Haematology Department, Saint-Antoine Hospital, Paris, France; Sorbonne University, Paris, France.
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14
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Grall M, Daviet F, Chiche NJ, Provot F, Presne C, Coindre JP, Pouteil-Noble C, Karras A, Guerrot D, François A, Benhamou Y, Veyradier A, Frémeaux-Bacchi V, Coppo P, Grangé S. Eculizumab in gemcitabine-induced thrombotic microangiopathy: experience of the French thrombotic microangiopathies reference centre. BMC Nephrol 2021; 22:267. [PMID: 34284729 PMCID: PMC8293501 DOI: 10.1186/s12882-021-02470-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gemcitabine is a broadly prescribed chemotherapy, the use of which can be limited by renal adverse events, including thrombotic microangiopathy (TMA). METHODS This study evaluated the efficacy of eculizumab, a monoclonal antibody targeting the terminal complement pathway, in patients with gemcitabine-induced TMA (G-TMA). We conducted an observational, retrospective, multicenter study in 5 French centres, between 2011 and 2016. RESULTS Twelve patients with a G-TMA treated by eculizumab were included. The main characteristics were acute renal failure (100%), including stage 3 acute kidney injury (AKI, 58%) and renal replacement therapy (17%), hypertension (92%) and diffuse oedema (83%). Eculizumab was started after a median of 15 days (range 4-44) following TMA diagnosis. A median of 4 injections of eculizumab was performed (range 2-22). Complete hematological remission was achieved in 10 patients (83%) and blood transfusion significantly decreased after only one injection of eculizumab (median of 3 packed red blood cells (range 0-10) before treatment vs 0 (range 0-1) after one injection, P < 0.001). Two patients recovered completely renal function (17%), and 8 achieved a partial remission (67%). Compared to a control group of G-TMA without use of eculizumab, renal outcome was more favourable. At the end of the follow up, median eGFR was 45 vs 33 ml/min/1.73m2 respectively in the eculizumab group and in the control group. CONCLUSIONS These results suggest that eculizumab is efficient on haemolysis and reduces transfusion requirement in G-TMA. Moreover, eculizumab may improve renal function recovery.
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Affiliation(s)
- Maximilien Grall
- Medical Intensive Care Unit, Rouen University Hospital, 37 boulevard Gambetta, 76031, Rouen Cedex, France
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
| | - Florence Daviet
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Conception University Hospital, APHM, Marseille, France
| | - Noémie Jourde Chiche
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Conception University Hospital, APHM, Marseille, France
| | - François Provot
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Lille University Hospital, Lille, France
| | - Claire Presne
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Amiens University Hospital, Amiens, France
| | - Jean-Philippe Coindre
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, Le Mans General Hospital, Le Mans, France
| | - Claire Pouteil-Noble
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Nephrology, E. Herriot Hospital, Lyon I university, Lyon, France
| | - Alexandre Karras
- Department of Nephrology, Georges Pompidou Hospital, APHP, Paris, France
| | | | - Arnaud François
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Ygal Benhamou
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Agnès Veyradier
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Biological Hematology, Lariboisière University Hospital, APHP, Paris, France
| | - Véronique Frémeaux-Bacchi
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of immunology, Georges Pompidou Hospital, APHP, Paris, France
| | - Paul Coppo
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Department of Hematology, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 37 boulevard Gambetta, 76031, Rouen Cedex, France.
- French TMA Reference Centre, Hopital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France.
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15
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Travert B, Dossier A, Jamme M, Cointe A, Delmas Y, Malot S, Wynckel A, Seguin A, Presne C, Hie M, Benhamou Y, Ribes D, Choukroun G, Grangé S, Hertig A, Le Gall EC, Galicier L, Daugas E, Bouadma L, Weill FX, Azoulay E, Fakhouri F, Veyradier A, Bonacorsi S, Hogan J, Frémeaux-Bacchi V, Rondeau E, Mariani-Kurkdjian P, Coppo P. Shiga Toxin-Associated Hemolytic Uremic Syndrome in Adults, France, 2009-2017. Emerg Infect Dis 2021; 27:1876-1885. [PMID: 34152955 PMCID: PMC8237898 DOI: 10.3201/eid2707.204638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We conducted a retrospective study on hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli (STEC) in 96 adults enrolled in the cohort of the National Reference Center for Thrombotic Microangiopathies network in France during 2009–2017. Most infections were caused by STEC strains not belonging to the O157 or O104 serogroups. Thirty (31.3%) patients had multiple risk factors for thrombotic microangiopathy. In total, 61 (63.5%) patients required dialysis, 50 (52.1%) had a serious neurologic complication, 34 (35.4%) required mechanical ventilation, and 19 (19.8%) died during hospitalization. We used multivariate analysis to determine that the greatest risk factors for death were underlying immunodeficiency (hazard ratio 3.54) and severe neurologic events (hazard ratio 3.40). According to multivariate analysis and propensity score-matching, eculizumab treatment was not associated with survival. We found that underlying conditions, especially immunodeficiency, are strongly associated with decreased survival in adults who have hemolytic uremic syndrome caused by STEC.
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16
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Beduneau G, Boyer D, Guitard PG, Gouin P, Carpentier D, Grangé S, Veber B, Girault C, Tamion F. Covid-19 severe hypoxemic pneumonia: A clinical experience using high-flow nasal oxygen therapy as first-line management. Respir Med Res 2021; 80:100834. [PMID: 34153702 PMCID: PMC8175099 DOI: 10.1016/j.resmer.2021.100834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/01/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE To report a French experience in patients admitted to Intensive Care Unit (ICU) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring high fractional concentration of inspired oxygen supported by high flow nasal cannula (HFNC) as first-line therapy. METHODS Retrospective cohort study conducted in two ICUs of a French university hospital. All consecutive patients admitted during 28-days after the first admission for SARS-CoV-2 pneumonia were screened. Demographic, clinical, respiratory support, specific therapeutics, ICU length-of-stay and survival data were collected. RESULTS Data of 43 patients were analyzed: mainly men (72%), median age 61 (51-69) years, median body mass index of 28 (25-31) kg/m2, median simplified acute physiology score (SAPS II) of 29 (22-37) and median PaO2/fraction of inspired oxygen (FiO2) (P/F) ratio of 146 (100-189) mmHg. HFNC was initiated at ICU admission in 76% of patients. Median flow was 50 (45-50) L/min and median FiO2 was 0.6 (0.5-0.8). 79% of patients presented at least one comorbidity, mainly hypertension (58%). At day (D) 28, 32% of patients required invasive mechanical ventilation, 3 patients died in ICU. Risk factors for intubation were diabetes (10% vs. 43%, P=0.04) and extensive lesions on chest computed tomography (CT) (P=0.023). Patients with more than 25% of lesions on chest CT were more frequently intubated during ICU stay (P=0.012). At ICU admission (D1), patients with higher SAPS II and Sequential Organ Failure Assessment (SOFA) scores (respectively 39 (28-50) vs. 27 (22-31), P=0.0031 and 5 (2-8) vs. 2 (2-2.2), P=0.0019), and a lower P/F ratio (98 (63-109) vs. 178 (126-206), P=0.0005) were more frequently intubated. Among non-intubated patients, the median lowest P/F was 131 (85-180) mmHg. Four caregivers had to stop working following coronavirus 2 contamination, but did not require hospitalization. CONCLUSION Our clinical experience supports the use of HFNC as first line-therapy in patients with SARS-COV-2 pneumonia for whom face mask oxygen does not provide adequate respiratory support.
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Affiliation(s)
- G Beduneau
- UNIROUEN, EA 3830, medical intensive care unit, Rouen university hospital, Normandie university, 76000 Rouen, France.
| | - D Boyer
- Medical intensive care unit, Rouen university hospital, 76000 Rouen, France
| | - P-G Guitard
- Department of anesthesiology and critical care, Rouen university hospital, 76000 Rouen, France
| | - P Gouin
- Department of anesthesiology and critical care, Rouen university hospital, 76000 Rouen, France
| | - D Carpentier
- Medical intensive care unit, Rouen university hospital, 76000 Rouen, France
| | - S Grangé
- Medical intensive care unit, Rouen university hospital, 76000 Rouen, France
| | - B Veber
- Department of anesthesiology and critical care, Rouen university hospital, 76000 Rouen, France
| | - C Girault
- UNIROUEN, EA 3830, medical intensive care unit, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - F Tamion
- UNIROUEN, Inserm U1096, medical intensive care unit, Rouen university hospital, Normandie university, 76000 Rouen, France
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17
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Perrier Q, Noble J, Grangé S, Bedouch P, Tetaz R, Rostaing L. Atypical Evolution of Secondary Hemolytic Uremic Syndrome Defined as Paraneoplastic Syndrome under Eculizumab and Palbociclib Therapies. Case Rep Oncol 2021; 14:676-680. [PMID: 33976652 PMCID: PMC8077600 DOI: 10.1159/000514982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
Thrombotic microangiopathy (TMA) is most of the time caused by thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. A 60-year-old female was diagnosed in 2014 with mammary breast adenocarcinoma treated by several-line therapy: mastectomy, docetaxel, cyclophosphamide, radiotherapy, doxorubicine, and capecitabine. By mid-November, the patient was admitted to the hospital with regenerative, mechanical, and hemolytic anemia, schistocytes at 3%, and thrombopenia (99 G/L), associated with high blood transfusion requirement. After 9 sessions of plasmapheresis, there was no significant improvement in the biological parameters, nor after 2 cycles of paclitaxel. The patient was then treated with eculizumab during 4 weeks, with a slight reduction in blood requirement, and simultaneously with palbociclib. Since being treated with palpociclib, she had a great reduction in blood requirement and a good clinical condition. To conclude, we reported an initial moderate improvement of paraneoplasm-related TMA syndrome under eculizumab therapy with a slight reduction in red blood cell requirement; however, palbociclib therapy achieved a very good response with a dramatic reduction in red blood cell requirement.
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Affiliation(s)
- Quentin Perrier
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.,Centre de référence des microangiopathies thrombotiques (CNR-MAT), AP-HP, Paris, France
| | - Pierrick Bedouch
- Department of Clinical Pharmacy, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France.,Grenoble Alpes University, CNRS TIMC-IMAG, UMR 5525, Grenoble, France
| | - Rachel Tetaz
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France
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18
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de Laforcade L, Bobot M, Bellin MF, Clément O, Grangé S, Grenier N, Wynckel A, Guerrot D. [ESUR recommendations on the use of contrast media: Practice survey, review and commentary by CJN, FIRN and SFNDT]. Nephrol Ther 2021; 17:80-91. [PMID: 33551369 DOI: 10.1016/j.nephro.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/20/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
Contrast media administration is classically considered to cause or worsen kidney failure. Recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. The present work evaluates the practice of French nephrologists, and provides a commentary on these recommendations based on an updated review of the literature. We conducted survey among French nephrologists, using an electronic questionnaire distributed by the Société Francophone de Néphrologie, Dialyse et Transplantation, the French Intensive care Renal Network and the Club des Jeunes Néphrologues. 266 responses were collected. The European Society of Urogenital Radiology guidelines are poorly known among the panel of nephrologists. Their practices differ from the guidelines by the more frequent and earlier implementation of measures to prevent renal failure post contrast media. In accordance with the guidelines, hydration is prescribed as a first-line preventive measure, mainly with saline and bicarbonate. Inhibitors of the renin-angiotensin-aldosterone system are frequently discontinued before an injection of contrast media, contrary to what is recommended. In conclusion, the European Society of Urogenital Radiology guidelines, which the working group endorses, but which are still too little known and applied in clinical nephrology in France, prompt nephrologists to lift some of the restrictions on the use of PCI as well as on the continuation of ARS inhibitors before injecting PCI.
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Affiliation(s)
- Louis de Laforcade
- Service d'endocrinologie-diabétologie-néphrologie, centre hospitalier Pierre-Oudot, 30, avenue du Médipole, 38300 Bourgoin-Jallieu, France; Commission Néphrologie Clinique de la SFNDT, 24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France.
| | - Mickaël Bobot
- Commission Néphrologie Clinique de la SFNDT, 24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France; Centre de néphrologie et transplantation rénale, CHU de conception, 147, boulevard Baille, 13005 Marseille, France; Inserm 1263, Inrae 1260, C2VN, université Aix-Marseille, 27, boulevard Jean-Moulin, 13385 Marseille, France; Comité Scientifique du Club des Jeunes Néphrologues, clinique du Landy, 93400 Saint-Ouen, France
| | - Marie-France Bellin
- CEA, CNRS, Inserm, BioMaps, service de radiologie, hôpital-bicêtre Paul-Brousse, université Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Olivier Clément
- Service de radiologie, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - Steven Grangé
- Service de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; French Intensive care Renal Network,24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France
| | - Nicolas Grenier
- Service de radiologie et d'imagerie diagnostique et interventionnelle de l'adulte, CHU de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Alain Wynckel
- French Intensive care Renal Network,24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France; Service de néphrologie, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France
| | - Dominique Guerrot
- Commission Néphrologie Clinique de la SFNDT, 24, Montée des Roches, Saint-Sorlin, 69440 Chabanière, France; Service de néphrologie, hémodialyse, transplantation rénale, lithiase rénale, hypertension artérielle, unité de surveillance continue, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Rafat C, Garcia H, Grangé S. [Acute renal failure and cancer treatment]. Rev Prat 2021; 71:216-222. [PMID: 34160987] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
"Acute renal failure and cancer treatment The interplay between cancer and acute kidney injury is intricate. Cancer, as much as therapies developed against it, may be responsible for acute kidney injury. Tumor lysis syndrome stems from the synergetic effects of anti-tumoral therapies in combination with the specific characteristics of the underlying tumor. Intra-tubular methotrexate precipitation is characterized by extra-renal clinical manifestations due to delayed renal drug clearance: prophylactic therapy based on optimized hydration and avoidance of nephrotoxic drugs represent the cornerstone of its management whereas rescue therapy relies on folinic acid substitution and enzyme-based therapy. Thrombotic microangiopathy is likely to result either from the cancer per se or treatments targeting the cancer. Gemcitabine stands as one the drug well acknowledged for eliciting thrombotic microngioapathy with potentially devastating consequences so that eculizumab has been contemplated as a possible therapy, on a case to case basis. Finally, it should be kept in mind that acute kidney injury in the setting of cancer represents a severe complication in the course of the disease."
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Affiliation(s)
- Cédric Rafat
- "Département de néphrologie, hôpital Tenon, AP-HP, Sorbonne Université, Paris, France."
| | - Hugo Garcia
- "Unité néphrologie, groupe hospitalier La Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France."
| | - Steven Grangé
- "Service de réanimation médicale, CHU de Rouen, Rouen, France."
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de Laforcade L, Bobot M, Bellin MF, Clément O, Grangé S, Grenier N, Wynckel A, Guerrot D. Kidney and contrast media: Common viewpoint of the French Nephrology societies (SFNDT, FIRN, CJN) and the French Radiological Society (SFR) following ESUR guidelines. Diagn Interv Imaging 2021; 102:131-139. [PMID: 33531265 DOI: 10.1016/j.diii.2021.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/24/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/29/2022]
Abstract
Contrast medium administration is classically considered to cause or worsen kidney failure, but recent data may moderate this assertion. The European Society of Urogenital Radiology recently published guidelines re-evaluating the precautions before administering contrast media. Kidney injury does not constitute a contra-indication to the administration of iodinated contrast medium, as long as the benefit-risk ratio justifies it. Intravenous hydration with 0.9% NaCl or 1.4% sodium bicarbonate is the only validated measure for the prevention of post-iodine contrast nephropathy. This is necessary for intravenous or intra-arterial administration of iodinated contrast agent without first renal pass when the glomerular filtration rate is less than 30mL/min/1.73m2, for intra-arterial administration of iodinated contrast agent with first renal passage when the glomerular filtration rate is less than 45mL/min/1.73m2, or in patients with acute renal failure. The use of iodinated contrast medium should allow the carrying out of relevant examinations based on an analysis of the benefit-risk ratio and the implementation of measures to prevent toxicity when necessary.
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Affiliation(s)
- Louis de Laforcade
- Department of Nephrology, Bourgoin-Jallieu Hospital, 38300 Bourgoin-Jallieu, France.
| | - Mickaël Bobot
- Department of Nephrology and Renal Transplantation, Hôpital de la Conception, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France; C2VN, INSERM 1263, INRAE 1260, Aix-Marseille Univ, 13005 Marseille, France
| | - Marie-France Bellin
- Department of Radiology, Bicêtre Hospital, APHP, University Paris-Saclay, BioMaps, 94043 Le Kremlin Bicêtre, France
| | - Olivier Clément
- Department of Radiology, Hopital Européen Georges Pompidou, AP-HP, Centre, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, 76000 Rouen, France
| | - Nicolas Grenier
- Radiology Department, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Alain Wynckel
- Nephrology Department, Reims University Hospital, 51100 Reims, France
| | - Dominique Guerrot
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, 76000 Rouen, France
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21
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Benhamou Y, Sauvètre G, Grangé S, Veyradier A, Coppo P. La maladie thrombo-embolique veineuse au cours du purpura thrombotique thrombocytopénique autoimmun est associée à un traitement prolongé par échanges plasmatiques. Rev Med Interne 2020; 41:809-813. [DOI: 10.1016/j.revmed.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
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Pineton de Chambrun M, Larcher R, Pène F, Argaud L, Mayaux J, Jamme M, Coudroy R, Mathian A, Gibelin A, Azoulay E, Tandjaoui-Lambiotte Y, Dargent A, Beloncle FM, Raphalen JH, Couteau-Chardon A, de Prost N, Devaquet J, Contou D, Gaugain S, Trouiller P, Grangé S, Ledochowski S, Lemarie J, Faguer S, Degos V, Luyt CE, Combes A, Amoura Z. In-Hospital Mortality-Associated Factors in Patients With Thrombotic Antiphospholipid Syndrome Requiring ICU Admission. Chest 2020; 157:1158-1166. [DOI: 10.1016/j.chest.2019.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/09/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
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de Nattes T, Moreau-Grangé L, Vezzosi D, Hadoux J, Hie M, Guerrot D, Grangé S. Correction to: Adrenocortical carcinoma complicated by renal thrombotic microangiopathy, a case-series. BMC Nephrol 2020; 21:44. [PMID: 32039708 PMCID: PMC7008570 DOI: 10.1186/s12882-020-1712-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tristan de Nattes
- Nephrology - Kidney Transplant Unit, Rouen University Hospital, 76031, Rouen, France.
| | | | | | - Julien Hadoux
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Miguel Hie
- Department of Internal Medicine, Pitie-Salpetriere Hospital, AP-HP, Paris, France
| | - Dominique Guerrot
- Nephrology - Kidney Transplant Unit, Rouen University Hospital, 76031, Rouen, France
| | - Steven Grangé
- Department of Medical Critical Care, Rouen University Hospital, Rouen, France
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de Nattes T, Moreau-Grangé L, Vezzosi D, Hadoux J, Hie M, Guerrot D, Grangé S. Adrenocortical carcinoma complicated by renal thrombotic microangiopathy, a case-series. BMC Nephrol 2020; 21:35. [PMID: 32000700 PMCID: PMC6993319 DOI: 10.1186/s12882-020-1703-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background Cancer-related thrombotic microangiopathy (CR-TMA) is a rare entity associated with a dismal prognosis. Usually, CR-TMA is associated with mucin-producing carcinomas among which stomach, breast, prostate, lung and pancreas tumours are the most frequent. Cases presentation We describe for the first time three cases of CR-TMA due to adrenocortical carcinoma (ACC). All of them had mechanical hemolytic anemia and thrombocytopenia without any other identifiable cause. Bicytopenia was diagnosed either simultaneously with ACC or at the time of metastatic evolution. Two patients had acute kidney injury (AKI) with severe pathological findings on kidney biopsy. Despite total adrenalectomy, chemotherapy, and specific treatment of TMA with plasma-exchanges, renal failure and hemolytic anemia remained. The only manifestation of CR-TMA in the third patient was hemolytic anemia, which resolved after surgical removal of ACC. The evolutions in these patients suggests ACC-related TMA may be related to a circulating factor. Conclusions CR-TMAs are rare. Here we describe the first case series of ACC-related TMA, among which two had renal involvement. This entity is associated with dismal renal prognosis despite specific treatment of TMA. According to patients’ evolution, the persistence of TMA may reflect an uncontrolled malignancy.
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Affiliation(s)
- Tristan de Nattes
- Nephrology - Kidney Transplant Unit, Rouen University Hospital, 76031, Rouen, France.
| | | | | | - Julien Hadoux
- Medical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Miguel Hie
- Department of Internal Medicine, Pitie-Salpetriere Hospital, AP-HP, Paris, France
| | - Dominique Guerrot
- Nephrology - Kidney Transplant Unit, Rouen University Hospital, 76031, Rouen, France
| | - Steven Grangé
- Department of Medical Critical Care, Rouen University Hospital, Rouen, France
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Clavier T, Grangé S, Pressat-Laffouilhere T, Besnier E, Renet S, Fraineau S, Thiebaut PA, Richard V, Veber B, Tamion F. Gene Expression of Protein Tyrosine Phosphatase 1B and Endoplasmic Reticulum Stress During Septic Shock. Front Med (Lausanne) 2019; 6:240. [PMID: 31737637 PMCID: PMC6839276 DOI: 10.3389/fmed.2019.00240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/14/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Protein Tyrosine Phosphatase 1B (PTP1B) and endoplasmic reticulum stress (ERS) are involved in the septic inflammatory response. Their inhibition is associated with improved survival in murine models of sepsis. The objective was to describe PTP1B and ERS expression during septic shock in human. Material and Methods: Prospective study including patients admitted to intensive care unit (ICU) for septic shock. Blood samples were collected on days 1 (D1), 3 and 5 (D5). Quantitative PCR (performed from whole blood) evaluated the expression of genes coding for PTP1B (PTPN1) and key elements of ERS (GRP78, ATF6, CHOP) or for endothelial dysfunction-related markers (ICAM1 and ET1). We analyzed gene variation between D5 and D1, collected glycemic parameters, insulin resistance and organ failure was evaluated by Sequential Organ Failure Assessment (SOFA) score. Results: We included 44 patients with a mean SAPS II 50 ± 16 and a mortality rate of 13.6%. Between D1 and D5, there was a significant decrease of PTPN1 (p < 0.001) and ATF6 (p < 0.001) expressions. Their variations of expression were correlated with SOFA variation (PTPN1, r = 0.35, CI 95% [0.05; 0.54], p = 0.03 and ATF6, r = 0.45 CI 95% [0.20; 0.65], p < 0.001). We did not find any correlation between PTPN1 expression and insulin resistance or glycemic parameters. Between D1 and D5, ATF6 and PTPN1 expressions were correlated with that of ET1. Conclusions: Our study has evaluated for the first time the expression of PTP1B and ERS in patients with septic shock, revealing that gene expression variation of PTPN1 and ATF6 are partly correlated with the evolution of septic organ failure and with endothelial dysfunction markers expression.
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Affiliation(s)
- Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France.,Department of Medical Critical Care, Rouen University Hospital, Rouen, France
| | - Steven Grangé
- Department of Medical Critical Care, Rouen University Hospital, Rouen, France
| | | | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - Sylvanie Renet
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - Sylvain Fraineau
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | | | - Vincent Richard
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Fabienne Tamion
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France.,Department of Medical Critical Care, Rouen University Hospital, Rouen, France
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Lemoine M, Dilly B, Curie A, Hébert V, Laurent C, Hanoy M, Grangé S, Guerrot D, François A, Bertrand D. Ipilimumab-induced renal granulomatous arteritis: a case report. BMC Nephrol 2019; 20:366. [PMID: 31604452 PMCID: PMC6788031 DOI: 10.1186/s12882-019-1552-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 09/06/2019] [Indexed: 12/13/2022] Open
Abstract
Background Immune Checkpoint Inhibitors (ICPIs) are promising new drugs in treatment of advanced tumours targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed cell death protein-1 (PD1) or its ligand (PDL-1). Ipilimumab is a monoclonal antibody targeting the CTLA-4 receptor used in treatment of metastatic melanoma. By increasing activity of the immune system, ICPIs lead to immune-related adverse events, such as dermatitis, colitis or hepatitis. ICPIs-related kidney adverse events are rare and acute tubulointerstitial nephritis with or without granuloma have mainly been reported. Case presentation We report a case of acute kidney injury in a patient with melanoma treated by ipilimumab. Kidney biopsy revealed acute interlobular and juxtaglomerular granulomatous arteritis, which has not yet been reported in patients treated by ICPIs. Kidney function partially recovered after ipilimumab discontinuation and oral prednisone. Unfortunately, the patient died a few months later from progression of his melanoma. Conclusion This case highlights a new mechanism of acute kidney injury related to ICPIs and supports the interest of kidney biopsy in case of ICPIs related acute renal failure.
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Affiliation(s)
- Mathilde Lemoine
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France.
| | - Baptiste Dilly
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France
| | - Alexandre Curie
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France
| | - Vivien Hébert
- Dermatology department, Rouen University Hospital, Rouen, France
| | - Charlotte Laurent
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France
| | - Mélanie Hanoy
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Dominique Guerrot
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France.,INSERM U1096, Rouen University Medical School, Rouen, France
| | - Arnaud François
- Pathology department, Rouen University Hospital, Rouen, France
| | - Dominique Bertrand
- Nephrology department, Rouen University Hospital, 147 avenue du Maréchal Juin 76230 Bois Guillaume, Rouen, France
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27
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Pineton de Chambrun M, Larcher R, Pène F, Argaud L, Demoule A, Jamme M, Coudroy R, Mathian A, Gibelin A, Azoulay E, Tandjaoui-Lambiotte Y, Dargent A, Beloncle FM, Raphalen JH, Couteau-Chardon A, de Prost N, Devaquet J, Contou D, Gaugain S, Trouiller P, Grangé S, Ledochowski S, Lemarie J, Faguer S, Degos V, Combes A, Luyt CE, Amoura Z. CAPS criteria fail to identify most severely-ill thrombotic antiphospholipid syndrome patients requiring intensive care unit admission. J Autoimmun 2019; 103:102292. [PMID: 31253464 DOI: 10.1016/j.jaut.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Catastrophic antiphospholipid syndrome (CAPS), the most severe manifestation of antiphospholipid syndrome (APS), is characterised by simultaneous thromboses in multiple organs. Diagnosing CAPS can be challenging but its early recognition and management is crucial for a favourable outcome. This study was undertaken to evaluate the frequencies, distributions and ability to predict mortality of "definite/probable" or "no-CAPS" categories of thrombotic APS patients requiring admission to the intensive care unit (ICU). METHODS This French national multicentre retrospective study, conducted from January 2000 to September 2018, included all APS patients with any new thrombotic manifestation(s) admitted to 24 ICUs. RESULTS One hundred and thirty-four patients (male/female ratio: 0.4; mean age at admission: 45.4 ± 15.0 years), who experienced 152 CAPS episodes, required ICU admission. The numbers of definite, probable or no-CAPS episodes, respectively, were: 11 (7.2%), 60 (39.5%) and 81 (53.3%). No histopathological proof of microvascular thrombosis was the most frequent reason for not being classified as definite CAPS. Overall, 35/152 (23.0%) episodes were fatal, with comparable rates for definite/probable CAPS and no CAPS (23% vs. 28.8% respectively, p = 0.4). The Kaplan-Meier curve of estimated probability of survival showed no between-group survival difference (log-rank test p = 0.5). CONCLUSIONS In this study, CAPS criteria were not associated with mortality of thrombotic APS patients requiring ICU admission. Further studies are need evaluate the adequacy of CAPS criteria for critically-ill APS patients.
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Affiliation(s)
- Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et autres maladies auto-immunes systémiques rares, Paris, France; Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiométabolisme et Nutrition (ICAN), Service de Médecine Intensive-Réanimation, Paris, France.
| | - Romaric Larcher
- Service de Médecine Intensive-Réanimation, Hôpital Lapeyronie, Centre Hospitalier Universitaire (CHU) de Montpellier; PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Frédéric Pène
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, APHP & Université Paris Descartes, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Alexandre Demoule
- APHP, Hôpital La Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation Médicale, Département R3S, Sorbonne Université, INSERM UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Matthieu Jamme
- Sorbonne Université, APHP, Hôpital Tenon, Service d'Urgences Néphrologiques et de Transplantation Rénale, Paris, France
| | - Remi Coudroy
- Service de Médecine Intensive-Réanimation, INSERM CIC1402, Groupe ALIVE, Université de Poitiers, CHU de Poitiers, Poitiers, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et autres maladies auto-immunes systémiques rares, Paris, France
| | - Aude Gibelin
- Sorbonne Université, APHP, Hôpital Tenon, Service de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Paris, France
| | - Elie Azoulay
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France
| | | | - Auguste Dargent
- Service de Médecine Intensive-Réanimation, CHU Dijon; INSERM UMR 1231 LabEx Lipstic, Dijon, France
| | - François-Michel Beloncle
- Département de Médecine Intensive-Réanimation et Médecine Hyperbare, CHU d'Angers, Université d'Angers, Angers, France
| | - Jean-Herlé Raphalen
- Service d'Anesthésie et de Réanimation, Hôpital Necker, Université Paris Descartes, APHP, Paris, France
| | - Amélie Couteau-Chardon
- Service de Médecine Intensive-Réanimation, Hôpital Européen George-Pompidou, Université Paris Descartes, APHP, Paris, France
| | - Nicolas de Prost
- Service de Médecine Intensive-Réanimation, CHU Henri-Mondor, APHP, Créteil, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor-Dupouy, Argenteuil, France
| | - Samuel Gaugain
- Département d'Anesthésie et Réanimation, Hôpital Saint Louis-Lariboisière, Université Paris Diderot, APHP, Paris, France
| | - Pierre Trouiller
- Service de Réanimation Polyvalente et Unité de surveillance continue, Hôpital Antoine-Béclère, Hôpitaux Universitaires Paris-Sud, APHP, Clamart, France
| | - Steven Grangé
- Service de Médecine Intensive-Réanimation, Hôpital Charles-Nicolle, CHU de Rouen, Rouen, France
| | | | - Jérémie Lemarie
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, Nancy, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'organes - Unité de Réanimation, Centre de Référence des Maladies Rénales Rares, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Vincent Degos
- Service de Réanimation Neurochirurgicale, Sorbonne Université, Hôpital La Pitié-Salpêtrière, APHP, Paris, France
| | - Alain Combes
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiométabolisme et Nutrition (ICAN), Service de Médecine Intensive-Réanimation, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiométabolisme et Nutrition (ICAN), Service de Médecine Intensive-Réanimation, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et autres maladies auto-immunes systémiques rares, Paris, France
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Abstract
Cobalamin C deficiency (cblC) is the most common inborn error of vitamin B12 metabolism. This autosomal recessive disease is due to mutations in MMACHC gene, encoding a cyanocobalamin decyanase. It leads to hyperhomocysteinemia associated with hypomethioninemia and methylmalonic aciduria. Two distinct phenotypes have been described : early-onset forms occur before the age of one year and are characterized by a severe multisystem disease associating failure to thrive to neurological and ophthalmological manifestations. They are opposed to late-onset forms, less severe and heterogeneous. CblC deficiency-associated kidney lesions remain poorly defined. Thirty-eight cases have been described. Age at initial presentation varied from a few days to 28 years. Most of the patients presented renal thrombotic microangiopathy (TMA) associated with acute renal failure, and 21 patients presented typical lesions of renal thrombotic microangiopathy on kidney biopsy. Prognosis was poor, leading to death in the absence of treatment, and related to the severity of renal lesions in the early-onset forms. Late-onset disease had better prognosis and most of patients were weaned off dialysis after treatment initiation. We suggest that all the patients with renal TMA be screened for cobalamin metabolism disorder, regardless of age and even in the absence of neurological symptoms, to rapidly initiate the appropriate treatment.
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Affiliation(s)
- Mathilde Lemoine
- Service de néphrologie, dialyse et transplantation, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France.
| | - Steven Grangé
- Service de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - Dominique Guerrot
- Service de néphrologie, dialyse et transplantation, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France; Inserm U1096, UFR médecine pharmacie, 22, boulevard Gambetta, 76183 Rouen, France
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29
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Billoir P, Girault C, Barbay V, Boyer D, Grangé S, Fresel M, Chrétien MH, Le Cam Duchez V. Management of dabigatran after overdosage: two case reports and suggestions for monitoring. Blood Coagul Fibrinolysis 2019; 29:653-655. [PMID: 30045050 DOI: 10.1097/mbc.0000000000000763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Bleeding is the main complication of anticoagulant treatments as dabigatran etexilate. In patients with atrial fibrillation, dabigatran, at certain doses, has been associated with similar rates of stroke and embolism, and a lower rate of major hemorrhage compared to warfarin. Before the recent possibility of reversing the anticoagulant effect of dabigatran with idarucizumab, prothrombin complex concentrate (PCC) was the main available treatment in cases of severe bleeding or emergency surgery . We describe two different cases with very high overdosage in which PCC or idarucizumab was used to reverse the effect of dabigatran etexilate.
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Affiliation(s)
- Paul Billoir
- Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular Hemostasis Unit
| | - Christophe Girault
- Normandie Univ, UPRES EA 3830-IRIB, Rouen University Hospital.,Rouen University Hospital, Medical Intensive Care Department
| | - Virginie Barbay
- Rouen University Hospital, Vascular Hemostasis Unit, F 76000 Rouen, France
| | - Deborah Boyer
- Rouen University Hospital, Medical Intensive Care Department
| | - Steven Grangé
- Rouen University Hospital, Medical Intensive Care Department
| | - Marielle Fresel
- Rouen University Hospital, Vascular Hemostasis Unit, F 76000 Rouen, France
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Romero A, François A, Hau F, Hamelin F, Hanoy M, Le Roy F, Grangé S, Etienne I, Guerrot D, Bertrand D. Étude rétrospective : comparaison de l’efficacité et de la tolérance de l’immunoadsorption versus échanges plasmatiques dans le traitement des rejets humoraux en transplantation rénale. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.386] [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: 10/28/2022]
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Lemoine M, François A, Grangé S, Rabant M, Cassiman D, Cassuto E, Le Meur Y, Benoist J, Guerrot D. Néphropathies secondaires à un déficit en cobalamine C : première étude histopathologique comparative. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.077] [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: 11/30/2022]
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Deverrière G, Lemée L, Grangé S, Boyer S, Picard C, Fischer A, Marguet C. Life-Threatening Pneumopathy and U urealyticum in a STAT3-Deficient Hyper-IgE Syndrome Patient. Pediatrics 2017; 139:peds.2016-0845. [PMID: 28562253 DOI: 10.1542/peds.2016-0845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/24/2022] Open
Abstract
A deficiency in signal transducer and activator of transcription 3 (STAT3) is responsible for autosomal dominant hyperimmunoglobulin E syndrome, an immunodeficiency syndrome causing Staphylococcus aureus, Streptococcus pneumonia, Haemophilus influenzae, and, rarely, Pseudomonas aeruginosa and Aspergillus sp infections. Currently, intracellular pathogens are not targeted in the management of severe infections. The pathophysiologic mechanism of hyperimmunoglobulin E syndrome immunodeficiency has recently been linked to a disorder in the T helper 17 pathway and disruption of the interleukin -23/interleukin-17 axis. We report an unusual case of severe pleuropneumopathy by Ureaplasma urealyticum in a teenage girl with STAT3-deficient hyperimmunoglobulin E syndrome (STAT3 HIES). A previous case of severe lung infection by Mycoplasma pneumoniae has already been described in a STAT3-deficient patient, but U urealyticum has never been reported in patients with STAT3 HIES. After a review of the literature, it seems that the specific immunodeficiency pathway of STAT3 HIES exposes STAT3 HIES patients to Ureaplasma lung infections because the pathophysiology of STAT3 HIES and Ureaplasma is based on STAT3 and T helper 17 cells.
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Affiliation(s)
| | - Ludovic Lemée
- Laboratory of Bacteriology, Rouen University Charles Nicolle Hospital, Rouen, France.,Groupe de Recherche sur les Antimicrobiens et les Micro-Organismes, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen, France
| | | | - Sophie Boyer
- Laboratory of Bacteriology, Rouen University Charles Nicolle Hospital, Rouen, France
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies.,INSERM UMR 1163 Institut Imagine.,Centre de Référence des Déficits Immunitaires Héréditaires and
| | - Alain Fischer
- INSERM UMR 1163 Institut Imagine.,Centre de Référence des Déficits Immunitaires Héréditaires and.,Pediatric Immunology-Hematology Unit, Necker-Enfants Malades Hospital, Paris, France; and.,Collège de France, Paris, France
| | - Christophe Marguet
- Departments of Pediatric Respiratory and Allergy Diseases and.,Groupe de Recherche sur les Antimicrobiens et les Micro-Organismes, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen, France
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Demiselle J, Auchabie J, Beloncle F, Gatault P, Grangé S, Du Cheyron D, Dellamonica J, Boyer S, Beauport DT, Piquilloud L, Letheulle J, Guitton C, Chudeau N, Geri G, Fourrier F, Robert R, Guérot E, Boisramé-Helms J, Galichon P, Dequin PF, Lautrette A, Bollaert PE, Meziani F, Guillevin L, Lerolle N, Augusto JF. Patients with ANCA-associated vasculitis admitted to the intensive care unit with acute vasculitis manifestations: a retrospective and comparative multicentric study. Ann Intensive Care 2017; 7:39. [PMID: 28382598 PMCID: PMC5382116 DOI: 10.1186/s13613-017-0262-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 11/25/2016] [Accepted: 03/23/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce. METHODS We included 97 consecutive patients with acute AAV manifestations (new onset or relapsing disease), admitted to 18 intensive care units (ICUs) over a 10-year period (2002-2012). A group of 95 consecutive AAV patients with new onset or relapsing disease, admitted to two nephrology departments with acute vasculitis manifestations, constituted the control group. RESULTS In the ICU group, patients predominantly showed granulomatosis with polyangiitis and proteinase-3 ANCAs. Compared with the non-ICU group, the ICU group showed comparable Birmingham vasculitis activity score and a higher frequency of heart, central nervous system and lungs involvements. Respiratory assistance, renal replacement therapy and vasopressors were required in 68.0, 56.7 and 26.8% of ICU patients, respectively. All but one patient (99%) received glucocorticoids, 85.6% received cyclophosphamide, and 49.5% had plasma exchanges as remission induction regimens. Fifteen (15.5%) patients died during the ICU stay. The following were significantly associated with ICU mortality in the univariate analysis: the need for respiratory assistance, the use of vasopressors, the occurrence of at least one infection event in ICU, cyclophosphamide treatment, sequential organ failure assessment at admission and simplified acute physiology score II. After adjustment on sequential organ failure assessment or infection, cyclophosphamide was no longer a risk factor for mortality. Despite a higher initial mortality rate of ICU patients within the first hospital stay (p < 0.0001), the long-term mortality of hospital survivors did not differ between ICU and non-ICU groups (18.6 and 20.4%, respectively, p = 0.36). Moreover, we observed no renal survival difference between groups after a 1-year follow-up (82.1 and 80.5%, p = 0.94). CONCLUSION This study supports the idea that experiencing an ICU challenge does not impact the long-term prognosis of AAV patients.
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Affiliation(s)
- Julien Demiselle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.,Néphrologie-Dialyse-Transplantation, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Johann Auchabie
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - François Beloncle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Philippe Gatault
- Service de Néphrologie et Immunologie Clinique, CHRU Tours, Tours, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Damien Du Cheyron
- Service de Réanimation Médicale, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, 14033, Caen Cedex 9, France
| | - Jean Dellamonica
- Medical Intensive Care Unit, Archet 1 University Hospital, Route de St Antoine, CS 23079, 06202, Nice, France
| | - Sonia Boyer
- Medical Intensive Care Unit, Archet 1 University Hospital, Route de St Antoine, CS 23079, 06202, Nice, France
| | - Dimitri Titeca Beauport
- Medical Intensive Care Unit, Amiens University Medical Center, 80054, Amiens, Cedex 1, France
| | - Lise Piquilloud
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.,Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Julien Letheulle
- Service de Réanimation Médicale, Hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Christophe Guitton
- Medical Intensive Care Unit, Hôtel-Dieu, University Hospital of Nantes, 30 bd Jean Monnet, 44093, Nantes, France.,UMR 1064, Inserm, 30 bd Jean Monnet, 44093, Nantes, France
| | - Nicolas Chudeau
- Service de Reanimation Medico-Chirurgicale, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans, France
| | - Guillaume Geri
- Service de Réanimation Médicale, Hôpital Cochin, Paris, France
| | - François Fourrier
- Réanimation, Centre de Réanimation Polyvalente, Hôpital Roger Salengro, CHRU de Lille, Lille, France
| | - René Robert
- Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - Emmanuel Guérot
- Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Paris, France
| | - Julie Boisramé-Helms
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Pierre Galichon
- APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Paris, France
| | | | - Alexandre Lautrette
- Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, CHU de Nancy Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035, Nancy Cedex, France
| | - Ferhat Meziani
- Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Loïc Guillevin
- Département de Médecine Interne, Assistance Public des Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Jean-François Augusto
- Néphrologie-Dialyse-Transplantation, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
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Grangé S, Coppo P. Thrombotic microangiopathies and antineoplastic agents. Nephrol Ther 2017; 13 Suppl 1:S109-S113. [DOI: 10.1016/j.nephro.2017.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022]
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Béduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Nicolas Terzi, Grangé S, Barberet G, Guitard PG, Frat JP, Constan A, Chretien JM, Mancebo J, Mercat A, Richard JCM, Brochard L. Epidemiology of Weaning Outcome according to a New Definition. The WIND Study. Am J Respir Crit Care Med 2017; 195:772-783. [DOI: 10.1164/rccm.201602-0320oc] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gaëtan Béduneau
- Medical Intensive Care Unit and
- Normandie Univ, UNIROUEN, EA 3830, Rouen, France
| | - Tài Pham
- AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l’Est Parisien, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Paris, France
- Unité Mixte de Recherche 1153, INSERM, Sorbonne Paris Cité, Epidémiologie Clinique et Statistiques pour la Recherche en Santé Team, Université Paris Diderot, Paris, France
| | - Frédérique Schortgen
- Medical Intensive Care Unit, Centres Hospitaliers Universitaires Henri Mondor, APHP Paris, Paris, France
| | - Lise Piquilloud
- Department of Medical Intensive Care and
- Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Elie Zogheib
- Cardio Thoracic and Vascular Intensive Care Unit, Centres Hospitaliers Universitaires Amiens-Picardie, Amiens, France
- INSERM U1088, CURS, Université Jules Verne, Picardie, France
| | - Maud Jonas
- Medical Intensive Care Unit, Hôtel-Dieu, University Hospital of Nantes, Nantes, France
| | - Fabien Grelon
- Intensive Care Unit, Hospital of Le Mans, Le Mans, France
| | - Isabelle Runge
- Medical Intensive Care Unit Regional Medical Center, Orleans, France
| | - Nicolas Terzi
- INSERM, U1075, Caen, France
- Université de Caen, Caen, France
- Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire Caen, Caen, France
- Service de Réanimation Médicale, Centres Hospitaliers Universitaires Grenoble Alpes, Grenoble, France
| | | | - Guillaume Barberet
- Medical Intensive Care Unit, Mulhouse Regional Hospital, Mulhouse, France
| | | | - Jean-Pierre Frat
- Service de Réanimation Médicale, Centres Hospitaliers Universitaires de Poitiers, Poitiers, France
- INSERM, CIC-1402, Équipe 5 ALIVE, Poitiers, France
- Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Adrien Constan
- Medical Intensive Care Unit, Centres Hospitaliers Universitaires Henri Mondor, APHP Paris, Paris, France
| | - Jean-Marie Chretien
- Department of Clinical Research and Innovation, University Hospital of Angers, Angers, France
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | | | | | - Laurent Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, Saint Michael’s Hospital, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Velasquez T, Mackey G, Lusk J, Kyle UG, Fontenot T, Marshall P, Shekerdemian LS, Coss-Bu JA, Nishigaki A, Yatabe T, Tamura T, Yamashita K, Yokoyama M, Ruiz-Rodriguez JC, Encina B, Belmonte R, Troncoso I, Tormos P, Riveiro M, Baena J, Sanchez A, Bañeras J, Cordón J, Duran N, Ruiz A, Caballero J, Nuvials X, Riera J, Serra J, Rutten AMF, van Ieperen SNM, Der Kinderen EPHM, Van Logten T, Kovacikova L, Skrak P, Zahorec M, Kyle UG, Akcan-Arikan A, Silva JC, Mackey G, Lusk J, Goldsworthy M, Shekerdemian LS, Coss-Bu JA, Wood D, Harrison D, Parslow R, Davis P, Pappachan J, Goodwin S, Ramnarayan P, Chernyshuk S, Yemets H, Zhovnir V, Pulitano’ SM, De Rosa S, Mancino A, Villa G, Tosi F, Franchi P, Conti G, Patel B, Khine H, Shah A, Sung D, Singer L, Haghbin S, Inaloo S, Serati Z, Idei M, Nomura T, Yamamoto N, Sakai Y, Yoshida T, Matsuda Y, Yamaguchi Y, Takaki S, Yamaguchi O, Goto T, Longani N, Medar S, Abdel-Aal IR, El Adawy AS, Mohammed HMEH, Mohamed AN, Parry SM, Knight LD, Denehy L, De Morton N, Baldwin CE, Sani D, Kayambu G, da Silva VZM, Phongpagdi P, Puthucheary ZA, Granger CL, Rydingsward JE, Horkan CM, Christopher KB, Muscedere J, Scott SH, Saha T, Hamilton A, Petsikas D, Payne D, Boyd JG, Puthucheary ZA, McNelly AS, Rawal J, McWilliams D, Connolly B, McPhail MJ, Sidhu P, Rowlerson A, Moxham J, Harridge SD, Hart N, Montgomery HE, Jovaisa T, Thomas B, Jones C, Gupta D, Wijayatilake DS, Shum HP, King HS, Chan KC, Tang KB, Yan WW, Arias CC, Latorre J, De La Rica AS, Reeves E, Garrido EM, Feijoo AM, Gancedo CH, Tofiño AL, Rodríguez FG, Gemmell LK, Campbell R, Doherty P, MacKay A, Singh N, Atkins G, Vitaller S, Nagib H, Prieto J, Del Arco A, Zayas B, Gomez C, Tirumala S, Pasha SA, Kumari BK, Martinez-Lopez P, Snelson C, Puerto-Morlán A, Nuevo-Ortega P, Pujol LM, Dolset RA, González BS, Riera SQ, Álvarez JT, Quintana S, Martínez L, Algarte R, Aitken LM, Sánchez B, Trenado J, Tomas E, Brock N, Viegas E, Filipe E, Cottle D, Traynor T, Martínez MVT, Márquez MP, Rattray J, Gómez LC, Martínez NA, Muñoz JMM, Bellver BQ, Varea MM, Llorente MÁA, Calvo CP, Hillier SD, Faulds MC, Hendra H, Kenardy J, Lawrence N, Maekawa K, Hayakawa M, Ono Y, Kodate A, Sadamoto Y, Tominaga N, Mizugaki A, Murakami H, Yoshida T, Hull AM, Katabami K, Wada T, Sawamura A, Gando S, Silva S, Kerhuel L, Malagurski B, Citerio G, Chabanne R, Laureys S, Ullman A, Puybasset L, Nobile L, Pognuz ER, Rossetti AO, Verginella F, Gaspard N, Creteur J, Ben-Hamouda N, Oddo M, Taccone FS, Le Brocque R, Ono Y, Hayakawa M, Iijima H, Maekawa K, Kodate A, Sadamoto Y, Mizugaki A, Murakami H, Katabami K, Wada T, Mitchell M, Sawamura A, Gando S, Kodate A, Katabami K, Wada T, Ono Y, Maekawa K, Hayakawa M, Sawamura A, Gando S, Davis C, Andersen LW, Raymond T, Berg R, Nadkarni V, Grossestreuer A, Kurth T, Donnino M, Krüger A, Ostadal P, Janotka M, Macfarlane B, Vondrakova D, Kongpolprom N, Cholkraisuwat J, Pekkarinen PT, Ristagno G, Masson S, Latini R, Bendel S, Ala-Kokko T, Varpula T, Azevedo JC, Vaahersalo J, Hoppu S, Tiainen M, Mion MM, Plebani M, Pettilä V, Skrifvars M, Son Y, Kim KS, Suh GJ, Rocha LL, Kwon WY, Ko JI, Park MJ, Cavicchi FZ, Iesu E, Nobile L, Vincent JL, Creteur J, Taccone FS, Tanaka H, De Freitas FFM, Otani N, Ode S, Ishimatsu S, Martínez L, Algarte R, Sánchez B, Romero I, Martínez F, Quintana S, Trenado J, Cavalheiro AM, Vondrakova D, Ostadal P, Kruger A, Janotka M, Malek F, Neuzil P, Yeh YC, Chen YS, Wang CH, Huang CH, Lucinio NM, Chao A, Lee CT, Lai CH, Chan WS, Cheng YJ, Sun WZ, Kaese S, Horstmann C, Lebiedz P, Mourad M, Lobato MS, Gaudard P, Eliet J, Zeroual N, Colson P, Ostadal P, Mlcek M, Hrachovina M, Kruger A, Vondrakova D, Janotka M, Ebeling G, Mates M, Hala P, Kittnar O, Neuzil P, Jacky A, Rudiger A, Spahn DR, Bettex DA, Kara A, Akin S, Kraegpoeth A, Dos reis Miranda D, Struijs A, Caliskan K, van Thiel RJ, Dubois EA, de Wilde W, Zijlstra F, Gommers D, Ince C, Marca L, Laerkner E, Xini A, Mongkolpun W, Cordeiro CPR, Leite RT, Lheureux O, Bader A, Rincon L, Santacruz C, Preiser JC, Chao A, De Brito-Ashurst I, Chao AS, Chen YS, Kim W, Ahn C, Cho Y, Lim TH, Oh J, Choi KS, Jang BH, Ha JK, White C, Mecklenburg A, Stamm J, Soeffker G, Kubik M, Sydow K, Reichenspurner H, Kluge S, Braune S, Bergantino B, Ruberto F, Gregory S, Magnanimi E, Privato E, Zullino V, Bruno K, Pugliese F, Sales G, Girotto V, Vittone F, Brazzi L, Fritz C, Forni LG, Kimmoun A, Vanhuyse F, Trifan B, Orlowski S, Albuisson E, Tran N, Levy B, Chhor V, Joachim J, Follin A, Flowers E, Champigneulle B, Chatelon J, Fave G, Mantz J, Pirracchio R, Diaz DD, Villanova M, Aguirregabyria M, Andrade G, López L, Curtis A, Palencia E, John G, Cowan R, Hart R, Lake K, Litchfield K, Song JW, Lee YJ, Cho YJ, Choi S, Wood CA, Vermeir P, Vandijck D, Blot S, Mariman A, Verhaeghe R, Deveugele M, Vogelaers D, Chok L, Bachli EB, Bettex D, Siu K, Cottini SR, Keller E, Maggiorini M, Schuepbach R, Fiks T, Stiphout C, Grevelink M, Vaneker I, Ruijter A, Buise M, Venkatesan K, Spronk PE, Tena SA, Barrachina LG, Portillo JHR, Aznar GP, Campos LM, Sellés MDF, Tomás MA, Muncharaz AB, Skinner L, Muhammad JBH, Monsalvo S, Olavarria E, Stümpfle R, Na SJ, Park J, Chung CR, Park CM, Suh GY, Yang JH, Witter T, Ng L, Brousseau C, Butler MB, Erdogan M, Dougall PCM, Green RS, Abbott TEF, Torrance HDT, Cron N, Vaid N, Emmanuel J, Seet E, Siddiqui SS, Prabu N, Chaudhari HK, Patil VP, Divatia JV, Solanki S, Kulkarni AP, Gutierrez LAR, Bader A, Brasseur A, Baptista N, Lheureux O, Vincent JL, Creteur J, Taccone FS, Hempel D, Stauffert N, Recker F, Schröder T, Reusch S, Schleifer J, Escoval A, Breitkreutz R, Sjövall F, Perner A, Møller MH, Moraes RB, Borges FK, Guillen JAV, Zabaletta WJC, Ruiz-Ramos J, Ramirez P, Tomas E, Marqués-Miñana MR, Villarreal E, Gordon M, Sosa M, Concha P, Castellanos A, Menendez R, Ramírez CS, Santana MC, Balcázar LC, Agrawal R, Escalada SH, Viera MAH, Vázquez CFL, Díaz JJD, Campelo FA, Monroy NS, Santana PS, Santana SR, Gutiérrez-Pizarraya A, Garnacho-Montero J, Mathew R, Martin C, Baumstarck K, Leone M, Martín-Loeches I, Pirracchio R, Legrand M, Mainardi JL, Mantz J, Cholley B, Hubbard A, Varma A, Frontera PR, Vega LMC, Miguelena PRDG, Usón MCV, López AR, Clemente EA, Ibañes PG, Aguilar ALR, Palomar M, Olaechea P, Dima E, Uriona S, Vallverdu M, Catalan M, Nuvials X, Aragon C, Lerma FA, Jeon YD, Jeong WY, Kim MH, Jeong IY, Charitidou E, Ahn MY, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS, Bassi GL, Xiol EA, Senussi T, Perivolioti E, Idone FA, Motos A, Chiurazzi C, Travierso C, Fernández-Barat L, Amaro R, Hua Y, Ranzani OT, Bobi Q, Rigol M, Pratikaki M, Torres A, Fernández IF, Soler EA, de Vera APR, Pastor EE, Hernandis V, Ros Martínez J, Rubio RJ, Torner MM, Brugger SC, Vrettou C, Eroles AA, Moles SI, Cabello JT, Schoenenberger JA, Casals XN, Vidal MV, Garrido BB, Martinez MP, Mirabella L, Cotoia A, Giannopoulos A, Tullo L, Stella A, Di Bello F, Di Gregorio A, Dambrosio M, Cinnella G, Rosario LEDLC, Lesmes SPG, Romero JCG, Herrera ANG, Zakynthinos S, Pertuz EDD, Sánchez MJG, Sanz ER, Hualde JB, Hernández AA, Ramirez JR, Takahashi H, Kazutoshi F, Okada Y, Oobayashi W, Routsi C, Naito T, Baidya DK, Maitra S, Anand RK, Ray BR, Arora MK, Ruffini C, Rota L, Corona A, Sesana G, Atchade E, Ravasi S, Catena E, Naumann DN, Mellis C, Husheer SL, Bishop J, Midwinter MJ, Hutchings S, Corradi F, Brusasco C, Houzé S, Manca T, Ramelli A, Lattuada M, Nicolini F, Gherli T, Vezzani A, Young A, Carmona AF, Santiago AI, Guillamon LN, Jean-Baptiste S, Delgado MJG, Delgado-Amaya M, Curiel-Balsera E, Rivera-Romero L, Castillo-Lorente E, Carrero-Gómez F, Aguayo-DeHoyos E, Healey AJ, Cameron C, Jiao L, Thabut G, Stümpfle R, Pérez A, Martin S, del Moral OL, Toval S, Rico J, Aldecoa C, Oguzhan K, Demirkiran O, Kirman M, Genève C, Bozbay S, Kosuk ME, Asyralyyeva G, Dilek M, Duzgun M, Telli S, Aydin M, Yilmazer F, Hodgson LE, Dimitrov BD, Tanaka S, Stubbs C, Forni LG, Venn R, Vedage D, Shawaf S, Naran P, Sirisena N, Kinnear J, Dimitrov BD, 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Pirracchio R, Rigon MR, Carone M, Chevret S, Annane D, Eladawy S, El-Hamamsy M, Bazan N, Elgendy M, De Pascale G, Vallecoccia MS, Cutuli SL, Di Gravio V, Pennisi MA, Conti G, Antonelli M, Andreis DT, Khaliq W, Singer M, Hartmann J, Harm S, Carmona SA, Almudevar PM, Abellán AN, Ramos JV, Pérez LP, Valbuena BL, Sanz NM, Simón IF, Arrigo M, Feliot E, Deye N, Cariou A, Guidet B, Jaber S, Leone M, Resche-Rigon M, Baron AV, Legrand M, Gayat E, Mebazaa A, Balik M, Kolnikova I, Maly M, Waldauf P, Tavazzi G, Kristof J, Herpain A, Su F, Post E, Taccone F, Vincent JL, Creteur J, Lee C, Hatib F, Jian Z, Buddi S, Cannesson M, Fileković S, Turel M, Knafelj R, Gorjup V, Stanić R, Gradišek P, Cerović O, Mirković T, Noč M, Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S, Lin KC, Hung WT, Chiang CC, Huang WC, Juan WC, Lin SC, Cheng CC, Lin PH, Fong KY, Hou DS, Kang PL, Wann SR, Chen YS, Mar GY, Liu CP, Paul M, Bougouin W, Geri G, Dumas F, Champigneulle B, Legriel S, Charpentier J, Mira JP, Sandroni C, 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Anzueto A, Aliberti S, Restrepo MI, Larsson JS, Redfors B, Ricksten SE, Haines R, Powell-Tuck J, Leonard H, Ostermann M, Berthelsen RE, Itenov TS, Perner A, Jensen JU, Ibsen M, Jensen AEK, Bestle MH, Bucknall T, Dixon J, Boa F, MacPhee I, Philips BJ, Doyle J, Saadat F, Samuels T, Huddart S, McCormick B, DeBrunnar R, Preece J, Swart M, Peden C, Richardson S, Forni L, Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste M, Collange O, Levrat Q, Villard I, Thévenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Mimoz O, Auquier P, Pawar S, Jacques T, Deshpande K, Pusapati R, Wood B, Pulham RA, Wray J, Brown K, Pierce C, Nadel S, Ramnarayan P, Azevedo JR, Montenegro WS, Rodrigues DP, Sousa SC, Araujo VF, Leitao AL, Prazeres PH, Mendonca AV, Paula MP, Das Neves A, Loudet CI, Busico M, Vazquez D, Villalba D, Lischinsky A, Veronesi M, Emmerich M, Descotte E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Grall M, Miranda S, Cailleux-Talbot N, Cardinael N, Contentin N, Grangé S, Girault C, Benhamou Y, Lévesque H, Armengol G. [An unusual cause of digital ischemia]. Rev Med Interne 2016; 38:282-283. [PMID: 27062099 DOI: 10.1016/j.revmed.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/04/2016] [Indexed: 12/28/2022]
Affiliation(s)
- M Grall
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - S Miranda
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - N Cailleux-Talbot
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - N Cardinael
- Département d'hématologie, centre Henri-Becquerel, Rouen, France
| | - N Contentin
- Département d'hématologie, centre Henri-Becquerel, Rouen, France
| | - S Grangé
- Département de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Girault
- Département de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U1096, université de Rouen, Rouen, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Grangé S, Bekri S, Artaud-Macari E, Francois A, Girault C, Poitou AL, Benhamou Y, Vianey-Saban C, Benoist JF, Châtelet V, Tamion F, Guerrot D. Adult-onset renal thrombotic microangiopathy and pulmonary arterial hypertension in cobalamin C deficiency. Lancet 2015; 386:1011-2. [PMID: 26369474 DOI: 10.1016/s0140-6736(15)00076-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
| | - Soumeya Bekri
- Metabolic Biochemistry Department, Rouen University Hospital, Rouen, France
| | | | - Arnaud Francois
- Pathology Department, Rouen University Hospital, Rouen, France
| | - Christophe Girault
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France; UPRES EA 3830, Rouen University Medical School, Rouen, France; IRIB, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Anne-Laure Poitou
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France; Nephrology Department, Rouen University Hospital, Rouen, France
| | - Ygal Benhamou
- Internal Medicine Department, Rouen University Hospital, Rouen, France; INSERM U1096, Rouen University Medical School, Rouen, France
| | | | | | | | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France; INSERM U1096, Rouen University Medical School, Rouen, France; IRIB, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Dominique Guerrot
- Nephrology Department, Rouen University Hospital, Rouen, France; INSERM U1096, Rouen University Medical School, Rouen, France; IRIB, Institute for Research and Innovation in Biomedicine, Rouen, France
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Giabicani M, Guitard PG, Guerrot D, Grangé S, Teule L, Dureuil B, Veber B. [Successful treatment of extreme hypernatremia by continuous veno-venous hemodiafiltration]. Nephrol Ther 2015; 11:492-5. [PMID: 26169976 DOI: 10.1016/j.nephro.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/24/2014] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 11/29/2022]
Abstract
Extreme hypernatremia in intensive care unit are frequently associated with a poor prognosis and their treatment, when associated with acute renal failure, is not consensual. We report the case of a 39-year-old man admitted in our intensive care unit for coma who presented extreme hyperosmolar hypernatremia (sodium 180 mmol/L, osmolarity 507 mOsm/L) associated with acute renal failure (urea 139.3 mmol/L, creatinine 748 μmol/L) and many other metabolic abnormalities. He was treated with hypotonic fluid administration and continuous renal replacement therapy (veno-venous hemodiafiltration) using an industrial dialysate fluid. Natremia was controlled by modulating intravenous water and sodium intake according to biological data. After 10 days, continuous renal replacement therapy was stopped and neurological exam was normal. Continuous veno-venous hemodiafiltration may be useful for treatment of extreme hypernatremia by allowing gradual correction of fluid and electrolyte disorders.
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Affiliation(s)
- Mikhael Giabicani
- Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - Pierre-Gildas Guitard
- Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - Dominique Guerrot
- Service de néphrologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - Steven Grangé
- Service de néphrologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - Lauranne Teule
- Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - Bertrand Dureuil
- Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - Benoît Veber
- Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France
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Grangé S, Hanoy M, Le Roy F, Guerrot D, Godin M. Monitoring of hemodialysis quality-of-care indicators: why is it important? BMC Nephrol 2013; 14:109. [PMID: 23705852 PMCID: PMC3701507 DOI: 10.1186/1471-2369-14-109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 05/03/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Meeting specific guideline targets is associated with improved survival rates and reduced hospitalizations in the dialysis population. This prospective work evaluated the adequacy of hemodialysis quality indicators in an in-center hemodialysis population with severe comorbidities, and assessed whether clinical practice could impact intermediate outcomes. METHODS All the chronic hemodialysis patients treated in Rouen University Hospital hemodialysis Unit between January 2009 and April 2010 were included in this observational study. Every quarter, mean levels and prevalence of conformity were collected for the following indicators: anemia, dialysis dose, serum calcium and phosphorus, PTH, 25OH-vitamin D, albumin, serum bicarbonate, LDL-cholesterol, serum β2-microglobulin, systolic and diastolic blood pressure, intradialytic hypotension and vascular access. Conformity of quality-of-care indicators was determined according to targets defined by international guidelines, whenever available. RESULTS Altogether, 124 patients were included in the study. Thirty-three patients were evaluated during the entire follow-up period. An improvement in the percentage of conformity was observed for hemoglobin, dialysis dose, phosphates, PTH, serum bicarbonate and β2-microglobulin in the global population. Failure to improve conformity rates for several indicators, including serum albumin, was found, possibly depending on patients' comorbidities rather than on quality of care. CONCLUSION Overall, this study shows that following quality-of-care indicators can improve clinical practice by identifying center-specific weaknesses, prompting the establishment of corrective measures. Finally, we suggest that the definition and targets of some indicators, especially hypertension and LDL-cholesterol, be reviewed, since evidence of their association with mortality is not demonstrated.
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Affiliation(s)
- Steven Grangé
- Nephrology department, Rouen University Hospital, 1 Avenue de Germont 76031 Rouen Cedex, Rouen, France
| | - Mélanie Hanoy
- Nephrology department, Rouen University Hospital, 1 Avenue de Germont 76031 Rouen Cedex, Rouen, France
| | - Frank Le Roy
- Nephrology department, Rouen University Hospital, 1 Avenue de Germont 76031 Rouen Cedex, Rouen, France
| | - Dominique Guerrot
- Nephrology department, Rouen University Hospital, 1 Avenue de Germont 76031 Rouen Cedex, Rouen, France
- INSERM Unit 1096, Rouen University Medical School, Rouen, France
| | - Michel Godin
- Nephrology department, Rouen University Hospital, 1 Avenue de Germont 76031 Rouen Cedex, Rouen, France
- INSERM Unit 1096, Rouen University Medical School, Rouen, France
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Grangé S, Hanoy M, Renou M, Gavard MS, Le Roy F, Godin M. Caractérisation des paramètres hémodynamiques per-dialytiques associés au phénomène d’hypertension artérielle intra-dialytique. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.088] [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: 11/27/2022]
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Grangé S, Legallicier B, Francois A, Soulis F, Guerrot D, Freguin-Bouilland C, Godin M. Étude de corrélation entre index de résistance vasculaire et indices histomorphométriques rénaux chez le patient transplanté rénal. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.276] [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: 10/17/2022]
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Laurent C, Grangé S, Hanoy M, Le Roy F, Godin M. À propos d’un cas de calcinose tumorale traité par hémodiafiltration post-dilution quotidienne. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.109] [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: 10/17/2022]
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Grangé S, Legallicier B, Francois A, Soulis F, Guerrot D, Freguin-Bouilland C, Godin M. Étude de corrélation entre index de résistance vasculaire et indices histomorphométriques rénaux. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.209] [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: 10/17/2022]
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Abstract
Deferasirox is the first oral iron chelator and, as such, is widely used for the treatment of chronic iron overload. However, recent data from large studies confirmed the renal toxicity of deferasirox. We report a case of Fanconi syndrome associated with acute renal failure in a patient receiving deferasirox. In particular, new insights regarding the pathophysiology of the renal disease due to this treatment are discussed. This case highlights the importance of a careful monitoring of kidney function, markers of proximal tubulopathy and ferritinaemia in patients receiving deferasirox.
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Affiliation(s)
- Steven Grangé
- Nephrology Department, Rouen University Hospital, 1 Avenue de Germont, 76031 Rouen Cedex, Rouen, France.
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