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Ait Hssain A, Petit M, Wiest C, Simon L, Al-Fares AA, Hany A, Garcia-Gomez DI, Besa S, Nseir S, Guervilly C, Alqassem W, Lesouhaitier M, Chelaru A, Sin SW, Roncon-Albuquerque R, Giani M, Lepper PM, Lavillegrand JR, Park S, Schellongowski P, Fawzy Hassan I, Combes A, Sonneville R, Schmidt M. Extracorporeal membrane oxygenation for tuberculosis-related acute respiratory distress syndrome: An international multicentre retrospective cohort study. Crit Care 2024; 28:332. [PMID: 39385275 PMCID: PMC11465915 DOI: 10.1186/s13054-024-05110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/24/2024] [Indexed: 10/12/2024] Open
Abstract
OBJECTIVE To report the outcomes of patients with severe tuberculosis (TB)-related acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO), including predictors of 90-day mortality and associated complications. METHODS An international multicenter retrospective study was conducted in 20 ECMO centers across 13 countries between 2002 and 2022. RESULTS We collected demographic data, clinical details, ECMO-related complications, and 90-day survival status for 79 patients (median APACHE II score of 20 [25th to 75th percentile, 16 to 28], median age 39 [28 to 48] years, PaO2/FiO2 ratio of 69 [55 to 82] mmHg before ECMO) who met the inclusion criteria. Thoracic computed tomography showed that 61 patients (77%) had cavitary TB, while 18 patients (23%) had miliary TB. ECMO-related complications included major bleeding (23%), ventilator-associated pneumonia (41%), and bloodstream infections (32%). The overall 90-day survival rate was 51%, with a median ECMO duration of 20 days [10 to 34] and a median ICU stay of 42 days [24 to 65]. Among patients on VV ECMO, those with miliary TB had a higher 90-day survival rate than those with cavitary TB (90-day survival rates of 81% vs. 46%, respectively; log-rank P = 0.02). Multivariable analyses identified older age, drug-resistant TB, and pre-ECMO SOFA scores as independent predictors of 90-day mortality. CONCLUSION The use of ECMO for TB-related ARDS appears to be justifiable. Patients with miliary TB have a much better prognosis compared to those with cavitary TB on VV ECMO.
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Affiliation(s)
- Ali Ait Hssain
- Medical Intensive Care Unit, Hamad General Hospital, Department of Medicine, Weill Cornell Medical College Doha, College of Health and Life Science, Hamad Bin Khalifa University, Doha, Qatar
| | - Matthieu Petit
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, Inserm U1018, CESP, University Versailles Saint Quentin - University Paris Saclay, Guyancourt, France
| | - Clemens Wiest
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Laura Simon
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Abdulrahman A Al-Fares
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Center for Advanced Respiratory and Cardiac Failure, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Ahmed Hany
- Intensive Care Unit-Al-Adan Hospital, Ministry of Health-Kuwait, Kuwait City, Kuwait
| | | | - Santiago Besa
- Division of Surgery, Department of Cardiac Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille et Inserm U1285, Université de Lille, CNRS, UMR 8576 - UGSF, 59000, Lille, France
| | - Christophe Guervilly
- Center for Studies and Research on Health Services and Quality of Life EA3279, Aix-Marseille University, Service de Medecine Intensive et Reanimation, CHU Hopital Nord, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
| | - Wael Alqassem
- Critical Care Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, UMR 1236, Univ Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Adrian Chelaru
- INSERM U1137, APHP.Nord, Médecine intensive - réanimation, Hôpital Bichat - Claude Bernard, Université Paris Cité, Paris, France
| | | | | | - Marco Giani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Philipp M Lepper
- Department of Pneumology, Allergology and Critical Care Medicine, Department of Emergency Medicine, University Hospital of Saarland and University of Saarland, Homburg, Germany
| | | | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, South Korea
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Ibrahim Fawzy Hassan
- Medical Intensive Care Unit, Hamad General Hospital, Department of Medicine, Weill Cornell Medical College Doha, College of Health and Life Science, Hamad Bin Khalifa University, Doha, Qatar
| | - Alain Combes
- Sorbonne Université, GRC 30 RESPIRE, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013, Paris, France
| | - Romain Sonneville
- INSERM U1137, APHP.Nord, Médecine intensive - réanimation, Hôpital Bichat - Claude Bernard, Université Paris Cité, Paris, France
| | - Matthieu Schmidt
- Sorbonne Université, GRC 30 RESPIRE, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013, Paris, France.
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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Benaïs M, Duprey M, Federici L, Arnaout M, Mora P, Amouretti M, Bourgeon-Ghittori I, Gaudry S, Garçon P, Reuter D, Geri G, Megarbane B, Lebut J, Mekontso-Dessap A, Ricard JD, da Silva D, de Montmollin E. Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study. Ann Intensive Care 2024; 14:54. [PMID: 38592412 PMCID: PMC11004098 DOI: 10.1186/s13613-024-01279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. METHODS Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. RESULTS A total of 1,748 patients were included. Median age was 62.9 [47.4-74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1-6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1-2] deprivations and all had housing deprivation, phenotype D patients had 2 [1-2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2-4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65-1.12); phenotype C (HR, 0.56; 95% CI 0.34-0.93); phenotype D (HR, 1.09; 95% CI 0.78-1.51); phenotype E (HR, 1.20; 95% CI 0.73-1.96). CONCLUSIONS In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.
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Affiliation(s)
- Morgan Benaïs
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Matthieu Duprey
- Service de Réanimation, Grand Hôpital de l'Est Francilien-Site de Marne-la-Vallée, Jossigny, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Michel Arnaout
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Pierre Mora
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - Marc Amouretti
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord-Essonne, Longjumeau, France
| | - Irma Bourgeon-Ghittori
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Stéphane Gaudry
- DMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Pierre Garçon
- Service de Réanimation, Grand Hôpital de l'Est Francilien-Site de Marne-la-Vallée, Jossigny, France
| | - Danielle Reuter
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Guillaume Geri
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Bruno Megarbane
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jordane Lebut
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord-Essonne, Longjumeau, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Jean-Damien Ricard
- DMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
- IAME, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, 75018, Paris, France
| | - Daniel da Silva
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Etienne de Montmollin
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France.
- IAME, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, 75018, Paris, France.
- Service de Médecine Intensive - Réanimation Infectieuse, AP-HP, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
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Hraiech S, Pauly V, Orleans V, Auquier P, Azoulay E, Roch A, Boyer L, Papazian L. COVID-19 among undocumented migrants admitted to French intensive care units during the 2020-2021 period: a retrospective nationwide study. Ann Intensive Care 2023; 13:99. [PMID: 37803153 PMCID: PMC10558416 DOI: 10.1186/s13613-023-01197-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Before the Coronavirus Disease 2019 (COVID-19) pandemic in France, undocumented migrants had a higher risk than general population for being admitted to the intensive care unit (ICU) because of acute respiratory failure or severe infection. Specific data concerning the impact of COVID-19 on undocumented migrants in France are lacking. We aimed to analyze the mortality and respiratory severity of COVID-19 in this specific population. We retrospectively included all undocumented adult migrants admitted in French ICUs from March 2020 through April 2021 using the French nationwide hospital information system (Programme de Médicalisation des Systèmes d'Information). We focused on admissions related to COVID-19. Undocumented migrants were compared to the general population, first in crude analysis, then after matching on age, severity and main comorbidities. The primary outcome was the ICU mortality from COVID-19. Secondary objectives were the incidence of acute respiratory distress syndrome (ARDS), the need for mechanical ventilation (MV), the duration of MV, ICU and hospital stay. RESULTS During the study period, the rate of ICU admission among patients hospitalized for COVID-19 was higher for undocumented migrants than for general population (463/1627 (28.5%) vs. 81 813/344 001 (23.8%); p < 0.001). Although ICU mortality was comparable after matching (14.3% for general population vs. 13.3% for undocumented migrants; p = 0.50), the incidence of ARDS was higher among undocumented migrants (odds ratio, confidence interval (OR (CI)) 1.25 (1.06-1.48); p = 0.01). Undocumented migrants needed more frequently invasive MV (OR (CI) 1.2 (1.01-1.42); p = 0.04 than general population. There were no differences between groups concerning duration of MV, ICU and hospital length of stay. CONCLUSION During the first waves of COVID-19 in France, undocumented migrants had a mortality similar to the general population but a higher risk for ICU admission and for developing an ARDS. These results highlight the need for reinforcing prevention and improving primary healthcare access for people in irregular situation.
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Affiliation(s)
- Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.
| | - Vanessa Pauly
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Départment d'Informatique Médical, AP-HM, Marseille, France
| | - Véronica Orleans
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Départment d'Informatique Médical, AP-HM, Marseille, France
| | - Pascal Auquier
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Elie Azoulay
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Antoine Roch
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Laurent Boyer
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Départment d'Informatique Médical, AP-HM, Marseille, France
| | - Laurent Papazian
- Faculté de medecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France
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Vignier N, Moussaoui S, Marsaudon A, Wittwer J, Jusot F, Dourgnon P. Burden of infectious diseases among undocumented migrants in France: Results of the Premiers Pas survey. Front Public Health 2022; 10:934050. [PMID: 35991026 PMCID: PMC9386354 DOI: 10.3389/fpubh.2022.934050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction An increase in migration rates to the European Union has been observed over the last few years. Part of these migrants is undocumented. This work aimed to describe the reported frequency of infectious diseases and their associated factors among unselected samples of undocumented migrants in France. Methodology The Premier Pas survey is a cross-sectional epidemiological survey of a random sample (two-stage sample design) conducted among undocumented migrants recruited in Paris and the Bordeaux region, in places and facilities likely to be frequented by undocumented migrants. The percentages were weighted. The analysis was performed using Stata 15.1 software. Results A total of 1,223 undocumented migrants were recruited from 63 places and facilities, with a participation rate of 50%. Most of them were between 30 and 40 years of age (36%), 69% were men, aged mainly 30–40 (36%) years old, from sub-Saharan Africa (60%) or North Africa (25%), and 60% had arrived <3 years earlier. Among the participants, 24.8% declared a poor perceived health status and 33.5% a chronic health condition. Dental infections concerned 43.2% of the participants. Apart from dental issues, 12.9% reported suffering from at least one infectious disease: HIV infection (3.5%), chronic hepatitis B virus infection (3.1%), upper respiratory tract infection (1.7%), skin mycosis (1.2%), skin and soft tissue infection (0.8%), chronic hepatitis C infection (0.8%), urinary tract infection (0.7%), lower respiratory tract infection (0.7%), scabies (0.3%), tuberculosis disease (0.2%), vaginal mycosis (0.6%), and herpes (0.1%). Regarding HIV, HBV, and HCV infections, 56, 71, and 89%, respectively, were diagnosed after their arrival. Chronic viral infections were more often reported by undocumented migrants from sub-Saharan Africa and Latin America. In multivariate analysis, a higher risk of reporting chronic viral infection was observed among people food insecure. Conclusion This original study on a large random sample confirms the frequency of infectious diseases among undocumented migrants in France and the importance of integrating their screening during a health Rendezvous and their management into early access to care and inclusive medico-psycho-social management.
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Affiliation(s)
- Nicolas Vignier
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre hospitalier de Cayenne, Cayenne, French Guiana
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, Paris, France
- French Collaborative Institute on Migration, Institut Convergences Migrations, ICM, Aubervilliers, France
- Université Sorbonne Paris Nord, UFR SMBH, IAME, INSERM UMR 1137, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Department of Infectious and Tropical diseases, Bobigny, France
- *Correspondence: Nicolas Vignier
| | - Sohela Moussaoui
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, Paris, France
- Bordeaux University, Bordeaux Population Health, INSERM U1219, Economic and Management of Healthcare Organizations Team, Emos Team, Bordeaux, France
| | - Antoine Marsaudon
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
| | - Jérome Wittwer
- Bordeaux University, Bordeaux Population Health, INSERM U1219, Economic and Management of Healthcare Organizations Team, Emos Team, Bordeaux, France
| | - Florence Jusot
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
- Université Paris-Dauphine, PSL-Research University, Leda-Legos, Paris, France
| | - Paul Dourgnon
- Institut de recherche et documentation en économie de la santé, IRDES, Paris, France
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