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Asakage A, Ishihara S, Boutin L, Dépret F, Sugaya T, Sato N, Gayat E, Mebazaa A, Deniau B. Predictive Performance of Neutrophil Gelatinase Associated Lipocalin, Liver Type Fatty Acid Binding Protein, and Cystatin C for Acute Kidney Injury and Mortality in Severely Ill Patients. Ann Lab Med 2024; 44:144-154. [PMID: 37749888 PMCID: PMC10628750 DOI: 10.3343/alm.2023.0083] [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: 02/25/2023] [Revised: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common condition in severely ill patients associated with poor outcomes. We assessed the associations between urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes. Methods We assessed the predictive performances of uNGAL, uLFABP, and uCysC measured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes. The primary outcome was the occurrence of AKI during ICU stay; secondary outcomes were 28-day and 1-yr allcause mortality. Results In total, 1,759 patients were admitted to the ICU, and 728 (41.4%) developed AKI. Median (interquartile range, IQR) uNGAL, uLFABP, and uCysC concentrations on admission were 147.6 (39.9-827.7) ng/mL, 32.4 (10.5-96.0) ng/mL, and 0.33 (0.12-2.05) mg/L, respectively. Biomarker concentrations on admission were higher in patients who developed AKI and associated with AKI severity. Three hundred fifty-six (20.3%) and 647 (37.9%) patients had died by 28 days and 1-yr, respectively. Urinary biomarker concentrations at ICU discharge were higher in non-survivors than in survivors. The areas under the ROC curve (95% confidence interval) of uLFABP for the prediction of AKI, 28-day mortality, and 1-yr mortality (0.70 [0.67-0.72], 0.63 [0.59-0.66], and 0.57 [0.51-0.63], respectively) were inferior to those of the other biomarkers. Conclusions uNGAL, uLFABP, and uCysC concentrations on admission were associated with poor outcomes. However, their predictive performance, individually and in combination, was limited. Further studies are required to confirm our results.
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Affiliation(s)
- Ayu Asakage
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
| | - Shiro Ishihara
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Louis Boutin
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - François Dépret
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Takeshi Sugaya
- Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Etienne Gayat
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Benjamin Deniau
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- Department of UFR de Médecine, Université de Paris Cité, Paris, France
- FHU PROMICE, Paris, France
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Boutin L, Latosinska A, Mischak H, Deniau B, Asakage A, Legrand M, Gayat E, Mebazaa A, Chadjichristos CE, Depret F. Subclinical and clinical acute kidney injury share similar urinary peptide signatures and prognosis. Intensive Care Med 2023; 49:1191-1202. [PMID: 37670154 DOI: 10.1007/s00134-023-07198-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Acute kidney injury (AKI) is a frequent and severe condition in intensive care units (ICUs). In 2020, the Acute Dialysis Quality Initiative (ADQI) group proposed a new stage of AKI, referred to as stage 1S, which represents subclinical disease (sAKI) defined as a positive biomarker but no increase in serum creatinine (sCr). This study aimed to determine and compare the urinary peptide signature of sAKI as defined by biomarkers. METHODS This is an ancillary analysis of the prospective, observational, multinational FROG-ICU cohort study. AKI was defined according to the Kidney Disease Improving Global Outcome definition (AKIKDIGO). sAKI was defined based on the levels of the following biomarkers, which exceeded the median value: neutrophil gelatinase-associated lipocalin (pNGAL, uNGAL), cystatin C (pCysC, uCysC), proenkephalin A 119-159 (pPENKID) and liver fatty acid binding protein (uLFABP). Urinary peptidomics analysis was performed using capillary electrophoresis-mass spectrometry. Samples were collected at the time of study inclusion. RESULTS One thousand eight hundred eighty-five patients had all biomarkers measured at inclusion, which included 1154 patients without AKI (non-AKIKDIGO subgroup). The non-AKIKDIGO subgroup consisted of individuals at a median age of 60 years [48, 71], among whom 321 (27.8%) died. The urinary peptide signatures of sAKI, regardless of the biomarkers used for its definition, were similar to the urinary peptide signatures of AKIKDIGO (inflammation, haemolysis, and endothelial dysfunction). These signatures were also associated with 1-year mortality. CONCLUSION Biomarker-defined sAKI is a common and severe condition observed in patients within intensive care units with a urinary peptide signature that is similar to that of AKI, along with a comparable prognosis.
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Affiliation(s)
- Louis Boutin
- Department of Anesthesiology, Critical Care Medicine and Burn Unit, FHU PROMICE AP-HP, Saint Louis and DMU Parabol, AP-HP, Université Paris Cité, 75010, Paris, France
- UMR-942, MASCOT, INSERM, Cardiovascular Markers in Stress Condition, Université de Paris, 75010, Paris, France
- UMR-S1155, Faculty of Medicine, INSERM Bâtiment Recherche, Tenon Hospital Sorbonne University, 75020, Paris, France
| | | | | | - Benjamin Deniau
- Department of Anesthesiology, Critical Care Medicine and Burn Unit, FHU PROMICE AP-HP, Saint Louis and DMU Parabol, AP-HP, Université Paris Cité, 75010, Paris, France
- UMR-942, MASCOT, INSERM, Cardiovascular Markers in Stress Condition, Université de Paris, 75010, Paris, France
| | - Ayu Asakage
- UMR-942, MASCOT, INSERM, Cardiovascular Markers in Stress Condition, Université de Paris, 75010, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Peri-Operative Medicine, Division of Critical Care Medicine, University of California, UCSF Medical Center, 500 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care Medicine and Burn Unit, FHU PROMICE AP-HP, Saint Louis and DMU Parabol, AP-HP, Université Paris Cité, 75010, Paris, France
- UMR-942, MASCOT, INSERM, Cardiovascular Markers in Stress Condition, Université de Paris, 75010, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care Medicine and Burn Unit, FHU PROMICE AP-HP, Saint Louis and DMU Parabol, AP-HP, Université Paris Cité, 75010, Paris, France
- UMR-942, MASCOT, INSERM, Cardiovascular Markers in Stress Condition, Université de Paris, 75010, Paris, France
| | - Christos E Chadjichristos
- UMR-S1155, Faculty of Medicine, INSERM Bâtiment Recherche, Tenon Hospital Sorbonne University, 75020, Paris, France
| | - François Depret
- Department of Anesthesiology, Critical Care Medicine and Burn Unit, FHU PROMICE AP-HP, Saint Louis and DMU Parabol, AP-HP, Université Paris Cité, 75010, Paris, France.
- UMR-942, MASCOT, INSERM, Cardiovascular Markers in Stress Condition, Université de Paris, 75010, Paris, France.
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Keller F, Beige J, Siwy J, Mebazaa A, An D, Mischak H, Schanstra JP, Mokou M, Perco P, Staessen JA, Vlahou A, Latosinska A. Urinary peptides provide information about the risk of mortality across a spectrum of diseases and scenarios. J Transl Med 2023; 21:663. [PMID: 37741989 PMCID: PMC10518109 DOI: 10.1186/s12967-023-04508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND There is evidence of pre-established vulnerability in individuals that increases the risk of their progression to severe disease or death, although the mechanisms causing this are still not fully understood. Previous research has demonstrated that a urinary peptide classifier (COV50) predicts disease progression and death from SARS-CoV-2 at an early stage, indicating that the outcome prediction may be partly due to vulnerabilities that are already present. The aim of this study is to examine the ability of COV50 to predict future non-COVID-19-related mortality, and evaluate whether the pre-established vulnerability can be generic and explained on a molecular level by urinary peptides. METHODS Urinary proteomic data from 9193 patients (1719 patients sampled at intensive care unit (ICU) admission and 7474 patients with other diseases (non-ICU)) were extracted from the Human Urinary Proteome Database. The previously developed COV50 classifier, a urinary proteomics biomarker panel consisting of 50 peptides, was applied to all datasets. The association of COV50 scoring with mortality was evaluated. RESULTS In the ICU group, an increase in the COV50 score of one unit resulted in a 20% higher relative risk of death [adjusted HR 1.2 (95% CI 1.17-1.24)]. The same increase in COV50 in non-ICU patients resulted in a higher relative risk of 61% [adjusted HR 1.61 (95% CI 1.47-1.76)], consistent with adjusted meta-analytic HR estimate of 1.55 [95% CI 1.39-1.73]. The most notable and significant changes associated with future fatal events were reductions of specific collagen fragments, most of collagen alpha I (I). CONCLUSION The COV50 classifier is predictive of death in the absence of SARS-CoV-2 infection, suggesting that it detects pre-existing vulnerability. This prediction is mainly based on collagen fragments, possibly reflecting disturbances in the integrity of the extracellular matrix. These data may serve as a basis for proteomics-guided intervention aiming towards manipulating/ improving collagen turnover, thereby reducing the risk of death.
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Affiliation(s)
- Felix Keller
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020, Innsbruck, Austria
| | - Joachim Beige
- Martin-Luther-University Halle-Wittenberg, 06108, Halle (Saale), Germany
- Kuratorium for Dialysis and Transplantation, 04129, Leipzig, Germany
| | - Justyna Siwy
- Mosaiques Diagnostics GmbH, 30659, Hannover, Germany
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care, Hôpital Lariboisière, AP-HP, 75010, Paris, France
| | - Dewei An
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, 2800, Mechelen, Belgium
| | | | - Joost P Schanstra
- Institute of Cardiovascular and Metabolic Disease, U1297, Institut National de la Santé et de la Recherche Médicale, 31432, Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062, Toulouse, France
| | - Marika Mokou
- Mosaiques Diagnostics GmbH, 30659, Hannover, Germany
| | - Paul Perco
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020, Innsbruck, Austria
| | - Jan A Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, 2800, Mechelen, Belgium
| | - Antonia Vlahou
- Center of Systems Biology, Biomedical Research Foundation of the Academy of Athens, 11527, Athens, Greece
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Gwin MS, Alexeyev MF, Geurts AM, Lee JY, Zhou C, Yang XM, Cohen MV, Downey JM, Barrington RA, Spadafora D, Audia JP, Frank DW, Voth S, Pastukh VV, Bell J, Ayers L, Tambe DT, Nelson AR, Balczon R, Lin MT, Stevens T. Gamma secretase activating protein promotes end-organ dysfunction after bacterial pneumonia. Am J Physiol Lung Cell Mol Physiol 2023; 325:L174-L189. [PMID: 37366533 PMCID: PMC10396227 DOI: 10.1152/ajplung.00018.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
Pneumonia elicits the production of cytotoxic beta amyloid (Aβ) that contributes to end-organ dysfunction, yet the mechanism(s) linking infection to activation of the amyloidogenic pathway that produces cytotoxic Aβ is unknown. Here, we tested the hypothesis that gamma-secretase activating protein (GSAP), which contributes to the amyloidogenic pathway in the brain, promotes end-organ dysfunction following bacterial pneumonia. First-in-kind Gsap knockout rats were generated. Wild-type and knockout rats possessed similar body weights, organ weights, circulating blood cell counts, arterial blood gases, and cardiac indices at baseline. Intratracheal Pseudomonas aeruginosa infection caused acute lung injury and a hyperdynamic circulatory state. Whereas infection led to arterial hypoxemia in wild-type rats, the alveolar-capillary barrier integrity was preserved in Gsap knockout rats. Infection potentiated myocardial infarction following ischemia-reperfusion injury, and this potentiation was abolished in knockout rats. In the hippocampus, GSAP contributed to both pre- and postsynaptic neurotransmission, increasing the presynaptic action potential recruitment, decreasing neurotransmitter release probability, decreasing the postsynaptic response, and preventing postsynaptic hyperexcitability, resulting in greater early long-term potentiation but reduced late long-term potentiation. Infection abolished early and late long-term potentiation in wild-type rats, whereas the late long-term potentiation was partially preserved in Gsap knockout rats. Furthermore, hippocampi from knockout rats, and both the wild-type and knockout rats following infection, exhibited a GSAP-dependent increase in neurotransmitter release probability and postsynaptic hyperexcitability. These results elucidate an unappreciated role for GSAP in innate immunity and highlight the contribution of GSAP to end-organ dysfunction during infection.NEW & NOTEWORTHY Pneumonia is a common cause of end-organ dysfunction, both during and in the aftermath of infection. In particular, pneumonia is a common cause of lung injury, increased risk of myocardial infarction, and neurocognitive dysfunction, although the mechanisms responsible for such increased risk are unknown. Here, we reveal that gamma-secretase activating protein, which contributes to the amyloidogenic pathway, is important for end-organ dysfunction following infection.
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Affiliation(s)
- Meredith S Gwin
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Mikhail F Alexeyev
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Aron M Geurts
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Ji Young Lee
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Chun Zhou
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Xi-Ming Yang
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Michael V Cohen
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - James M Downey
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Robert A Barrington
- Department of Microbiology and Immunology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Domenico Spadafora
- Department of Microbiology and Immunology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Jonathon P Audia
- Department of Microbiology and Immunology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Dara W Frank
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Sarah Voth
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine, Monroe, Louisiana, United States
| | - Viktoriya V Pastukh
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Jessica Bell
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Linn Ayers
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Dhananjay T Tambe
- Department of Mechanical, Aerospace, and Biomedical Engineering, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Amy R Nelson
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Ron Balczon
- Department of Biochemistry and Molecular Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Mike T Lin
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Troy Stevens
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
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Davison BA, Edwards C, Cotter G, Kimmoun A, Gayat É, Latosinska A, Mischak H, Takagi K, Deniau B, Picod A, Mebazaa A. Plasma and Urinary Biomarkers Improve Prediction of Mortality through 1 Year in Intensive Care Patients: An Analysis from FROG-ICU. J Clin Med 2023; 12:jcm12093311. [PMID: 37176751 PMCID: PMC10179283 DOI: 10.3390/jcm12093311] [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: 04/14/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND This study aimed to assess the value of blood and urine biomarkers in addition to routine clinical variables in risk stratification of patients admitted to ICU. METHODS Multivariable prognostic models were developed in this post hoc analysis of the French and EuRopean Outcome ReGistry in Intensive Care Units study, a prospective observational study of patients admitted to ICUs. The study included 2087 patients consecutively admitted to the ICU who required invasive mechanical ventilation or a vasoactive agent for more than 24 h. The main outcome measures were in-ICU, in-hospital, and 1 year mortality. RESULTS Models including only SAPS II or APACHE II scores had c-indexes for in-hospital and 1 year mortality of 0.64 and 0.65, and 0.63 and 0.61, respectively. The c-indexes for a model including age and estimated glomerular filtration rate were higher at 0.69 and 0.67, respectively. Models utilizing available clinical variables increased the c-index for in-hospital and 1 year mortality to 0.80 and 0.76, respectively. The addition of biomarkers and urine proteomic markers increased c-indexes to 0.83 and 0.78. CONCLUSIONS The commonly used scores for risk stratification in ICU patients did not perform well in this study. Models including clinical variables and biomarkers had significantly higher predictive values.
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Affiliation(s)
- Beth A Davison
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 75010 Paris, France
- Momentum Research, Inc., Durham, NC 27713, USA
| | | | - Gad Cotter
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 75010 Paris, France
- Momentum Research, Inc., Durham, NC 27713, USA
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation Brabois, CHRU de Nancy, Université de Lorraine, 54511 Nancy, France
- Inserm U1116, F-CRIN INI-CRCT, 54500 Nancy, France
| | - Étienne Gayat
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 75010 Paris, France
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 75010 Paris, France
- Université Paris Cité, 75006 Paris, France
| | | | | | - Koji Takagi
- Momentum Research, Inc., Durham, NC 27713, USA
| | - Benjamin Deniau
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 75010 Paris, France
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 75010 Paris, France
- Université Paris Cité, 75006 Paris, France
| | - Adrien Picod
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 75010 Paris, France
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 75010 Paris, France
| | - Alexandre Mebazaa
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, 75010 Paris, France
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 75010 Paris, France
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6
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Pharaboz A, Kimmoun A, Gunst J, Duarte K, Merkling T, Gayat E, Mebazaa A, Glenn-Chousterman B. Association between type II diabetes mellitus and 90-day mortality in a large multicenter prospectively collected cohort. A FROG ICU post-hoc study. J Crit Care 2023; 73:154195. [PMID: 36368176 DOI: 10.1016/j.jcrc.2022.154195] [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: 05/17/2022] [Revised: 09/01/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Factors associated with adverse outcomes in ICU patients with type II (T2DM) are poorly defined. The main goal of this study is to determine the impact of pre-existing T2DM on 90-day mortality post ICU admission. MATERIAL Post-hoc analysis from the FROG-ICU cohort. All patients admitted to ICU who were ventilated and/or treated by a vasoactive agent for >24 h were included. Association between T2DM and 90-day mortality was analyzed in unmatched, and populations matched by propensity score (PS) method to balance confounders recorded before ICU admission. Analysis was performed in non-imputed and imputed datasets. RESULTS 2002 patients were included, and 16% had a history of T2DM. The latter were at inclusion more severely ill (SAPSII score 51(39-67) vs 48(35-61), p < 0.0001; Charlson score 2(1-3) vs 0(0-2), p < 0.0001). In the unmatched cohort, T2DM patients had a higher 90-day risk of death compared to no-DM patients (HR 1.35(1.1-1.65)). The 90-day risk of death was not significantly different T2DM and no T2DM patients after PS matching (HR: 0.81 (0.56-1.18). Results were similar with the analysis performed on imputed datasets (pooled HR: 0.95 (0.69-1.30)). CONCLUSIONS In the present study, T2DM was not associated with 90-day mortality post ICU admission.
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Affiliation(s)
- Alexandre Pharaboz
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Médecine Intensive et Réanimation Brabois, INSERM INSERM U942 and U1116, F-CRIN-INIC RCT, Vandœuvre-lès-Nancy, France
| | - Jan Gunst
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven Herestraat 49, B-3000 Leuven, Belgium
| | - Kevin Duarte
- Université de Lorraine, CHRU de Nancy, INSERM CIC-P 1433, INSERM, F-CRIN-INI CRCT, Vandœuvre-lès-Nancy, France
| | - Thomas Merkling
- Université de Lorraine, CHRU de Nancy, INSERM CIC-P 1433, INSERM, F-CRIN-INI CRCT, Vandœuvre-lès-Nancy, France
| | - Etienne Gayat
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France
| | - Alexandre Mebazaa
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France
| | - Benjamin Glenn-Chousterman
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France.
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7
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Piedrafita A, Siwy J, Klein J, Akkari A, Amaya-garrido A, Mebazaa A, Sanz AB, Breuil B, Montero Herrero L, Marcheix B, Depret F, Fernandez L, Tardif E, Minville V, Alves M, Metzger J, Grossac J, Mischak H, Ortiz A, Gazut S, Schanstra JP, Faguer S, Mayeur N, Casemayou A, Labaste F, Mayeur N, Casemayou A, Labaste F. A universal predictive and mechanistic urinary peptide signature in acute kidney injury. Crit Care 2022; 26:344. [PMID: 36345008 PMCID: PMC9640896 DOI: 10.1186/s13054-022-04193-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The delayed diagnosis of acute kidney injury (AKI) episodes and the lack of specificity of current single AKI biomarkers hamper its management. Urinary peptidome analysis may help to identify early molecular changes in AKI and grasp its complexity to identify potential targetable molecular pathways. METHODS In derivation and validation cohorts totalizing 1170 major cardiac bypass surgery patients and in an external cohort of 1569 intensive care unit (ICU) patients, a peptide-based score predictive of AKI (7-day KDIGO classification) was developed, validated, and compared to the reference biomarker urinary NGAL and NephroCheck and clinical scores. RESULTS A set of 204 urinary peptides derived from 48 proteins related to hemolysis, inflammation, immune cells trafficking, innate immunity, and cell growth and survival was identified and validated for the early discrimination (< 4 h) of patients according to their risk to develop AKI (OR 6.13 [3.96-9.59], p < 0.001) outperforming reference biomarkers (urinary NGAL and [IGFBP7].[TIMP2] product) and clinical scores. In an external cohort of 1569 ICU patients, performances of the signature were similar (OR 5.92 [4.73-7.45], p < 0.001), and it was also associated with the in-hospital mortality (OR 2.62 [2.05-3.38], p < 0.001). CONCLUSIONS An overarching AKI physiopathology-driven urinary peptide signature shows significant promise for identifying, at an early stage, patients who will progress to AKI and thus to develop tailored treatments for this frequent and life-threatening condition. Performance of the urine peptide signature is as high as or higher than that of single biomarkers but adds mechanistic information that may help to discriminate sub-phenotypes of AKI offering new therapeutic avenues.
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Affiliation(s)
- Alexis Piedrafita
- grid.411175.70000 0001 1457 2980Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, and French Intensive Care Renal Network, 31000 Toulouse, France ,grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France
| | - Justyna Siwy
- grid.421873.bMosaiques Diagnostics GmbH, Hannover, Germany
| | - Julie Klein
- grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France
| | - Amal Akkari
- grid.457331.7Université Paris-Saclay, CEA, List, 91120 Palaiseau, France
| | - Ana Amaya-garrido
- grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, France, INI-CRCT, ParisNancy, France
| | - Anna Belen Sanz
- grid.5515.40000000119578126School of Medicine, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, FRIAT and REDINREN, Madrid, Spain
| | - Benjamin Breuil
- grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France
| | - Laura Montero Herrero
- grid.5515.40000000119578126School of Medicine, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, FRIAT and REDINREN, Madrid, Spain
| | - Bertrand Marcheix
- grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France ,grid.411175.70000 0001 1457 2980Department of Cardiac and Vascular Surgery, University Hospital of Toulouse, 31000 Toulouse, France
| | - François Depret
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, France, INI-CRCT, ParisNancy, France
| | - Lucie Fernandez
- grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France
| | - Elsa Tardif
- grid.411175.70000 0001 1457 2980Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, 31000 Toulouse, France
| | - Vincent Minville
- grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France ,grid.411175.70000 0001 1457 2980Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, 31000 Toulouse, France
| | - Melinda Alves
- grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France
| | - Jochen Metzger
- grid.421873.bMosaiques Diagnostics GmbH, Hannover, Germany
| | | | - Julia Grossac
- grid.411175.70000 0001 1457 2980Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, 31000 Toulouse, France
| | - Harald Mischak
- grid.421873.bMosaiques Diagnostics GmbH, Hannover, Germany
| | - Alberto Ortiz
- grid.5515.40000000119578126School of Medicine, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, FRIAT and REDINREN, Madrid, Spain
| | - Stéphane Gazut
- grid.457331.7Université Paris-Saclay, CEA, List, 91120 Palaiseau, France
| | - Joost P. Schanstra
- grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France
| | - Stanislas Faguer
- grid.411175.70000 0001 1457 2980Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, and French Intensive Care Renal Network, 31000 Toulouse, France ,grid.7429.80000000121866389National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Cardiovascular and Metabolic Disease, 31000 Toulouse, France ,grid.15781.3a0000 0001 0723 035XUniversity Paul Sabatier, Toulouse-III, 31000 Toulouse, France
| | - Nicolas Mayeur
- grid.411175.70000 0001 1457 2980Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, 31000 Toulouse, France
| | - Audrey Casemayou
- grid.7429.80000000121866389Institute for Metabolic and Cardiovascular Disease, National Institute of Health and Medical Research, Toulouse, France
| | - François Labaste
- grid.411175.70000 0001 1457 2980Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, 31000 Toulouse, France
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8
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Blet A, McNeil JB, Josse J, Cholley B, Cinotti R, Cotter G, Dauvergne A, Davison B, Duarte K, Duranteau J, Fournier MC, Gayat E, Jaber S, Lasocki S, Merkling T, Peoc’h K, Mayer I, Sadoune M, Laterre PF, Sonneville R, Ware L, Mebazaa A, Kimmoun A. Association between in-ICU red blood cells transfusion and 1-year mortality in ICU survivors. Crit Care 2022; 26:307. [PMID: 36207737 PMCID: PMC9547456 DOI: 10.1186/s13054-022-04171-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Impact of in-ICU transfusion on long-term outcomes remains unknown. The purpose of this study was to assess in critical-care survivors the association between in-ICU red blood cells transfusion and 1-year mortality. METHODS FROG-ICU, a multicenter European study enrolling all-comers critical care patients was analyzed (n = 1551). Association between red blood cells transfusion administered in intensive care unit and 1-year mortality in critical care survivors was analyzed using an augmented inverse probability of treatment weighting-augmented inverse probability of censoring weighting method to control confounders. RESULTS Among the 1551 ICU-survivors, 42% received at least one unit of red blood cells while in intensive care unit. Patients in the transfusion group had greater severity scores than those in the no-transfusion group. According to unweighted analysis, 1-year post-critical care mortality was greater in the transfusion group compared to the no-transfusion group (hazard ratio (HR) 1.78, 95% CI 1.45-2.16). Weighted analyses including 40 confounders, showed that transfusion remained associated with a higher risk of long-term mortality (HR 1.21, 95% CI 1.06-1.46). CONCLUSIONS Our results suggest a high incidence of in-ICU RBC transfusion and that in-ICU transfusion is associated with a higher 1-year mortality among in-ICU survivors. Trial registration ( NCT01367093 ; Registered 6 June 2011).
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Affiliation(s)
- Alice Blet
- grid.7429.80000000121866389Université Paris Cité, Department of Anesthesiology, Critical Care and Burn Unit, INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Hôpitaux Universitaires Saint Louis – Lariboisière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Joel B. McNeil
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University School of Medicine, Nashville, Vanderbilt, TN USA
| | - Julie Josse
- grid.121334.60000 0001 2097 0141Université de Montpellier, IDESP-Institut Desbrest d’Épidémiologie et de Santé Publique, PREMEDICAL - Médecine de Précision Par Intégration de Données et Inférence Causale, CRISAM- Inria Sophia Antipolis – Méditerranée, Montpellier, France
| | - Bernard Cholley
- grid.508487.60000 0004 7885 7602Université Paris Cité, INSERM UMR_S 1140 “Innovations Thérapeutiques en Hémostase”, 75006 Paris, France ,grid.414093.b0000 0001 2183 5849Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Raphaël Cinotti
- grid.4817.a0000 0001 2189 0784University of Nantes, Department of Anesthesia and Critical Care, Hôtel Dieu, Intensive Care Unit, University Hospital of Nantes, Nantes, France
| | - Gad Cotter
- grid.512324.30000 0004 7644 8303Momentum Research, Inc., Chapel Hill, NC 27517 USA
| | - Agnès Dauvergne
- grid.411599.10000 0000 8595 4540Université Paris Cité, Department of Biochemistry, Assistance Publique – Hôpitaux de Paris, Hôpital Beaujon, Clichy, France
| | - Beth Davison
- grid.512324.30000 0004 7644 8303Momentum Research, Inc., Chapel Hill, NC 27517 USA
| | - Kévin Duarte
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, INSERM 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France
| | - Jacques Duranteau
- grid.413784.d0000 0001 2181 7253Université Paris-Sud, Anesthesia and Intensive Care Department, Assistance Publique Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-Céline Fournier
- grid.7429.80000000121866389Université Paris Cité, Department of Anesthesiology, Critical Care and Burn Unit, INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Hôpitaux Universitaires Saint Louis – Lariboisière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Etienne Gayat
- grid.7429.80000000121866389Université Paris Cité, Department of Anesthesiology, Critical Care and Burn Unit, INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Hôpitaux Universitaires Saint Louis – Lariboisière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Samir Jaber
- grid.414352.5Université de Montpellier, Department of Anesthesia and Intensive Care Unit, PhyMedExp, INSERM U1046, CNRS UMR, 9214, CHRU de Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Sigismond Lasocki
- grid.411147.60000 0004 0472 0283Université d’Angers, Department of Anesthesia and Intensive Care Unit, CHU d’Angers, Angers, France
| | - Thomas Merkling
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, INSERM 1433 CIC-P CHRU de Nancy, Inserm U1116 and FCRIN INI-CRCT, Nancy, France
| | - Katell Peoc’h
- grid.50550.350000 0001 2175 4109Université Paris Cité, Department of Biochemistry, CRI INSERM UMR1149, HUPNVS, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Imke Mayer
- grid.6363.00000 0001 2218 4662Institute for Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Malha Sadoune
- grid.7429.80000000121866389Université Paris Cité, Department of Anesthesiology, Critical Care and Burn Unit, INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Hôpitaux Universitaires Saint Louis – Lariboisière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Pierre-François Laterre
- grid.48769.340000 0004 0461 6320Intensive Care Unit, Clinique Universitaire St Luc UCL, Brussels, Belgium
| | - Romain Sonneville
- grid.50550.350000 0001 2175 4109Université Paris Cité, Department of Intensive Care Medicine, INSERM UMR1148, HUPNVS, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Lorraine Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University School of Medicine, Nashville, Vanderbilt, TN USA
| | - Alexandre Mebazaa
- grid.7429.80000000121866389Université Paris Cité, Department of Anesthesiology, Critical Care and Burn Unit, INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Hôpitaux Universitaires Saint Louis – Lariboisière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, CHRU de Nancy, Intensive Care Medicine Babois, INSERM U1116, FCRIN INI-CRCT, Nancy, France
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9
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Takagi K, Akiyama E, Paternot A, Miró Ò, Charron C, Gayat E, Deye N, Cariou A, Monnet X, Jaber S, Guidet B, Damoisel C, Barthélémy R, Azoulay E, Kimmoun A, Fournier MC, Cholley B, Edwards C, Davison BA, Cotter G, Vieillard-Baron A, Mebazaa A. Early echocardiography by treating physicians and outcome in the critically ill: An ancillary study from the prospective multicenter trial FROG-ICU. J Crit Care 2022; 69:154013. [PMID: 35278876 DOI: 10.1016/j.jcrc.2022.154013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the association between the use of early echocardiography performed by the treating physician certified in critical care ultrasound and mortality in ICU patients. MATERIALS AND METHODS FROG-ICU was a multi-center cohort designed to investigate the outcome of critically ill patients. Of the 1359 patients admitted to centers where echocardiography was available, 372 patients underwent echocardiography during the initial 3 days. RESULTS Of the ICU patients admitted for cardiac disease, 47.4% underwent echocardiography, and those patients had the lowest left ventricular ejection fraction 40 [31-58] % and the lowest cardiac output 4.2 [3.2-5.7] L/min compared to patients admitted for other causes (p < 0.001 for both). One-year mortality was 36.8% and 39.9% in patients with and without echocardiography, respectively [HR 0.92 (95% CI 0.75-1.11)]. This result was confirmed after multivariable Cox regression analysis [HR 0.88 (95% CI 0.71-1.08)]. Subgroup analyses suggest that among patients admitted to ICU for cardiac disease, those managed with echocardiography had a lower risk of one-year mortality [HR 0.65 (95% CI 0.43-0.98)]. CONCLUSIONS Early echocardiography by treating physicians was not associated with short- or long-term survival in ICU patients. In subgroups, early echocardiography improved survival in ICU patients admitted for cardiac disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01367093.
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Affiliation(s)
- Koji Takagi
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | - Eiichi Akiyama
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Alexis Paternot
- Intensive Care Unit, University hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Spain; IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain; Medical School, University of Barcelona, Barcelona, Spain
| | - Cyril Charron
- Intensive Care Unit, University hospital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - Etienne Gayat
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Nicolas Deye
- Medical and Toxicology Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, AP-HP, Université Paris Diderot-Paris 7, Inserm U942, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, AP-HP, Université de Paris, Paris, France
| | - Xavier Monnet
- Medical Intensive Care Unit, Bicêtre Hospital, Paris-Saclay University Hospitals, Inserm UMR_S999, Paris-Suclay University, Le Kremlin-Bicetre, France
| | - Samir Jaber
- Intensive Care Unit, Anaesthesia and Critical Care Department, Saint Eloi Teaching Hospital, Centre Hospitalier, Montpellier, France
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de réanimation, F75012 Paris, France
| | - Charles Damoisel
- Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, AP-HP et Université de Paris, Paris, France
| | - Antoine Kimmoun
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Intensive Care Medicine Brabois, CHRU de Nancy, INSERM U1116, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France
| | - Marie-Céline Fournier
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France
| | - Bernard Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France; Inserm UMR_S 1140, Innovations Thérapeutiques en Hémostase, Paris, France
| | | | - Beth A Davison
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | - Gad Cotter
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Momentum Research, Inc., Chapel Hill, NC, USA
| | | | - Alexandre Mebazaa
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France; Department of Anesthesia and Critical Care, University Hospitals Saint-Louis-Lariboisière, DMU Parabol, FHU Promice, APHP.Nord, INI-CRCT, Paris, France.
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10
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Davoudi A, Shickel B, Tighe PJ, Bihorac A, Rashidi P. Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit. Front Digit Health 2022; 4:773387. [PMID: 35656333 PMCID: PMC9152012 DOI: 10.3389/fdgth.2022.773387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patients in critical care settings often require continuous and multifaceted monitoring. However, current clinical monitoring practices fail to capture important functional and behavioral indices such as mobility or agitation. Recent advances in non-invasive sensing technology, high throughput computing, and deep learning techniques are expected to transform the existing patient monitoring paradigm by enabling and streamlining granular and continuous monitoring of these crucial critical care measures. In this review, we highlight current approaches to pervasive sensing in critical care and identify limitations, future challenges, and opportunities in this emerging field.
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Affiliation(s)
- Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States,*Correspondence: Anis Davoudi
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Patrick James Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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11
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Picod A, Morisson L, de Roquetaillade C, Sadoune M, Mebazaa A, Gayat E, Davison BA, Cotter G, Chousterman BG. Systemic Inflammation Evaluated by Interleukin-6 or C-Reactive Protein in Critically Ill Patients: Results From the FROG-ICU Study. Front Immunol 2022; 13:868348. [PMID: 35634339 PMCID: PMC9134087 DOI: 10.3389/fimmu.2022.868348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundThe prognostic impact of high concentration of interleukin-6 (IL-6) or C-reactive protein (CRP), two routinely available markers of systemic inflammation in the general population of critically ill patients, remains unclear. In a large cohort of critically ill patients including septic and non-septic patients, we assessed the relationship between baseline IL-6 or CRP and mortality, organ dysfunction, and the need for organ support.MethodsThis was an ancillary analysis of the prospective French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study including patients with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following intensive care unit (ICU) admission. The primary objective was to determine the association between baseline IL-6 or CRP concentration and survival until day 90. Secondary outcomes included organ dysfunction as evaluated by the Sequential Organ Failure Assessment (SOFA) score, and the need for organ support, including vasopressors/inotropes and/or renal replacement therapy (RRT).ResultsMedian IL-6 and CRP concentrations (n = 2,076) at baseline were 100.9 pg/ml (IQR 43.5–261.7) and 143.7 mg/L (IQR 78.6–219.8), respectively. Day-90 mortality was 30%. High IL-6 or CRP was associated with worse 90-day survival (hazard ratios 1.92 [1.63–2.26] and 1.21 [1.03–1.41], respectively), after adjustment on the Simplified Acute Physiology Score II (SAPS-II). High IL-6 was also associated with the need for organ-support therapies, such as vasopressors/inotropes (OR 2.67 [2.15–3.31]) and RRT (OR 1.55 [1.26–1.91]), including when considering only patients independent from those supports at the time of IL-6 measurement. Associations between high CRP and organ support were inconsistent.ConclusionIL-6 appears to be preferred over CRP to evaluate critically ill patients’ prognoses.
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Affiliation(s)
- Adrien Picod
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
- Sorbonne University, Paris, France
- *Correspondence: Adrien Picod,
| | - Louis Morisson
- Department of Anesthesiology and Pain Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l’Est de l’Ile de Montréal, Montréal, QC, Canada
| | - Charles de Roquetaillade
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
| | - Malha Sadoune
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
| | - Beth A. Davison
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
- Momentum Research Inc., Durham, NC, United States
| | - Gad Cotter
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
- Momentum Research Inc., Durham, NC, United States
| | - Benjamin Glenn Chousterman
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis—Lariboisière, AP-HP, Paris, France
- UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovascular Markers in Stressed Conditions (MASCOT), Paris University, Paris, France
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12
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Soussi S, Sharma D, Jüni P, Lebovic G, Brochard L, Marshall JC, Lawler PR, Herridge M, Ferguson N, Del Sorbo L, Feliot E, Mebazaa A, Acton E, Kennedy JN, Xu W, Gayat E, Dos Santos CC. Identifying clinical subtypes in sepsis-survivors with different one-year outcomes: a secondary latent class analysis of the FROG-ICU cohort. Crit Care 2022; 26:114. [PMID: 35449071 PMCID: PMC9022336 DOI: 10.1186/s13054-022-03972-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis. METHODS In the original FROG-ICU prospective, observational, multicenter study, intensive care unit (ICU) patients with sepsis on admission (Sepsis-3) were identified (N = 655). Among them, 467 were discharged alive from the ICU and included in the current study. Latent class analysis was applied to identify distinct sepsis-survivors clinical classes using readily available data at ICU discharge. The primary endpoint was one-year mortality after ICU discharge. RESULTS At ICU discharge, two distinct subtypes were identified (A and B) using 15 readily available clinical and biological variables. Patients assigned to subtype B (48% of the studied population) had more impaired cardiovascular and kidney functions, hematological disorders and inflammation at ICU discharge than subtype A. Sepsis-survivors in subtype B had significantly higher one-year mortality compared to subtype A (respectively, 34% vs 16%, p < 0.001). When adjusted for standard long-term risk factors (e.g., age, comorbidities, severity of illness, renal function and duration of ICU stay), subtype B was independently associated with increased one-year mortality (adjusted hazard ratio (HR) = 1.74 (95% CI 1.16-2.60); p = 0.006). CONCLUSIONS A subtype with sustained organ failure and inflammation at ICU discharge can be identified from routine clinical and laboratory data and is independently associated with poor long-term outcome in sepsis-survivors. Trial registration NCT01367093; https://clinicaltrials.gov/ct2/show/NCT01367093 .
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Affiliation(s)
- Sabri Soussi
- Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada.
| | - Divya Sharma
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada
| | - John C Marshall
- Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, and Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada
| | - Margaret Herridge
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Niall Ferguson
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Elodie Feliot
- Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Erica Acton
- Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada
| | - Jason N Kennedy
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care, Lariboisière - Saint-Louis Hospitals, DMU Parabol, AP-HP Nord; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Claudia C Dos Santos
- Interdepartmental Division of Critical Care, Faculty of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, University of Toronto, 209 Victoria St 7th Floor, Toronto, ON, M5B 1T8, Canada
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Boutin L, Legrand M, Sadoune M, Mebazaa A, Gayat E, Chadjichristos CE, Dépret F. Elevated plasma Galectin-3 is associated with major adverse kidney events and death after ICU admission. Crit Care 2022; 26:13. [PMID: 34991653 PMCID: PMC8740042 DOI: 10.1186/s13054-021-03878-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Galectin-3 (Gal-3) is a proinflammatory and profibrotic protein especially overexpressed after Acute Kidney Injury (AKI). The early renal prognostic value of Gal-3 after AKI in critically ill patients remains unexplored. The objective was to evaluate the prognostic value of plasma level of Gal-3 for Major Adverse Kidney Events (MAKE) and mortality 30 days after ICU admission across AKI stages. Methods This is an ancillary study of a prospective, observational, multicenter cohort (FROG-ICU). AKI was defined using KDIGO definition. Results Two thousand and seventy-six patients had a Gal-3 plasma level measurement at ICU admission. Seven hundred and twenty-three (34.8%) were females and the median age was 63 [51, 74] years. Eight hundred and seven (38.9%) patients developed MAKE, 774 (37.3%) had AKI and mortality rate at 30 days was 22.4% (N = 465). Patients who developed MAKE had higher Gal-3 level at admission compared to patients without (30.2 [20.8, 49.2] ng/ml versus 16.9 [12.7, 24.3] ng/ml, p < 0.001, respectively. The area under the receiver operating characteristic curve of Gal-3 to predict MAKE was 0.76 CI95% [0.74–0.78], p < 0.001. Gal-3 was associated with MAKE (OR 1.80 CI95% [1.68–1.93], p < 0.001, non-adjusted and OR 1.37 CI95% [1.27–1.49], p < 0.001, adjusted). The use of Gal-3 improved prediction performance of prediction model including SAPSII, Screatadm, pNGAL with a NRI of 0.27 CI95%(0.16–0.38), p < 0.001. Median Gal-3 was higher in non-survivors than in survivors at 30 days (29.2 [20.2, 49.2] ng/ml versus 18.8 [13.3, 29.2] ng/ml, p < 0.001, respectively). Conclusion Plasma levels of Gal-3 were strongly associated with renal function, with an increased risk of MAKE and death after ICU admission. Trial registration ClinicalTrials.gov NCT01367093. Registered on 6 June 2011. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03878-x.
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Affiliation(s)
- L Boutin
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint-Louis Hospital, DMU Parabol, FHU PROMICE, Université de Paris, Paris, 75010, France.,INSERM, UMR 942, MASCOT: Cardiovascular Marker in Stress Condition, Lariboisière Hospital, Université de Paris, Paris, 75010, France
| | - M Legrand
- INSERM, UMR 942, MASCOT: Cardiovascular Marker in Stress Condition, Lariboisière Hospital, Université de Paris, Paris, 75010, France. .,Department of Anesthesiology and Peri-Operative Medicine, Division of Critical Care Medicine, University of California - UCSF Medical Center, 500 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - M Sadoune
- INSERM, UMR 942, MASCOT: Cardiovascular Marker in Stress Condition, Lariboisière Hospital, Université de Paris, Paris, 75010, France
| | - A Mebazaa
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint-Louis Hospital, DMU Parabol, FHU PROMICE, Université de Paris, Paris, 75010, France.,INSERM, UMR 942, MASCOT: Cardiovascular Marker in Stress Condition, Lariboisière Hospital, Université de Paris, Paris, 75010, France
| | - E Gayat
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint-Louis Hospital, DMU Parabol, FHU PROMICE, Université de Paris, Paris, 75010, France.,INSERM, UMR 942, MASCOT: Cardiovascular Marker in Stress Condition, Lariboisière Hospital, Université de Paris, Paris, 75010, France
| | - C E Chadjichristos
- INSERM, UMR 1155, CORAKID, Tenon Hospital, Université de Paris, 75020, Paris, France
| | - F Dépret
- Department of Anaesthesiology, Critical Care Medicine and Burn Unit, AP-HP, Saint-Louis Hospital, DMU Parabol, FHU PROMICE, Université de Paris, Paris, 75010, France.,INSERM, UMR 942, MASCOT: Cardiovascular Marker in Stress Condition, Lariboisière Hospital, Université de Paris, Paris, 75010, France
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14
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Magoon R. What separates the good from the bad in the critically ill? Anaesth Crit Care Pain Med 2022; 41:101022. [DOI: 10.1016/j.accpm.2022.101022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
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15
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Motiejunaite J, Deniau B, Blet A, Gayat E, Mebazaa A. Inotropes and vasopressors are associated with increased short-term mortality but not long-term survival in critically ill patients. Anaesth Crit Care Pain Med 2021; 41:101012. [PMID: 34952218 DOI: 10.1016/j.accpm.2021.101012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Limited information is currently available on the impact of vasoactive medications in intensive care (ICU) and long-term outcomes. The main objective of our study was to describe the association between the use of inotropes and/or vasopressors and ICU mortality. Secondary objectives were to evaluate the association between the use of vasoactive drugs and in-hospital as well as 1-year all-cause mortality in ICU survivors. METHODS FROG-ICU was a prospective, observational, multi-centre cohort designed to investigate long-term mortality of critically ill adult patients. Cox proportional hazards models were used to evaluate the association between the use of inotropes and/or vasopressors and ICU mortality, as well as in-hospital and 1-year all-cause mortality in a propensity-score matched cohort. RESULTS The study included 2087 patients, 939 of whom received inotropes and/or vasopressors during the initial ICU stay. Patients treated with vasoactive medications were older and had a more severe clinical presentation. In a propensity score-matched cohort of 1201 patients, ICU mortality was higher in patients who received vasoactive medications (HR of 1.40 [1.10 - 1.78], p = 0.007). One thousand six hundred thirty-five patients survived the index ICU hospitalisation. There was no significant difference according to the use of inotropes and/or vasopressors in the propensity-score matched cohort on in-hospital mortality (HR of 0.94 [0.60 - 1.49], p = 0.808) as well as one-year all-cause mortality (HR 0.94 [0.71 - 1.24], p = 0.643). CONCLUSION Inotropic and/or vasopressor therapy is a strong predictor of in-ICU death. However, the use of inotropes and/or vasopressors during ICU admission was not associated with a worse prognosis after ICU discharge.
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Affiliation(s)
- Justina Motiejunaite
- Service de Physiologie - Explorations Fonctionnelles, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France.
| | - Benjamin Deniau
- Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; Inserm UMR-S 942 MASCOT, Lariboisière Hospital - Paris, France
| | - Alice Blet
- Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; Inserm UMR-S 942 MASCOT, Lariboisière Hospital - Paris, France
| | - Etienne Gayat
- Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; Inserm UMR-S 942 MASCOT, Lariboisière Hospital - Paris, France
| | - Alexandre Mebazaa
- Université de Paris, Paris, France; Department of Anaesthesiology and Critical Care, Department of Anaesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, Paris, France; Inserm UMR-S 942 MASCOT, Lariboisière Hospital - Paris, France
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16
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High plasma dipeptidyl peptidase 3 levels are associated with mortality and organ failure in shock: results from the international, prospective and observational FROG-ICU cohort. Br J Anaesth 2021; 128:e54-e57. [PMID: 34895716 DOI: 10.1016/j.bja.2021.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 12/30/2022] Open
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17
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Urine peptidome analysis in cardiorenal syndrome reflects molecular processes. Sci Rep 2021; 11:16219. [PMID: 34376786 PMCID: PMC8355128 DOI: 10.1038/s41598-021-95695-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
The cardiorenal syndrome (CRS) is defined as the confluence of heart-kidney dysfunction. This study investigates the molecular differences at the level of the urinary peptidome between CRS patients and controls and their association to disease pathophysiology. The urinary peptidome of CRS patients (n = 353) was matched for age and sex with controls (n = 356) at a 1:1 ratio. Changes in the CRS peptidome versus controls were identified after applying the Mann-Whitney test, followed by correction for multiple testing. Proteasix tool was applied to investigate predicted proteases involved in CRS-associated peptide generation. Overall, 559 differentially excreted urinary peptides were associated with CRS patients. Of these, 193 peptides were specifically found in CRS when comparing with heart failure and chronic kidney disease urinary peptide profiles. Proteasix predicted 18 proteases involved in > 1% of proteolytic cleavage events including multiple forms of MMPs, proprotein convertases, cathepsins and kallikrein 4. Forty-four percent of the cleavage events were produced by 3 proteases including MMP13, MMP9 and MMP2. Pathway enrichment analysis supported that ECM-related pathways, fibrosis and inflammation were represented. Collectively, our study describes the changes in urinary peptides of CRS patients and potential proteases involved in their generation, laying the basis for further validation.
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Roumier A, Chahraoui K, Bioy A. COVID-19 et adaptation des dispositifs de suivi psychologique en réanimation médicale. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021; 5:100201. [PMID: 38620611 PMCID: PMC7857700 DOI: 10.1016/j.ejtd.2021.100201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
La pandémie de la COVID-19 est venue, par son ampleur, confronter notre société à une crise sanitaire sans précédent. La gravité de cette épidémie a focalisé toute son attention sur un monde encore très peu connu : la réanimation. Ces services ont été très fortement sollicités en phase aiguë de cette situation d’urgence. Cet article présente à partir de quelques données de la littérature et d’une illustration clinique, la spécificité des vécus psychiques en réanimation et comment le contexte de COVID est venu impacter ce vécu et invite à modifier les dispositifs de soins médico-psychologiques. La méthode utilise une étude de cas : un patient non covid, hospitalisé pendant deux mois aux soins intensifs pendant la période de confinement. Nous verrons ici l’illustration d’un soutien psychologique, dans ce contexte spécifique, par une unité de liaison du service de réanimation au service d’hospitalisation. La discussion théorico-clinique envisage la place de cette épidémie COVID ainsi que le contexte de confinement dans l’adaptation du dispositif de soins notamment avec le port du masque et la distanciation sociale.
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Affiliation(s)
- Agnès Roumier
- Laboratoire de psychopathologie et neuropsychologie, université Paris 8, 2, rue de la Liberté, 93526 Saint-Denis cedex, France
| | - Khadija Chahraoui
- Laboratoire de psychopathologie et neuropsychologie, université Paris 8, 2, rue de la Liberté, 93526 Saint-Denis cedex, France
| | - Antoine Bioy
- Laboratoire de psychopathologie et neuropsychologie, université Paris 8, 2, rue de la Liberté, 93526 Saint-Denis cedex, France
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One-Year Prognosis of Kidney Injury at Discharge From the ICU: A Multicenter Observational Study. Crit Care Med 2020; 47:e953-e961. [PMID: 31567524 DOI: 10.1097/ccm.0000000000004010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The association between outcome and kidney injury detected at discharge from the ICU using different biomarkers remains unknown. The objective was to evaluate the association between 1-year survival and kidney injury at ICU discharge. DESIGN Ancillary investigation of a prospective observational study. SETTING Twenty-one ICUs with 1-year follow-up. PATIENTS Critically ill patients receiving mechanical ventilation and/or hemodynamic support for at least 24 hours were included. INTERVENTIONS Serum creatinine, plasma Cystatin C, plasma neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, plasma Proenkephalin A 119-159, and estimated glomerular filtration rate (on serum creatinine and plasma Cystatin C) were measured at ICU discharge among ICU survivors. MEASUREMENTS AND MAIN RESULTS The association between kidney biomarkers at discharge and mortality was estimated using logistic model with and without adjustment for prognostic factors previously identified in this cohort. Subgroup analyses were performed in patients with discharge serum creatinine less than 1.5-fold baseline at ICU discharge. Among 1,207 ICU survivors included, 231 died during the year following ICU discharge (19.2%). Estimated glomerular filtration rate was significantly lower and kidney injury biomarkers higher at discharge in nonsurvivors. The association between biomarker levels or estimated glomerular filtration rate and mortality remained after adjustment to potential cofounding factors influencing outcome. In patients with low serum creatinine at ICU discharge, 25-47% of patients were classified as subclinical kidney injury depending on the biomarker. The association between kidney biomarkers and mortality remained and mortality was higher than patients without subclinical kidney injury. The majority of patients who developed acute kidney injury during ICU stay had elevated biomarkers of kidney injury at discharge even with apparent recovery based on serum creatinine (i.e., subclinical acute kidney disease). CONCLUSIONS Elevated kidney biomarkers measured at ICU discharge are associated with poor 1-year outcome, including in patients with low serum creatinine at ICU discharge.
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20
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Nkuipou-Kenfack E, Latosinska A, Yang WY, Fournier MC, Blet A, Mujaj B, Thijs L, Feliot E, Gayat E, Mischak H, Staessen JA, Mebazaa A, Zhang ZY. A novel urinary biomarker predicts 1-year mortality after discharge from intensive care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:10. [PMID: 31918764 PMCID: PMC6953276 DOI: 10.1186/s13054-019-2686-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/26/2019] [Indexed: 01/25/2023]
Abstract
Rationale The urinary proteome reflects molecular drivers of disease. Objectives To construct a urinary proteomic biomarker predicting 1-year post-ICU mortality. Methods In 1243 patients, the urinary proteome was measured on ICU admission, using capillary electrophoresis coupled with mass spectrometry along with clinical variables, circulating biomarkers (BNP, hsTnT, active ADM, and NGAL), and urinary albumin. Methods included support vector modeling to construct the classifier, Cox regression, the integrated discrimination (IDI), and net reclassification (NRI) improvement, and area under the curve (AUC) to assess predictive accuracy, and Proteasix and protein-proteome interactome analyses. Measurements and main results In the discovery (deaths/survivors, 70/299) and test (175/699) datasets, the new classifier ACM128, mainly consisting of collagen fragments, yielding AUCs of 0.755 (95% CI, 0.708–0.798) and 0.688 (0.656–0.719), respectively. While accounting for study site and clinical risk factors, hazard ratios in 1243 patients were 2.41 (2.00–2.91) for ACM128 (+ 1 SD), 1.24 (1.16–1.32) for the Charlson Comorbidity Index (+ 1 point), and ≥ 1.19 (P ≤ 0.022) for other biomarkers (+ 1 SD). ACM128 improved (P ≤ 0.0001) IDI (≥ + 0.50), NRI (≥ + 53.7), and AUC (≥ + 0.037) over and beyond clinical risk indicators and other biomarkers. Interactome mapping, using parental proteins derived from sequenced peptides included in ACM128 and in silico predicted proteases, including/excluding urinary collagen fragments (63/35 peptides), revealed as top molecular pathways protein digestion and absorption, lysosomal activity, and apoptosis. Conclusions The urinary proteomic classifier ACM128 predicts the 1-year post-ICU mortality over and beyond clinical risk factors and other biomarkers and revealed molecular pathways potentially contributing to a fatal outcome.
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Affiliation(s)
| | | | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium.,Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Marie-Céline Fournier
- Department of Anesthesiology and Intensive Care, Saint Louis-Lariboisière - Fernand Widal University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alice Blet
- Department of Anesthesiology and Intensive Care, Saint Louis-Lariboisière - Fernand Widal University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Blerim Mujaj
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium
| | - Elodie Feliot
- Department of Anesthesiology and Intensive Care, Saint Louis-Lariboisière - Fernand Widal University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Intensive Care, Saint Louis-Lariboisière - Fernand Widal University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France.,INSERM UMR-S 942 - MASCOT, Paris, France
| | | | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Alexandre Mebazaa
- Department of Anesthesiology and Intensive Care, Saint Louis-Lariboisière - Fernand Widal University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France.,INSERM UMR-S 942 - MASCOT, Paris, France
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Box 7001, 3000, Leuven, Belgium.
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Bioactive Adrenomedullin, Organ Support Therapies, and Survival in the Critically Ill. Crit Care Med 2020; 48:49-55. [DOI: 10.1097/ccm.0000000000004044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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22
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Kimmoun A, Cariou A, Gayat E, Feliot E, Takagi K, Megarbane B, Mebazaa A, Deye N. One-year outcome of patients admitted after cardiac arrest compared to other causes of ICU admission. An ancillary analysis of the observational prospective and multicentric FROG-ICU study. Resuscitation 2019; 146:237-246. [PMID: 31678408 DOI: 10.1016/j.resuscitation.2019.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE While cardiac arrest (CA) patients discharged alive from intensive care unit (ICU) are considered to have good one-year survival but potential neurological impairment, comparisons with other ICU sub-populations non-admitted for CA purpose are still lacking. This study aimed to compare long-term outcome and health-related quality of life (HRQOL) between CA patients and patients admitted to ICU for all other causes. METHODS In 1635 patients discharged alive from 21 European ICUs in an ancillary analysis of a prospective multicentric cohort, we compared CA causes of ICU admission to all other causes of ICU admissions (named non-CAs). The primary endpoint was one-year survival rate after ICU discharge. Secondary endpoints included HRQOL at 3, 6 and 12 months after ICU discharge using the outcome survey short form-36 (SF36). Propensity score matching was used to consider the probability of having CA. RESULTS Of the 1635 patients, 1561 were included in this study comprised of 1447 non-CAs and 114 CAs. At one-year in the non-matched population, survival rate was greater in the CA group 89% versus the non-CA group 78% (log rank p = 0.0056). In the matched population, this difference persisted between CAs and non-CAs (log rank p = 0.049). The physical component summary of the SF36 scale was higher in the CA group than in the non-CA group at all time points in both non-matched and matched populations. CONCLUSIONS CA patients discharged alive from ICU have a better one-year survival and a better HRQOL specifically on physical functions than patients admitted to ICU for other causes. TRIAL REGISTRATION ClinicalTrials.gov NCT01367093; registered on June 6, 2011.
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Affiliation(s)
- Antoine Kimmoun
- Medical Intensive Care Unit, Nancy University Hospital, University of Lorraine, Nancy, France; UMR-S 942, INSERM, Paris, France; U1116, INSERM, Nancy, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris Sudden Death Expertise Center, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Elodie Feliot
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Koji Takagi
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Bruno Megarbane
- Medical Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, INSERM UMRS-1144, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité,UMR-S 942, INSERM, Paris, France.
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23
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Prud’homme M, Coutrot M, Michel T, Boutin L, Genest M, Poirier F, Launay JM, Kane B, Kinugasa S, Prakoura N, Vandermeersch S, Cohen-Solal A, Delcayre C, Samuel JL, Mehta R, Gayat E, Mebazaa A, Chadjichristos CE, Legrand M. Acute Kidney Injury Induces Remote Cardiac Damage and Dysfunction Through the Galectin-3 Pathway. JACC Basic Transl Sci 2019; 4:717-732. [PMID: 31709320 PMCID: PMC6834958 DOI: 10.1016/j.jacbts.2019.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
Acute kidney injury is associated with increased risk of heart failure and mortality. This study demonstrates that acute kidney injury induces remote cardiac dysfunction, damage, injury, and fibrosis via a galectin-3 (Gal-3) dependent pathway. Gal-3 originates from bone marrow-derived immune cells. Cardiac damage could be prevented by blocking this pathway.
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Key Words
- AKI, acute kidney injury
- BM, bone marrow
- BUN, blood urea nitrogen
- Cr, creatinine
- Gal-3, galectin-3
- ICAM, intercellular adhesion molecule
- ICU, intensive care unit
- IL, interleukin
- IR, ischemia-reperfusion
- KDIGO, Kidney Disease Improving Global Outcome
- KO, knock-out
- MCP, modified citrus pectin
- NT-proBNP, N-terminal-pro-brain natriuretic peptide
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- UUO, unilateral ureteral obstruction
- WT, wild type
- eGFR, estimated glomerular filtration rate
- fibrosis
- heart failure
- inflammation
- macrophages
- renal failure
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Affiliation(s)
- Mathilde Prud’homme
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Maxime Coutrot
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | - Thibault Michel
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Louis Boutin
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | - Magali Genest
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- INSERM UMR-S 1155, Tenon Hospital, Paris, France
| | - Françoise Poirier
- Institut Jacques Monod, Team: Morphogenesis, Homeostasis and Pathologies, Paris, France
| | - Jean-Marie Launay
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Bocar Kane
- UMS-28 Phénotypage du petit animal, Université Pierre et Marie Curie, Paris, France
| | | | | | | | - Alain Cohen-Solal
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- Cardiology Department, Lariboisière Hospital, Paris, France
| | - Claude Delcayre
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Jane-Lise Samuel
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
| | - Ravindra Mehta
- Department of Medicine, University of California-San Diego, San Diego, California
| | - Etienne Gayat
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
| | | | - Matthieu Legrand
- INSERM UMR-S 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, and INI-CRCT-F-CRIN, Paris, France
- AP-HP, St-Louis-Lariboisière Hospital, Department of Anesthesiology and Critical Care and Burn Unit, University Paris Diderot, Paris, France
- Department of Anesthesiology and peri-operative Care, University of California San Francisco, United States
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24
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Pastene B, Cinotti R, Gayat E, Duranteau J, Lu Q, Montravers P, Pili-Floury S, Rennuit I, Mebazaa A, Leone M. Long-term mortality and quality of life after trauma: an ancillary study from the prospective multicenter trial FROG-ICU. Eur J Trauma Emerg Surg 2019; 47:461-466. [PMID: 31214722 DOI: 10.1007/s00068-019-01176-4] [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: 11/03/2018] [Accepted: 06/13/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The long-term outcomes of intensive care unit (ICU) patients are known to be worse than those of the general population, but they are poorly known in severe trauma patients. We conducted an ancillary examination of the FROG-ICU study to identify risk factors and biomarkers associated with the poorer long-term outcomes and mortality in trauma ICU patients. METHODS Mortality, quality of life (QoL) and stress level scores were obtained 1 year after discharge from ICU. Blood samples were collected at ICU admission and discharge for measurement of inflammatory and cardiovascular biomarkers. RESULTS ICU trauma patients had a significantly lower 1-year mortality than non-trauma patients (7% vs. 23%, p < 0.001), but had worse stress levels scores (19 vs. 13, p = 0.041). No difference was found regarding physical and mental QoL scores (33 vs. 31, p = 0.19 and 30 vs. 28, p = 0.42). Patients with better QoL scores had lower tracheotomy rates (11% vs. 30%, p = 0.01). Worse stress level scores are associated with poor QoL scores and vice versa. Some study biomarkers were significantly higher in those ICU trauma patients who had worse QoL scores at 1 year after discharge. DISCUSSION Our study suggests that quality of life 1 year after an ICU stay is poor and is similar in both trauma and non-trauma patients, but ICU trauma patients are at greater risk of developing post-traumatic stress disorder-related symptoms. Tracheotomy and high levels of inflammatory biomarkers could be associated with impaired quality of life.
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Affiliation(s)
- Bruno Pastene
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Raphaël Cinotti
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Jacques Duranteau
- Service de Réanimation Chirurgicale, Hôpital Bicêtre, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Qin Lu
- Service de Réanimation Chirurgicale, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Philippe Montravers
- Service de Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Sébastien Pili-Floury
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Isabelle Rennuit
- Service de Réanimation Polyvalente, Hôpital Beaujon, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
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25
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Health related quality of life and predictive factors six months after intensive care unit discharge. Anaesth Crit Care Pain Med 2019; 38:137-141. [DOI: 10.1016/j.accpm.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
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26
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Hollinger A, Gayat E, Féliot E, Paugam-Burtz C, Fournier MC, Duranteau J, Lefrant JY, Leone M, Jaber S, Mebazaa A, Arrigo M. Gender and survival of critically ill patients: results from the FROG-ICU study. Ann Intensive Care 2019; 9:43. [PMID: 30927096 PMCID: PMC6441070 DOI: 10.1186/s13613-019-0514-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/06/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Few studies analyzed gender-related outcome differences of critically ill patients and found inconsistent results. This study aimed to test the independent association of gender and long-term survival of ICU patients.
Materials and methods FROG-ICU was a prospective, observational, multi-center cohort designed to investigate the long-term mortality of critically ill adult patients. The primary endpoint of this study was 1-year mortality after ICU admission of women compared to men. Results The study included 2087 patients, 726 women and 1361 men. Women and men had similar baseline characteristics, clinical presentation, and disease severity. No significant difference in 1-year mortality was found between women and men (34.9% vs. 37.9%, P = 0.18). After multivariable adjustment, no difference in the hazard of death was observed [HR 0.99 (95% CI 0.77–1.28)]. Similar 1-year survival between women and men was found in a propensity score-matched patient cohort of 506 patients [HR 0.79 (95% CI 0.54–1.14)].
Conclusion Women constituted one-third of the population of critically ill patients and were unexpectedly similar to men regarding demographic characteristics, clinical presentation, and disease severity and had similar risk of death at 1 year after ICU admission. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011. Electronic supplementary material The online version of this article (10.1186/s13613-019-0514-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexa Hollinger
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France.,Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Elodie Féliot
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Catherine Paugam-Burtz
- Anesthesiology and Perioperative Care Medicine Department, APHP Hopital Beaujon and University, Paris 7, France
| | - Marie-Céline Fournier
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France
| | - Jacques Duranteau
- Département d'Anesthésie-Réanimation, UMR 942, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Yves Lefrant
- Service des Réanimations, CHU Nîmes, Place du Pr Robert Debré, 30029, Nîmes Cedex, France
| | - Marc Leone
- Department of Anaesthesiology and Critical Care Medicine, AP-HM, Hôpital Nord, Marseille, France
| | - Samir Jaber
- Department of Anesthesiology and Intensive Care (DAR B), Saint Eloi University Hospital, Montpellier, France.,PhyMedExp, INSERM U-1046, CNRS, Montpellier University, Montpellier, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis - Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot - Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France. .,Intensive Care Unit, Assistance Publique - Hopitaux de Paris, University Hospital Ambroise Paré, 26930, Boulogne-Billancourt, France. .,Department of Anesthesiology and Intensive Care, Saint Louis - Lariboisière University Hospitals, 2 rue Ambroise Paré, 75010, Paris, France.
| | - Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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27
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Lasocki S, Lefebvre T, Mayeur C, Puy H, Mebazaa A, Gayat E. Iron deficiency diagnosed using hepcidin on critical care discharge is an independent risk factor for death and poor quality of life at one year: an observational prospective study on 1161 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:314. [PMID: 30463596 PMCID: PMC6249884 DOI: 10.1186/s13054-018-2253-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/01/2018] [Indexed: 12/30/2022]
Abstract
Background Iron deficiency is difficult to diagnose in critically ill patients, but may be frequent and may impair recovery. Measurement of hepcidin could help in the diagnosis of iron deficiency. We aim to assess if iron deficiency diagnosed using hepcidin is associated with poorer outcome one year after an intensive care unit stay. Methods We used the prospective FROG-ICU, multicentre (n = 28 ICUs), observational cohort study of critically ill survivors followed up one year after intensive care unit discharge. Iron deficiency was defined as hepcidin < 20 ng/l, ferritin < 100 ng/l or soluble transferrin receptor (sTfR)/log(ferritin) > 0.8, measured in blood drawn at intensive care unit discharge. Main outcomes were one-year all-cause mortality and poor quality of life (defined as a Short Form 36 (SF-36) score below the median). Results Among the 2087 patients in the FROG-ICU cohort, 1570 were discharged alive and 1161 had a blood sample available at intensive care unit discharge and were included in the analysis. Using hepcidin, 429 (37%) patients had iron deficiency, compared to 72 (6%) using ferritin alone and 151 (13%) using the sTfR/log(ferritin) ratio. Iron deficiency diagnosed according to low hepcidin was an independent predictor of one-year mortality (OR 1.51 (1.10–2.08)) as was high sTfR/log ferritin ratio (OR = 1.95 (1.27–3.00)), but low ferritin was not. Severe ID, defined as hepcidin < 10 ng/l, was also an independent predictor of poor one-year physical recovery (1.58 (1.01–2.49)). Conclusions Iron deficiency, diagnosed using hepcidin, is very frequent at intensive care unit discharge and is associated with increased one-year mortality and poorer physical recovery. Whether iron treatment may improve these outcomes remains to be investigated. Electronic supplementary material The online version of this article (10.1186/s13054-018-2253-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sigismond Lasocki
- Département Anesthésie Réanimation, UBL Université, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Thibaud Lefebvre
- INSERM, UMR 1149/ERL CNRS 8252, Centre de Recherches sur l'inflammation, Université Paris Diderot, Paris, France.,Laboratoire d'excellence du Globule Rouge GR-Ex ; APHP, Hôpital Universitaire Louis Mourier, Colombes, France
| | - Claire Mayeur
- Department of Anesthesia, Université Paris Diderot ; U 942 Inserm ; APHP, Burn and Critical care, Hôpitaux Universitaires Saint louis - Lariboisiere, Paris, France
| | - Hervé Puy
- INSERM, UMR 1149/ERL CNRS 8252, Centre de Recherches sur l'inflammation, Université Paris Diderot, Paris, France.,Laboratoire d'excellence du Globule Rouge GR-Ex ; APHP, Hôpital Universitaire Louis Mourier, Colombes, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Université Paris Diderot ; U 942 Inserm ; APHP, Burn and Critical care, Hôpitaux Universitaires Saint louis - Lariboisiere, Paris, France
| | - Etienne Gayat
- Department of Anesthesia, Université Paris Diderot ; U 942 Inserm ; APHP, Burn and Critical care, Hôpitaux Universitaires Saint louis - Lariboisiere, Paris, France
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28
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Hollinger A, Wittebole X, François B, Pickkers P, Antonelli M, Gayat E, Chousterman BG, Lascarrou JB, Dugernier T, Di Somma S, Struck J, Bergmann A, Beishuizen A, Constantin JM, Damoisel C, Deye N, Gaudry S, Huberlant V, Marx G, Mercier E, Oueslati H, Hartmann O, Sonneville R, Laterre PF, Mebazaa A, Legrand M. Proenkephalin A 119-159 (Penkid) Is an Early Biomarker of Septic Acute Kidney Injury: The Kidney in Sepsis and Septic Shock (Kid-SSS) Study. Kidney Int Rep 2018; 3:1424-1433. [PMID: 30450469 PMCID: PMC6224621 DOI: 10.1016/j.ekir.2018.08.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Sepsis is the leading cause of acute kidney injury (AKI) in critically ill patients. The Kidney in Sepsis and Septic Shock (Kid-SSS) study evaluated the value of proenkephalin A 119-159 (penkid)-a sensitive biomarker of glomerular function, drawn within 24 hours upon intensive care unit (ICU) admission and analyzed using a chemiluminescence immunoassay-for kidney events in sepsis and septic shock. Methods The Kid-SSS study was a substudy of Adrenomedullin and Outcome in Severe Sepsis and Septic Shock (AdrenOSS) (NCT02393781), a prospective, observational, multinational study including 583 patients admitted to the intensive care unit with sepsis or septic shock and a validation cohort of 525 patients from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study. The primary endpoint was major adverse kidney events (MAKEs) at day 7, composite of death, renal replacement therapy, and persistent renal dysfunction. The secondary endpoints included AKI, transient AKI, worsening renal function (WRF), and 28-day mortality. Results Median age was 66 years (interquartile range 55-75), and 28-day mortality was 22% (95% confidence interval [CI] 19%-25%). Of the patients, 293 (50.3%) were in shock upon ICU admission. Penkid was significantly elevated in patients with MAKEs, persistent AKI, and WRF (median = 65 [IQR = 45-106] vs. 179 [114-242]; 53 [39-70] vs. 133 [79-196] pmol/l; and 70 [47-121] vs. 174 [93-242] pmol/l, all P < 0.0001), also after adjustment for confounding factors (adjusted odds ratio = 3.3 [95% CI = 1.8-6.0], 3.9 [95% CI = 2.1-7.2], and 3.4 [95% CI = 1.9-6.2], all P < 0.0001). Penkid increase preceded elevation of serum creatinine with WRF and was low in renal recovery. Conclusion Admission penkid concentration was associated with MAKEs, AKI, and WRF in a timely manner in septic patients.
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Affiliation(s)
- Alexa Hollinger
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
- INSERM 942, Paris, France
- Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Xavier Wittebole
- Department of Critical Care Medicine, St Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Bruno François
- Intensive Care Unit Department, CHU Dupuytren, Limoges, France
- INSERM CIC 1435/UMR 1092, Limoges, France
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Etienne Gayat
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
- INSERM 942, Paris, France
- University Paris Diderot, Paris, France, and INI-CRCT (F-CRIN) network
| | - Benjamin Glenn Chousterman
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | | | | | | | | | | | - Albertus Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, Netherlands
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles Damoisel
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Nicolas Deye
- INSERM 942, Paris, France
- Centre Hospitalier Universitair de Tours, Tours, France
| | | | | | - Gernot Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum der RWTH, Aachen, Germany
| | | | - Haikel Oueslati
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
| | | | | | - Pierre-François Laterre
- Department of Critical Care Medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Alexandre Mebazaa
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
- INSERM 942, Paris, France
- University Paris Diderot, Paris, France, and INI-CRCT (F-CRIN) network
| | - Matthieu Legrand
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
- INSERM 942, Paris, France
- University Paris Diderot, Paris, France, and INI-CRCT (F-CRIN) network
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29
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Vitamin K deficiency in critical ill patients; a prospective observational study. J Crit Care 2018; 49:105-109. [PMID: 30415179 DOI: 10.1016/j.jcrc.2018.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin K is a cofactor for proteins involved in cardiovascular health, bone metabolism and cancer. Measuring uncarboxylated prothrombin, also termed as "protein induced by vitamin K absence or antagonism for factor II (PIVKA-II)", has been used to assess vitamin K status. High levels may indicate vitamin K deficiency. The aim of this study was to measure PIVKA-II and prothrombin time (PT-INR) in intensive care (ICU) patients and correlate vitamin K status with mortality. METHODS Ninety-five patients admitted to the ICU had blood samples taken near admission and every third day. In addition to PIVKA-II and PT-INR, critical-care severity scores were computed. RESULTS The median baseline PIVKA-II was 4.97 μg/L compared to the upper reference of 2.0 μg/L. PIVKA-II further increased at days 3 and 6, (median 7.88 μg/L, p = .047 and median 8.14 μg/L, p = .011) predominantly in cardiac arrest patients (median 21.4 μg/L, day 3). CONCLUSION Intensive care patients have increased PIVKA-II levels at admission, which increases during the ICU stay, especially in cardiac arrest patients. There were no correlations between PIVKA-II and PT-INR, SOFA score or mortality. Further studies are needed to determine why PIVKA-II increases and whether high PIVKA-II levels in ICU patients affect long-term mortality or morbidity.
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Bastian K, Hollinger A, Mebazaa A, Azoulay E, Féliot E, Chevreul K, Fournier MC, Guidet B, Michel M, Montravers P, Pili-Floury S, Sonneville R, Siegemund M, Gayat E. Association of social deprivation with 1-year outcome of ICU survivors: results from the FROG-ICU study. Intensive Care Med 2018; 44:2025-2037. [PMID: 30353380 PMCID: PMC7095041 DOI: 10.1007/s00134-018-5412-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/10/2018] [Indexed: 11/25/2022]
Abstract
Purpose Intensive care unit survivors suffer from prolonged impairment, reduced quality of life, and higher mortality rates after discharge compared to the general population. Socioeconomic status may play a partial but important role in mortality and recovery. Therefore, the detection of factors that are responsible for poor long-term outcomes would be beneficial in designing targeted interventions for at-risk populations. Methods For an endpoint analysis, 1834 intensive care unit patients with known French Deprivation Index (FDep) scores were included from the French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study, which was a prospective, observational, multicenter cohort study performed in 20 French intensive care units in 13 different hospitals. Socioeconomic status was defined by using the FDep score [represented as quintiles when referring to the general French population, as quintiles when referring to the FROG-ICU cohort, or as dichotomized data (which was defined as a FDep ≤ 0 for nondeprived patients)] and by using a detailed social questionnaire that was completed 3 months after discharge. The primary outcome included an all-cause, 1-year mortality after ICU discharge when regarding socioeconomic status. The secondary outcomes included both ICU and hospital lengths of stay, both short- and medium-term mortality, and the quality of life, as assessed during the 1-year follow-up by using the Medical Outcome Survey Short Form-36 (SF-36). The Revised Impact of Event Scale (IES-R) was used to evaluate the symptoms of post-traumatic stress disorder, and the Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. Results Of the 1447 patients who were discharged alive from the ICU, 19.2% died over the following year. No association was found between 1-year mortality and socioeconomic status, regardless of whether this association was analyzed in quintiles (p = 0.911 in the quintiles of the general French population; p = 0.589 in the quintiles of the FROG-ICU cohort itself) or as dichotomized data [nondeprived (n = 177; 1-year mortality of 18.2%) versus deprived (n = 97; 1-year mortality of 20.5%; p = 0.304)]. Moreover, no differences were found between the nondeprived and the deprived patients in the ICU and hospital lengths of stay, ICU mortalities, in-hospital mortalities, or 28-day mortalities. The SF-36 was below the score for the normal French population throughout the follow-up period. Socially deprived patients showed significantly lower median scores in the physical function subscale [55, interquartile range (IQR) (28.8–80) vs. 65, IQR (35–90); p = 0.014], the physical role subscale [25, IQR (0–75) vs. 33.3, IQR (0–100); p = 0.022], and the overall physical component scale [47.5, IQR (30–68.8) vs. 54.4, IQR (35–78.8); p = 0.010]. Up to 31.6% of survivors presented symptoms that indicated post-traumatic stress disorder, and up to 31.5% of survivors reported clinically meaningful symptoms of anxiety or depression. Conclusions A lower socioeconomic status was associated with lower self-reported physical component scores in the nondeprived patients. Psychiatric symptoms are frequently reported after an ICU stay, and subsequent interventions should target those fields. Trial registration ClinicalTrials.gov NCT01367093; registered on June 6, 2011. Electronic supplementary material The online version of this article (10.1007/s00134-018-5412-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen Bastian
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexa Hollinger
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
| | - Elodie Féliot
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Karine Chevreul
- INSERM UMR1123, Paris, France
- Unité de Recherche Clinique en Économie de la Santé d’Ile-de-France, Paris, France
| | - Marie-Céline Fournier
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé d’Ile-de-France, Paris, France
| | - Philippe Montravers
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
- Department of Anesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sébastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, Besançon University Hospital, Besançon, France
- EA 3920, University of Bourgogne Franche-Comté, Besançon, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude, Paris, France
| | - Martin Siegemund
- Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Etienne Gayat
- Department of Anaesthesiology and Reanimation, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 Rue Ambroise Paré, 75010 Paris, France
- INSERM UMR-S942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital and INI-CRCT Network, Paris, France
- Université Paris Diderot-Paris 7, Sorbonne Paris Cité, Paris, France
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New-onset atrial fibrillation in critically ill patients and its association with mortality: A report from the FROG-ICU study. Int J Cardiol 2018; 266:95-99. [DOI: 10.1016/j.ijcard.2018.03.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/04/2018] [Accepted: 03/12/2018] [Indexed: 11/21/2022]
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Gayat E, Hollinger A, Cariou A, Deye N, Vieillard-Baron A, Jaber S, Chousterman BG, Lu Q, Laterre PF, Monnet X, Darmon M, Leone M, Guidet B, Sonneville R, Lefrant JY, Fournier MC, Resche-Rigon M, Mebazaa A, Legrand M. Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. Intensive Care Med 2018; 44:598-605. [DOI: 10.1007/s00134-018-5160-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/30/2018] [Indexed: 12/25/2022]
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Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Crit Care 2018; 22:8. [PMID: 29347987 PMCID: PMC5774139 DOI: 10.1186/s13054-017-1922-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive care unit (ICU) survivors have reduced long-term survival compared to the general population. Identifying parameters at ICU discharge that are associated with poor long-term outcomes may prove useful in targeting an at-risk population. The main objective of the study was to identify clinical and biological determinants of death in the year following ICU discharge. METHODS FROG-ICU was a prospective, observational, multicenter cohort study of ICU survivors followed 1 year after discharge, including 21 medical, surgical or mixed ICUs in France and Belgium. All consecutive patients admitted to intensive care with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following ICU admission and discharged from ICU were included. The main outcome measure was all-cause mortality at 1 year after ICU discharge. Clinical and biological parameters on ICU discharge were measured, including the circulating cardiovascular biomarkers N-terminal pro-B type natriuretic peptide, high-sensitive troponin I, bioactive-adrenomedullin and soluble-ST2. Socioeconomic status was assessed using a validated deprivation index (FDep). RESULTS Of 1570 patients discharged alive from the ICU, 333 (21%) died over the following year. Multivariable analysis identified age, comorbidity, red blood cell transfusion, ICU length of stay and abnormalities in common clinical factors at the time of ICU discharge (low systolic blood pressure, temperature, total protein, platelet and white cell count) as independent factors associated with 1-year mortality. Elevated biomarkers of cardiac and vascular failure independently associated with 1-year death when they are added to multivariable model, with an almost 3-fold increase in the risk of death when combined (adjusted odds ratio 2.84 (95% confidence interval 1.73-4.65), p < 0.001). CONCLUSIONS The FROG-ICU study identified, at the time of ICU discharge, potentially actionable clinical and biological factors associated with poor long-term outcome after ICU discharge. Those factors may guide discharge planning and directed interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT01367093 . Registered on 6 June 2011.
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