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De Roux Q, Coëffic A, Letord A, Kudela A, Mongardon N. Pharmacological and Nonpharmacological Supports in Shock. Am J Respir Crit Care Med 2023; 208:196-198. [PMID: 37141107 DOI: 10.1164/rccm.202206-1165rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 05/03/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Quentin De Roux
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé, Univ Paris Est Creteil, Créteil, France; and
- U955-IMRB, Equipe 03 "Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)", Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), Maisons-Alfort, France
| | - Adrien Coëffic
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé, Univ Paris Est Creteil, Créteil, France; and
| | - Alexia Letord
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé, Univ Paris Est Creteil, Créteil, France; and
| | - Agathe Kudela
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé, Univ Paris Est Creteil, Créteil, France; and
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé, Univ Paris Est Creteil, Créteil, France; and
- U955-IMRB, Equipe 03 "Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)", Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), Maisons-Alfort, France
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Jaspard M, Mulangu S, Juchet S, Serra B, Dicko I, Lang HJ, Baka BM, Komanda GM, Katsavara JM, Kabuni P, Mambu FM, Isnard M, Vanhecke C, Letord A, Dieye I, Patterson-Lomba O, Mbaya OT, Isekusu F, Mangala D, Biampata JL, Kitenge R, Kinda M, Anglaret X, Muyembe JJ, Kojan R, Ezzedine K, Malvy D. Development of the PREDS score to predict in-hospital mortality of patients with Ebola virus disease under advanced supportive care: Results from the EVISTA cohort in the Democratic Republic of the Congo. EClinicalMedicine 2022; 54:101699. [PMID: 36263398 PMCID: PMC9574409 DOI: 10.1016/j.eclinm.2022.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. METHODS In this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. FINDINGS Between August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). INTERPRETATION The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. FUNDING This study was funded by ALIMA.
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Affiliation(s)
- Marie Jaspard
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Sabue Mulangu
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Sylvain Juchet
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Beatrice Serra
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Ibrahim Dicko
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Hans-Joeg Lang
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | | | | | | | - Patricia Kabuni
- Kinshasa University Hospital, Democratic Republic of the Congo
| | - Fabrice Mbika Mambu
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | | | | | - Alexia Letord
- Surgical Intensive Care Unit, Henri Mondor University Hospital, Créteil, France
| | | | | | - Olivier Tshiani Mbaya
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Fiston Isekusu
- Kinshasa University Hospital, Democratic Republic of the Congo
| | | | - Jean Luc Biampata
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge
- Ministry of Health, National Emergency and Humanitarian Action Program, Democratic Republic of the Congo
| | - Moumouni Kinda
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Xavier Anglaret
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Jean Jacques Muyembe
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kojan
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Khaled Ezzedine
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France and Université Paris Est (UPEC), EpiDermE research unit, Paris, France
| | - Denis Malvy
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
- Department of Infectious Diseases and Tropical Medicine, Tropical Medicine and Clinical International Health Unit, Hôpital Pellegrin Bordeaux University Hospital, Bordeaux, France
- Corresponding author at: Department of Infectious Diseases and Tropical Medicine, Tropical Medicine and Clinical International Health Unit, Hôpital Pellegrin Bordeaux University Hospital, Bordeaux, France.
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Valent A, Pharaboz A, Letord A, Boughezala S, Boccara D, Plaud B. In Response. A A Pract 2021; 15:e01526. [PMID: 34529589 DOI: 10.1213/xaa.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Arnaud Valent
- Department of Anesthesiology and Critical Care, Saint-Louis Hospital, Département Médico-Universitaire Parabol, Assistance Publique - Hôpitaux de, Paris Nord & University of Paris, Paris, France, , INSERM U-942 Biomarkers in, Cardioneurovascular Diseases, Inserm, France
| | - Alexandre Pharaboz
- Department of Anesthesiology and Critical Care, Saint-Louis Hospital, Département Médico-Universitaire Parabol, Assistance Publique - Hôpitaux de, Paris Nord & University of Paris, Paris, France
| | - Alexia Letord
- Department of Anesthesiology and Critical Care, Saint-Louis Hospital, Département Médico-Universitaire Parabol, Assistance Publique - Hôpitaux de, Paris Nord & University of Paris, Paris, France
| | - Samia Boughezala
- Department of Anesthesiology and Critical Care, Saint-Louis Hospital, Département Médico-Universitaire Parabol, Assistance Publique - Hôpitaux de, Paris Nord & University of Paris, Paris, France
| | - David Boccara
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Burn Center, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Nord & University of Paris, Paris, France
| | - Benoit Plaud
- Department of Anesthesiology and Critical Care, Saint-Louis Hospital, Département Médico-Universitaire Parabol, Assistance Publique - Hôpitaux de Paris, Nord & University of Paris Paris, France, INSERM U-942 Biomarkers in Cardioneurovascular Diseases, Inserm, France
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