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Vally S, Ferdynus C, Persichini R, Bouchet B, Braunberger E, Lo Pinto H, Martinet O, Vandroux D, Aujoulat T, Allyn J, Allou N. Impact of levosimendan on weaning from peripheral venoarterial extracorporeal membrane oxygenation in intensive care unit. Ann Intensive Care 2019; 9:24. [PMID: 30707314 PMCID: PMC6358626 DOI: 10.1186/s13613-019-0503-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU). METHODS This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated. RESULTS A total of 150 patients undergoing VA-ECMO were eligible for the study. Thirty-eight propensity-matched patients were evaluated in the levosimendan group and 65 in the non-levosimendan group. In patients treated with levosimendan, left ventricular ejection fraction had increased from 21.5 ± 9.1% to 30.7 ± 13.5% (P < 0.0001) and aortic velocity-time integral from 8.9 ± 4 cm to 12.5 ± 3.8 cm (P = 0.002) 24 h after drug infusion. After propensity score matching, levosimendan was the only factor associated with a significant reduction in VA-ECMO weaning failure rates (hazard ratio = 0.16; 95% confidence interval 0.04-0.7; P = 0.01). Kaplan-Meier survival curves showed that survival rates at 30 days were 78.4% for the levosimendan group and 49.5% for the non-levosimendan group (P = 0.02). After propensity score matching analysis, the difference in 30-day mortality between the two groups was not significant (hazard ratio = 0.55; 95% confidence interval 0.27-1.10; P = 0.09). CONCLUSIONS Our results suggest that levosimendan was associated with a beneficial effect on VA-ECMO weaning in ICU patients.
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Affiliation(s)
- Shamir Vally
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, France.,INSERM, CIC 1410, Saint-Pierre, France
| | - Romain Persichini
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Bruno Bouchet
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Eric Braunberger
- Chirurgie cardiaque, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Hugo Lo Pinto
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Olivier Martinet
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - David Vandroux
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Thomas Aujoulat
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Jérôme Allyn
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France
| | - Nicolas Allou
- Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, 97405, Saint-Denis, Allée des Topazes, France. .,Réanimation polyvalente, Hôpital Félix Guyon, Bellepierre, 97405, Saint-Denis, France.
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Allyn J, Ferdynus C, Lo Pinto H, Bouchet B, Persichini R, Vandroux D, Puech B, Allou N. Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification. PLoS One 2018; 13:e0203643. [PMID: 30204777 PMCID: PMC6133279 DOI: 10.1371/journal.pone.0203643] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background Treatment by venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used today, even though it is associated with high risks of complications and death. While studies have focused on the relationship between some of these complications and the risk of death, the relationship between different complications has never been specifically examined, despite the fact that the occurrence of one complication is known to favor the occurrence of others. Our objective was to describe the relationship between complications in patients undergoing VA-ECMO in intensive care unit (ICU) and to identify, if possible, patterns of patients according to complications. Methods and findings As part of a retrospective cohort study, we conducted a multiple correspondence analysis followed by a hierarchical ascendant classification in order to identify patterns of patients according to main complications (sepsis, thromboembolic event, major transfusion, major bleeding, renal replacement therapy) and in-ICU death. Our cohort of 145 patients presented an in-ICU mortality rate of 50.3%. Morbidity was high, with 36.5% of patients presenting three or more of the five complications studied. Multiple correspondence analysis revealed a cumulative inertia of 76.9% for the first three dimensions. Complications were clustered together and clustered close to death, prompting the identification of four patterns of patients according to complications, including one with no complications. Conclusions Our study, based on a large cohort of patients undergoing VA-ECMO in ICU and presenting a mortality rate comparable to that reported in the literature, identified numerous and often interrelated complications. Multiple correspondence analysis and hierarchical ascendant classification yielded clusters of patients and highlighted specific links between some of the complications studied. Further research should be conducted in this area.
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Affiliation(s)
- Jérôme Allyn
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
- Departement d’Informatique Clinique, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
- * E-mail:
| | - Cyril Ferdynus
- Unité de Soutien Méthodologique, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, France
- INSERM, CIC 1410, Saint-Pierre, France
| | - Hugo Lo Pinto
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Bruno Bouchet
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Romain Persichini
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - David Vandroux
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Berenice Puech
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
| | - Nicolas Allou
- Réanimation Polyvalente, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
- Departement d’Informatique Clinique, Centre Hospitalier Universitaire de La Réunion Site Félix Guyon, Saint-Denis, France
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Lo Pinto H, Allyn J, Persichini R, Bouchet B, Brochier G, Martinet O, Brulliard C, Valance D, Delmas B, Braunberger E, Dangers L, Allou N. Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation. Int J Artif Organs 2018; 41:644-652. [PMID: 29998775 DOI: 10.1177/0391398818785132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Few data are available on the potential benefits and risks of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation. The aim of this study was to identify the determinants and prognosis of red blood cell transfusion in patients undergoing extracorporeal membrane oxygenation, with a special focus on biological parameters during extracorporeal membrane oxygenation treatment. METHODS We conducted a single-center retrospective cohort study including all consecutive patients who underwent extracorporeal membrane oxygenation between January 2010 and December 2015. RESULTS The 201 evaluated patients received a median of 0.9 [0.5-1.7] units of red blood cell per day. Significant and clinically relevant variables that best correlated with units of red blood cell transfused per day of extracorporeal membrane oxygenation were lower median daily prothrombin time in percentage (Quick) ( t = -0.016, p < 0.0001), higher median daily free bilirubin level ( t = 0.016, p < 0.0001), and lower pH ( t = -2.434, p < 0.0001). In multivariate analysis, red blood cell transfusion was associated with a significantly higher rate of in-intensive care unit mortality (per red blood cell unit increment; adjusted odds ratio: 1.07, 95% confidence interval: 1.02-1.12, p = 0.005). It was also associated with higher rates of acute renal failure ( p = 0.025), thromboembolic complications ( p = 0.0045), and sepsis ( p = 0.015). CONCLUSION This study suggests that red blood cell transfusion may be associated with a higher mortality rate and with severe complications. However, we cannot conclude a direct causal relationship, as red blood cell transfusion may be only a marker of poor outcome. We recommend that physicians correct acidosis and hemolysis in patients undergoing extracorporeal membrane oxygenation whenever possible.
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Affiliation(s)
- Hugo Lo Pinto
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Jérôme Allyn
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Romain Persichini
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Bruno Bouchet
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Gilbert Brochier
- 2 Établissement Français du Sang, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Olivier Martinet
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Caroline Brulliard
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Dorothée Valance
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Benjamin Delmas
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Eric Braunberger
- 3 Chirurgie Cardiaque, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Laurence Dangers
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
| | - Nicolas Allou
- 1 Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint-Denis, France
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Komas NP, Ghosh S, Abdou-Chekaraou M, Pradat P, Al Hawajri N, Manirakiza A, Laghoe GL, Bekondi C, Brichler S, Ouavéné JO, Sépou A, Yambiyo BM, Gody JC, Fikouma V, Gerber A, Abeywickrama Samarakoon N, Alfaiate D, Scholtès C, Martel N, Le Gal F, Lo Pinto H, Amri I, Hantz O, Durantel D, Lesbordes JL, Gordien E, Merle P, Drugan T, Trépo C, Zoulim F, Cortay JC, Kay AC, Dény P. Hepatitis B and hepatitis D virus infections in the Central African Republic, twenty-five years after a fulminant hepatitis outbreak, indicate continuing spread in asymptomatic young adults. PLoS Negl Trop Dis 2018; 12:e0006377. [PMID: 29698488 PMCID: PMC5940242 DOI: 10.1371/journal.pntd.0006377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 05/08/2018] [Accepted: 03/08/2018] [Indexed: 12/13/2022] Open
Abstract
Hepatitis delta virus (HDV) increases morbidity in Hepatitis B virus (HBV)-infected patients. In the mid-eighties, an outbreak of HDV fulminant hepatitis (FH) in the Central African Republic (CAR) killed 88% of patients hospitalized in Bangui. We evaluated infections with HBV and HDV among students and pregnant women, 25 years after the fulminant hepatitis (FH) outbreak to determine (i) the prevalence of HBV and HDV infection in this population, (ii) the clinical risk factors for HBV and/or HDV infections, and (iii) to characterize and compare the strains from the FH outbreak in the 1980s to the 2010 HBV–HDV strains. We performed a cross sectional study with historical comparison on FH-stored samples (n = 179) from 159 patients and dried blood-spots from volunteer students and pregnant women groups (n = 2172). We analyzed risk factors potentially associated with HBV and HDV. Previous HBV infection (presence of anti-HBc) occurred in 345/1290 students (26.7%) and 186/870 pregnant women (21.4%)(p = 0.005), including 110 students (8.8%) and 71 pregnant women (8.2%), who were also HBsAg-positive (p = 0.824). HDV infection occurred more frequently in pregnant women (n = 13; 18.8%) than students (n = 6; 5.4%) (p = 0.010). Infection in childhood was probably the main HBV risk factor. The risk factors for HDV infection were age (p = 0.040), transfusion (p = 0.039), and a tendency for tattooing (p = 0.055) and absence of condom use (p = 0.049). HBV-E and HDV-1 were highly prevalent during both the FH outbreak and the 2010 screening project. For historical samples, due to storage conditions and despite several attempts, we could only obtain partial HDV amplification representing 25% of the full-length genome. The HDV-1 mid-eighties FH-strains did not form a specific clade and were affiliated to two different HDV-1 African subgenotypes, one of which also includes the 2010 HDV-1 strains. In the Central African Republic, these findings indicate a high prevalence of previous and current HBV-E and HDV-1 infections both in the mid-eighties fulminant hepatitis outbreak and among asymptomatic young adults in 2010, and reinforce the need for universal HBV vaccination and the prevention of HDV transmission among HBsAg-positive patients through blood or sexual routes. In the Central African Republic (CAR), due to 20 years of conflict, the health system has been disorganized. This could contribute to maintenance of high transmission levels of Hepatitis B Virus (HBV) and its satellite Hepatitis Delta Virus (HDV). This work studies the evolution of both infections 25 years after a fulminant hepatitis (FH) outbreak occurring in the mid-1980s associated with HDV superinfection. In young asymptomatic adults, the results show that both HBV and HDV were still actively circulating in CAR in 2010. Indeed, more than one third of HBV-infected individuals were chronic HBV carriers. Furthermore, HDV infection could be spreading among 10% of them through blood and sexual transmission. The past FH outbreak and contemporary infections were both associated with heterogeneous HDV-1 strains, combined with HBV-E. Vaccination against HBV was uncommon among pregnant women and students, even among medical students. The study constitutes warning signals to help CAR health-care reconstruction and underlines the importance of HBV vaccination. The high level of HBV infection creates a background for HDV superinfection. Neonatal HBV vaccination is needed, together with vaccination of unprotected populations. Awareness of health authorities as well as the general public would help reduce HBV and HDV infections.
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Affiliation(s)
- Narcisse Patrice Komas
- Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic
- * E-mail: (NPK); (PD)
| | - Sumantra Ghosh
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Mariama Abdou-Chekaraou
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Pierre Pradat
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Center for Clinical Research, Croix-Rousse Hospital, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | | | - Alexandre Manirakiza
- Service d’Épidémiologie, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Gina Laure Laghoe
- Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Claudine Bekondi
- Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Ségolène Brichler
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Jean-Omer Ouavéné
- Service de Médecine Interne, Hôpital de l’Amitié, Avenue Indépendance, Bangui, Central African Republic
| | - Abdoulaye Sépou
- Service de Gynécologie Obstétrique, Hôpital Communautaire de Bangui, Avenue des Martyrs, Bangui, Central African Republic
| | - Brice Martial Yambiyo
- Service d’Épidémiologie, Institut Pasteur de Bangui, Bangui, Central African Republic
| | | | - Valentin Fikouma
- Centre de Traitement Ambulatoire de l’Hôpital Communautaire de Bangui, Bangui, Central African Republic
| | - Athénais Gerber
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | | | - Dulce Alfaiate
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Caroline Scholtès
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
- Laboratoire de Virologie, Croix-Rousse Hospital, Lyon, France
| | - Nora Martel
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Frédéric Le Gal
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Hugo Lo Pinto
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Ikram Amri
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Olivier Hantz
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - David Durantel
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Jean-Louis Lesbordes
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Emmanuel Gordien
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Philippe Merle
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Trépo
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | - Fabien Zoulim
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | - Jean-Claude Cortay
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Alan Campbell Kay
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Paul Dény
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
- * E-mail: (NPK); (PD)
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