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Canet E, Zafrani L. Questions about the BEST-Fluids trial. Lancet 2024; 403:908-909. [PMID: 38460984 DOI: 10.1016/s0140-6736(23)02681-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/24/2023] [Indexed: 03/11/2024]
Affiliation(s)
- Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France; Université de Nantes, Nantes 44093, France.
| | - Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France; INSERM U944, Saint-Louis Research Institute, University of Paris Cité, Paris, France
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Petit M, Bidar F, Fosse Q, Lefevre L, Paul M, Urbina T, Masi P, Bavozet F, Lemarié J, de Montmollin E, Andriamifidy-Berti C, Dessajan J, Zuber B, Zafrani L, Peju E, Meng P, Charrier L, Le Guennec L, Simon M, Luyt CE, Haudebourg L, Geri G. Antibiotic definitive treatment in ventilator associated pneumonia caused by AmpC-producing Enterobacterales in critically ill patients: a prospective multicenter observational study. Crit Care 2024; 28:40. [PMID: 38317262 PMCID: PMC10845500 DOI: 10.1186/s13054-024-04820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/28/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) due to wild-type AmpC-producing Enterobacterales (wtAE) is frequent in intensive care unit (ICU) patients. Despite a low level of evidence, definitive antimicrobial therapy (AMT) with third generation cephalosporins (3GCs) or piperacillin is discouraged. METHODS Observational prospective study including consecutive wtAE VAP patients in 20 French ICUs. The primary objective was to assess the association of the choice of definitive AMT, i.e. piperacillin ± tazobactam (PTZ), 3GCs or other molecule (4GCs, carbapenems, quinolones, cotrimoxazole; control group), with treatment success at day-7. Recurrence of infection was collected as a secondary outcome, and analyzed accounting for the competing risk of death. RESULTS From February 2021 to June 2022, 274 patients were included. Enterobacter cloacae was the most prevalent specie (31%). Seventy-eight patients (28%) had PTZ as definitive AMT while 44 (16%) had 3GCs and 152 (56%) were classified in the control group. Day-7 success rate was similar between the 3 groups (74% vs. 73% vs. 68% respectively, p = 0.814). Recurrence probability at day-28 was 31% (95% CI 21-42), 40% (95% CI 26-55) and 21% (95% CI 15-28) for PTZ, 3GCs and control groups (p = 0.020). In multivariable analysis, choice of definitive AMT was not associated with clinical success, but definitive AMT with 3GCs was associated with recurrence at day-28 [csHR(95%CI) 10.9 (1.92-61.91)]. CONCLUSION Choice of definitive antimicrobial therapy was not associated with treatment success at day 7. However, recurrence of pneumonia at day-28 was higher in patients treated with third generation cephalosporins with no differences in mortality or mechanical ventilation duration.
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Affiliation(s)
- Matthieu Petit
- Medical Intensive Care Unit, Ambroise Paré Hospital, APHP, UMR 1018, CESP Villejuif, 9, Avenue Charles de Gaulle, Boulogne-Billancourt, France.
| | - Frank Bidar
- Anesthesia and Critical Care Medicine Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Quentin Fosse
- AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Lucie Lefevre
- Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marine Paul
- Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Paul Masi
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France
| | | | - Jérémie Lemarié
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Etienne de Montmollin
- INSERM UMR 1137, 75018, Department of Intensive Care Medicine, APHP, Bichat-Claude Bernard University Hospital, Université Paris Cité, 75018, Paris, France
| | - Chloé Andriamifidy-Berti
- Médecine Intensive - Réanimation, Centre Hospitalier de Poissy - Saint Germain en Laye, Poissy, France
| | - Julien Dessajan
- Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Zuber
- Intensive Care Unit, Hôpital Foch, 92150, Suresnes, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France
| | - Edwige Peju
- Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris AP-HP Centre, Université Paris Cité, Paris, France
| | - Paris Meng
- Service de Médecine Intensive Réanimation, CHI Robert Ballanger, Aulnay-sous-Bois, France
| | - Liliane Charrier
- Service de Réanimation, Centre Hospitalier du Cotentin, Cherbourg, France
| | - Loic Le Guennec
- Médecine Intensive Réanimation Neurologique, Hôpital de la Pitié-Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Marie Simon
- Médecine Intensive Et Réanimation, CHU Edouard Herriot, Lyon, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Luc Haudebourg
- Service de Pneumologie et Réanimation Médicale du Département R3S, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France
| | - Guillaume Geri
- Medical and Surgical Intensive Care Unit, Ambroise Paré Clinic, Neuilly-sur-Seine, France.
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Picod A, Zafrani L, Azoulay E. Immune-mediated thrombotic thrombocytopenic purpura: don't miss the boat. Intensive Care Med 2024; 50:287-290. [PMID: 38193904 DOI: 10.1007/s00134-023-07300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Adrien Picod
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lara Zafrani
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris University, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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Demonchy J, Biard L, Clere-Jehl R, Wallet F, Mokart D, Moreau AS, Argaud L, Verlhac C, Pène F, Lautrette A, Bige N, de Jong A, Canet E, Quenot JP, Issa N, Zerbib Y, Bouard I, Picard M, Zafrani L. Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. Emerg Infect Dis 2024; 30. [PMID: 38270146 PMCID: PMC10826781 DOI: 10.3201/eid3002.231221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002----2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death.
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Souppart V, Zafrani L. [Restraint in intensive care: between patient safety and respect for autonomy]. Soins 2024; 69:51-53. [PMID: 38296422 DOI: 10.1016/j.soin.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The use of physical restraint in the context of medical resuscitation is relatively frequent. Although temporary or prolonged physical restraint is justified by patient safety (possibility of self-extubation, etc.), this practice is itself a source of risk, leads to suffering on the part of the patient, and raises dilemmas and ethical questions within teams. Inherent to the working conditions and training of professionals, restraint must nevertheless be balanced and lead to the search for alternatives.
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Affiliation(s)
- Virginie Souppart
- Médecine intensive réanimation, hôpital Saint-Louis, AP-HP, 1 avenue Claude-Vellefaux, 75010 Paris, France
| | - Lara Zafrani
- Médecine intensive réanimation, hôpital Saint-Louis, AP-HP, 1 avenue Claude-Vellefaux, 75010 Paris, France.
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de Boisriou I, Ellouze S, Kassasseya C, Feral-Pierssens AL, Gerlier C, Chauvin A, Beaune S, Dubreucq E, Pereira L, Chocron R, Khellaf M, Mariotte É, Zafrani L, Peyrony O. Misdiagnosis of thrombotic microangiopathy in the emergency department: a multicenter retrospective study. Intern Emerg Med 2024; 19:115-124. [PMID: 37914919 DOI: 10.1007/s11739-023-03457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/08/2023] [Indexed: 11/03/2023]
Abstract
To estimate the rate of inappropriate diagnosis in patients who visited the ED with thrombotic microangiopathy (TMA) and to assess the factors and outcomes associated with emergency department (ED) misdiagnosis. Retrospective multicenter study of adult patients admitted to the intensive care unit (ICU) for TMA from 2012 to 2021 who had previously attended the ED for a reason related to TMA. Patient characteristics and outcomes were compared in a univariate analysis based on whether a TMA diagnosis was mentioned in the ED or not. Forty patients were included. The diagnosis of TMA was not mentioned in the ED in 16 patients (40%). Patients for whom the diagnosis was mentioned in the ED had more frequently a request for schistocytes research, and therefore had more often objectified schistocytes. They also had more frequently a troponin dosage in the ED (even if the difference was not significant), an ECG performed or interpreted, and were admitted more quickly in the ICU (0 [0-0] vs 2 [0-2] days; P = 0.002). Hemoglobin levels decreased significantly in both groups, and creatinine levels increased significantly in the misdiagnosis group between ED arrival and ICU admission. In patients with a final diagnosis of TTP, the time to platelets durable recovery was shorter for those in whom the diagnosis was mentioned in the ED without reaching statistical significance (7 [5-11] vs 14 [5-21] days; P = 0.3).
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Affiliation(s)
| | - Sami Ellouze
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Christian Kassasseya
- Emergency Department, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Camille Gerlier
- Emergency Department, Groupe Hospitalier Paris-Saint-Joseph, Paris, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sebastien Beaune
- Emergency Department, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Versailles St Quentin- UFR Simone Veil santé, Montigny-le-Bretonneux, France
| | - Evelyne Dubreucq
- Emergency Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Pereira
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Richard Chocron
- Emergency Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Team "Integrative Epidemiology of Cardiovascular Diseases", Université Paris Cité, Paris, France
| | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Éric Mariotte
- Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France.
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7
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Joseph A, Zafrani L. How I Treat Tumor Lysis Syndrome. Clin J Am Soc Nephrol 2023; 18:1634-1636. [PMID: 37788006 PMCID: PMC10723907 DOI: 10.2215/cjn.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Adrien Joseph
- Department of medical intensive care unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Lara Zafrani
- Department of medical intensive care unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
- INSERM U944, Saint-Louis Research Institute, University of Paris Cité, Paris, France
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8
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Zafrani L, Canet E, Walter-Petrich A, Joly-Laffargue B, Veyradier A, Faguer S, Bigé N, Calvet L, Mayaux J, Grangé S, Rafat C, Poulain C, Klouche K, Perez P, Pène F, Pichereau C, Duceau B, Mariotte E, Chevret S, Azoulay E. Magnesium sulphate in patients with thrombotic thrombocytopenic purpura (MAGMAT): a randomised, double-blind, superiority trial. Intensive Care Med 2023; 49:1293-1304. [PMID: 37867165 DOI: 10.1007/s00134-023-07178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Studies have suggested benefits from magnesium sulphate in thrombotic thrombocytopenic purpura (TTP). We aimed to measure the effects of magnesium sulphate supplementation on TTP recovery. METHODS In this multicenter, randomised, double-blind, controlled, superiority study, we enrolled adults with a clinical diagnosis of TTP. Patients were randomly allocated to receive magnesium sulphate (6 g intravenously followed by a continuous infusion of 6 g/24 h for 3 days) or placebo, in addition to the standard treatment. The primary outcome was the median time to platelet normalisation (defined as a platelet count ≥ 150 G/L). Efficacy and safety were assessed by intention-to-treat. RESULTS Overall, we enrolled 74 participants, including one who withdrew his/her consent. Seventy-three patients were further analyzed, 35 (48%) allocated to magnesium sulphate and 38 (52%) to placebo. The median time to platelet normalisation was 4 days (95% confidence interval [CI], 3-4) in the magnesium sulphate group and 4 days (95% CI 3-5) in the placebo group. The cause-specific hazard ratio of response was 0.93 (95% CI 0.58-1.48, p = 0.75). The number of patients with ≥ 1 serious adverse reactions was similar in the two groups. By day 90, four patients in the magnesium sulphate group and two patients in the placebo group had died (p = 0.42). The most frequent adverse event was low blood pressure occurring in 34% in the magnesium sulphate group and 29% in the placebo group (p = 0.80). CONCLUSION Among patients with TTP, the addition of magnesium sulphate to the standard of care did not result in a significant improvement in time to platelet normalisation.
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Affiliation(s)
- Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France.
- INSERM U944, Saint-Louis Research Institute, University of Paris Cité, Paris, France.
| | - Emmanuel Canet
- Department of Medical Intensive Care Unit, Nantes University Hospital, Nantes University, Nantes, France
| | - Anouk Walter-Petrich
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, INSERM S 717, Paris, France
| | - Bérangère Joly-Laffargue
- Service d'Hématologie Biologique, Lariboisière Hospital and EA3518, Institut de Recherche Saint-Louis, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie Biologique, Lariboisière Hospital and EA3518, Institut de Recherche Saint-Louis, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, National Reference Center for Rare Kidney Diseases, University Hospital of Toulouse, INSERM UMR 1297 (I2MC), Toulouse, France
| | - Naïke Bigé
- Department of Medical Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Laure Calvet
- Department of Medical Intensive Care Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Mayaux
- Department of Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Steven Grangé
- Department of Nephrology, Rouen University Hospital, Rouen, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologiques et Rein Aigu (SINRA), French Intensive Renal Network, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Coralie Poulain
- Department of Nephrology Internal Medicine Dialysis Transplantation, Amiens University Medical Center, F-80054, Amiens, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie University Hospital, Montpellier, France
| | - Pierre Perez
- Medical Intensive Care Unit, Brabois Hospital, Vandoeuvre Les Nancy, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique -Hôpitaux de Paris, University of Paris Cité, Cochin Institute, INSERM U1016, CNRS UMR8104, Paris, France
| | - Claire Pichereau
- Department of Intensive Care Unit, Poissy Saint Germain en Laye Hospital, Poissy, France
| | - Baptiste Duceau
- Department of Anesthesiology and Critical Care Medicine, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Eric Mariotte
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, INSERM S 717, Paris, France
| | - Elie Azoulay
- Department of Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
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Chaba A, Fodil S, Lemiale V, Mariotte E, Valade S, Azoulay E, Zafrani L. Clinical Warburg effect in lymphoma patients admitted to intensive care unit. Ann Intensive Care 2023; 13:97. [PMID: 37796407 PMCID: PMC10555986 DOI: 10.1186/s13613-023-01192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The Warburg effect, characterized by elevated lactate levels without tissue hypoxia or shock, has been described in patients with aggressive lymphoproliferative malignancies. However, the clinical characteristics and long-term outcomes in this population remain poorly understood. METHODS We retrospectively analyzed 135 patients with aggressive lymphoproliferative malignancies admitted to the ICU between January 2017 and December 2022. Patients were classified into three groups: Clinical Warburg Effect (CWE), No Warburg with High Lactate level (NW-HL), and No Warburg with Normal Lactate level (NW-NL). Clinical characteristics and outcomes were compared between the groups and factors associated with 1-year mortality and CWE were identified using multivariable analyses. RESULTS Of the 135 patients, 46 (34%) had a CWE. This group had a higher proportion of Burkitt and T cell lymphomas, greater tumor burden, and more frequent bone and cerebral involvement than the other groups. At 1 year, 72 patients (53%) died, with significantly higher mortality in the CWE and NW-HL groups (70% each) than in the NW-NL group (38%). Factors independently associated with 1-year mortality were age [HR = 1.02 CI 95% (1.00-1.04)], total SOFA score at admission [HR = 1.19 CI 95% (1.12-1.25)], and CWE [HR = 3.87 CI 95% (2.13-7.02)]. The main factors associated with the CWE were tumor lysis syndrome [OR = 2.84 CI 95% (1.14-7.42)], bone involvement of the underlying malignancy [OR = 3.58 CI 95% (1.02-12.91)], the total SOFA score at admission [OR = 0.81 CI 95% (0.69-0.91)] and hypoglycemia at admission [OR = 14.90 CI 95% (5.42-47.18)]. CONCLUSION CWE is associated with a higher tumor burden and increased 1-year mortality compared to patients without this condition. Our findings underscore the importance of recognizing patients with CWE as a high-risk cohort, as their outcomes closely resemble those of individuals with lymphoma and shock, despite not requiring advanced organ support. Clinicians should recognize the urgency of managing these patients and consider early intervention to improve their prognosis.
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Affiliation(s)
- Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sofiane Fodil
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
- University Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.
- University Paris Cité, Paris, France.
- INSERM, UMR 944, University Paris Cité, Paris, France.
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David S, Russell L, Castro P, van de Louw A, Zafrani L, Pirani T, Nielsen ND, Mariotte E, Ferreyro BL, Kielstein JT, Montini L, Brignier AC, Kochanek M, Cid J, Robba C, Martin-Loeches I, Ostermann M, Juffermans NP. Research priorities for therapeutic plasma exchange in critically ill patients. Intensive Care Med Exp 2023; 11:26. [PMID: 37150798 PMCID: PMC10164453 DOI: 10.1186/s40635-023-00510-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to "TPE in the critically ill patient". These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk-benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.
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Affiliation(s)
- Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Andry van de Louw
- Medical Intensive Care Unit, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France
| | - Tasneem Pirani
- King's College Hospital, General and Liver Intensive Care, London, UK
| | - Nathan D Nielsen
- Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA
| | - Eric Mariotte
- Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France
| | - Bruno L Ferreyro
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada
| | - Jan T Kielstein
- Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Brunswick, Germany
| | - Luca Montini
- Department of Intensive Care Medicine and Anesthesiology, "Fondazione Policlinico Universitario Agostino Gemelli IRCCS" Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anne C Brignier
- Apheresis Unit, Saint-Louis Hospital, AP-HP, University of Paris Cite, Paris, France
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO), University of Cologne, Cologne, Germany
| | - Joan Cid
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Chiara Robba
- IRCCS per Oncologia e Neuroscienze, Genoa, Italy
- Dipartimento di Scienze Chirurgiche Diagnostiche ed Integrate, Universita' di Genova, Genoa, Italy
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, D08 NHY1, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, D02 PN91, Ireland
- Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Marlies Ostermann
- Department of Intensive Care, Guy's & St Thomas' Hospital, King's College London, London, UK
| | - Nicole P Juffermans
- Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus MC, Rotterdam, The Netherlands
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11
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Kapandji N, Darmon M, Valade S, Salmona M, Legoff J, Zafrani L, Azoulay E, Lemiale V. Clinical significance of human metapneumovirus detection in critically ill adults with lower respiratory tract infections. Ann Intensive Care 2023; 13:21. [PMID: 36940047 PMCID: PMC10026215 DOI: 10.1186/s13613-023-01117-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Unlike other viruses, the pathogenicity of human metapneumovirus (hMPV) in adults remains uncertain. To address this question, a retrospective monocentric cohort including all patients admitted to ICU with hMPV infection between January 1, 2010, and June 30, 2018 was performed. The characteristics of hMPV infected patients were studied and compared to matched influenza infected patients. Consecutively, a systematic review and meta-analyses investigating PUBMED, EMBASE and COCHRANE databases was conducted to explore the hMPV infections in adult patients (PROSPERO number: CRD42018106617). Trials, case series, and cohorts published between January 1, 2008 and August 31, 2019 compiling adults presenting hMPV infections were included. Pediatric studies were excluded. Data were extracted from published reports. Primary endpoint was the rate of low respiratory tract infections (LRTIs) among all hMPV infected patients. RESULTS During the study period, 402 patients were tested positive for hMPV. Among them 26 (6.5%) patients were admitted to the ICU, 19 (4.7%) for acute respiratory failure. Twenty-four (92%) were immunocompromised. Bacterial coinfections were frequent 53.8%. Hospital mortality rate was 30.8%. In the case-control analysis, the clinical and imaging characteristics were not different between hMPV and influenza infected patients. The systematic review identified 156 studies and 69 of them (1849 patients) were eligible for analysis. Although there was heterogeneity between the studies, the rate of hMPV LRTIs was 45% (95% CI 31-60%; I2 = 98%). Intensive care unit (ICU) admission was required for 33% (95% CI 21-45%; I2 = 99%). Hospital mortality rate was 10% (95% CI 7-13%; I2 = 83%) and ICU mortality rate was 23% (95% CI 12-34%; I2 = 65%). Underlying malignancy was independently associated with increased mortality rate. CONCLUSIONS This preliminary work suggested that hMPV may be associated with severe infection and high mortality in patients with underlying malignancies. However, regarding the small size of the cohort and the heterogeneity of the review, more cohort studies are warranted.
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Affiliation(s)
- Natacha Kapandji
- Medical ICU, Saint Louis Academic Hospital, APHP, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | - Michael Darmon
- Medical ICU, Saint Louis Academic Hospital, APHP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sandrine Valade
- Medical ICU, Saint Louis Academic Hospital, APHP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Maud Salmona
- Virology department, Saint Louis Hospital, Paris, France
| | - Jérôme Legoff
- Virology department, Saint Louis Hospital, Paris, France
| | - Lara Zafrani
- Medical ICU, Saint Louis Academic Hospital, APHP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Medical ICU, Saint Louis Academic Hospital, APHP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Lemiale
- Medical ICU, Saint Louis Academic Hospital, APHP, 1 Avenue Claude Vellefaux, 75010, Paris, France
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12
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Azoulay E, Souppart V, Kentish-Barnes N, Benhamou Y, Joly BS, Zafrani L, Joseph A, Canet E, Presne C, Grall M, Zerbib Y, Provot F, Fadlallah J, Mariotte E, Urbina T, Veyradier A, Coppo P. Post-traumatic stress disorder and quality of life alterations in survivors of immune-mediated thrombotic thrombocytopenic purpura and atypical hemolytic and uremic syndrome. J Crit Care 2023; 76:154283. [PMID: 36931181 DOI: 10.1016/j.jcrc.2023.154283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
Thrombotic thrombocytopenic purpura (iTTP) and atypical hemolytic-uremic syndrome (aHUS), once in remission, may cause long-term symptoms, among which mental-health impairments may be difficult to detect. We conducted telephone interviews 72 [48-84] months after ICU discharge to assess symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) and the 36-item Short Form questionnaire (SF-36). Of 103 included patients, 52 had iTTP and 51 aHUS; 74% were female, median age was 39 y (31-54), and 39 (38%) patients were still taking treatment. Symptoms of anxiety, PTSD and depression were present in 50%, 27% and 14% of patients, respectively, with no significant difference between the iTTP and aHUS groups. Patients with PTSD symptoms had significantly greater weight gain and significantly worse perceived physical and/or emotional wellbeing, anxiety symptoms, and depression symptoms. The SF-36 physical and mental components indicated significantly greater quality-of-life impairments in patients with vs. without PTSD symptoms and in those with aHUS and PTSD vs. iTTP with or without PTSD. In the aHUS group, quality of life was significantly better in patients with vs. without eculizumab treatment. Factors independently associated with PTSD symptoms were male sex (odds ratio [OR], 0.11; 95%CI, 0.02-0.53), platelet count ≤20 G/L at acute-episode presentation (OR, 2.68; 1.01-7.38), and current treatment (OR, 2.69; 95%CI, 1.01-7.36). Mental-health screening should be routine in patients with iTTP and aHUS to ensure appropriate care.
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Affiliation(s)
- Elie Azoulay
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France.
| | - Virginie Souppart
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France,; Famirea Study Group, APHP, Hôpital Saint Louis, Paris, France
| | - Ygal Benhamou
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de médecine interne, Hôpital universitaire de Rouen, Université de Normandie, Rouen, France
| | - Bérangère S Joly
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'hématologie biologique, laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; EA3518, Institut de recherche Saint Louis, Université Paris Cité, Paris, France
| | - Lara Zafrani
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Adrien Joseph
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Emmanuel Canet
- Médecine Intensive et Réanimation, CHU de Nantes, France
| | - Claire Presne
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service de Néphrologie, Médecine Interne, Hémodialyse, Transplantation du CHU d'AMIENS PICARDIE, France
| | - Maximilien Grall
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de médecine interne, Hôpital universitaire de Rouen, Université de Normandie, Rouen, France
| | - Yoann Zerbib
- Médecine Intensive et Réanimation, CHU d'Amiens, France
| | - François Provot
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Département de néphrologie, dialyse et transplantation, Université de Lille, CHU de Lille, France
| | - Jehane Fadlallah
- Département d'immunologie clinique, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Eric Mariotte
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint Louis, Paris, France
| | - Tomas Urbina
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Médecine Intensive et Réanimation, APHP, Hôpital Saint-Antoine, France
| | - Agnès Veyradier
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'hématologie biologique, laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université Paris Cité, Paris, France; EA3518, Institut de recherche Saint Louis, Université Paris Cité, Paris, France
| | - Paul Coppo
- Centre National de Référence des MicroAngiopathies Thrombotiques, Paris, France; Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
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13
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Zafrani L, Mooney N. Authors' Reply: A Crystal-Independent Role for Uric Acid in AKI Associated with Tumor Lysis Syndrome. J Am Soc Nephrol 2023; 34:176-177. [PMID: 36719149 PMCID: PMC10101627 DOI: 10.1681/asn.2022101097] [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: 01/22/2023] Open
Affiliation(s)
- Lara Zafrani
- University of Paris Cité—INSERM U976, Paris, France
- Medical Intensive Care Unit, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Nuala Mooney
- University of Paris Cité—INSERM U976, Paris, France
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14
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Lemiale V, Mabrouki A, Miry L, Mokart D, Pène F, Kouatchet A, Mayaux J, Bruneel F, Perez P, Meert AP, Moreau AS, Benoit D, Darmon M, Zafrani L, Clere-Jehl R. Sepsis-associated coagulopathy in onco-hematology patients presenting with thrombocytopenia: a multicentric observational study. Leuk Lymphoma 2023; 64:197-204. [PMID: 36305707 DOI: 10.1080/10428194.2022.2136971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coagulation disorders increase mortality rate during septic shock, but the impact of concomitant hematological malignancies remains unknown. The study assessed coagulation disorders in onco-hematological patients with thrombocytopenia (<100 G/L) admitted to ICU for septic shock. Among 146 included patients, 50 patients had lymphoma and 49 patients had acute leukemia. ICU mortality rate was 43.8% (n = 64). Median increase in prothrombin time (PT) at day(d) 1 was 4.7 s (IQR 3.2-7.9) in ICU survivors vs. 6.4 s (IQR 4.5-13.7; p < 0.01) in non-survivors. Fibrinogen kinetics (increase in fibrinogen levels between d1 and d2) was +0.55 (-0.22-1.55) vs. +0.10 g/L (-0.40-0.50; p = 0.03) in surviving and non-surviving patients, respectively. PT increase ≥6 s at d1 (OR 5.5; 95% CI 1.1-6.0; p = 0.03) and mechanical ventilation (OR 7.4; 95% CI 3.3-17.7; p < 0.001) were independently associated with ICU mortality. This study provides information and new ways to identify hematological patients with high-risk mortality.
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Affiliation(s)
- Virginie Lemiale
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Asma Mabrouki
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loïc Miry
- Neuro-Intensive Care Unit, Rothschild Foundation Hospital, France
| | - Djamel Mokart
- Medical and Surgical Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Frédéric Pène
- Service de Médecine Intensive-réanimation, Hôpital Cochin, AP-HP, Centre & Université Paris Cité, Paris, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - Julien Mayaux
- Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Fabrice Bruneel
- Department of Critical Care, Versailles Hospital, Le Chesnay, France
| | - Pierre Perez
- Medical Intensive Care Unit, Hôpital Brabois, Vandoeuvre Les Nancy, France
| | - Anne-Pascale Meert
- Soins intensifs et urgences oncologiques, Service de Médecine interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgique
| | - Anne-Sophie Moreau
- Pôle de médecine intensive réanimation, Hôpital Roger Salengro, CHU Lille, Lille cedex, France
| | - Dominique Benoit
- Medical Unit, Department of Intensive Care, Ghent University Hospitalc, Ghent, Belgium
| | - Michael Darmon
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U976, Human Immunology, Pathophysiology and Immunotherapy, Saint-Louis Teaching Hospital, Paris University, Paris, France
| | - Raphaël Clere-Jehl
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM (French National Institute of Health and Medical Research), UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg Cedex, France
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15
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Joseph A, Lafarge A, Azoulay E, Zafrani L. Acute Kidney Injury in Cancer Immunotherapy Recipients. Cells 2022; 11:cells11243991. [PMID: 36552755 PMCID: PMC9776910 DOI: 10.3390/cells11243991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer immunotherapy has now entered clinical practice and has reshaped the standard of care for many cancer patients. With these new strategies, specific toxicities have emerged, and renal side effects have been described. In this review, we will describe the causes of acute kidney injury in CAR T cell, immune checkpoint inhibitors and other cancer immuno-therapy recipients. CAR T cell therapy and bispecific T cell engaging antibodies can lead to acute kidney injury as a consequence of cytokine release syndrome, tumor lysis syndrome, sepsis or specific CAR T cell infiltration. Immune checkpoint blockade most often results in acute tubular interstitial nephritis, but glomerular diseases have also been described. Although the pathophysiology remains mostly elusive, we will describe the mechanisms of renal damage in these contexts, its prognosis and treatment. As the place of immunotherapy in the anti-cancer armamentarium is exponentially increasing, close collaboration between nephrologists and oncologists is of utmost importance to provide the best standard of care for these patients.
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16
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Pons S, Uhel F, Frapy E, Sérémé Y, Zafrani L, Aschard H, Skurnik D. How Protective are Antibodies to SARS-CoV-2, the Main Weapon of the B-Cell Response? Stem Cell Rev Rep 2022; 19:585-600. [PMID: 36422774 PMCID: PMC9685122 DOI: 10.1007/s12015-022-10477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
Since the beginning of the Coronavirus disease (COVID)-19 pandemic in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for more than 600 million infections and 6.5 million deaths worldwide. Given the persistence of SARS-CoV-2 and its ability to develop new variants, the implementation of an effective and long-term herd immunity appears to be crucial to overcome the pandemic. While a vast field of research has focused on the role of humoral immunity against SARS-CoV-2, a growing body of evidence suggest that antibodies alone only confer a partial protection against infection of reinfection which could be of high importance regarding the strategic development goals (SDG) of the United Nations (UN) and in particular UN SDG3 that aims towards the realization of good health and well being on a global scale in the context of the COVID-19 pandemic.In this review, we highlight the role of humoral immunity in the host defense against SARS-CoV-2, with a focus on highly neutralizing antibodies. We summarize the results of the main clinical trials leading to an overall disappointing efficacy of convalescent plasma therapy, variable results of monoclonal neutralizing antibodies in patients with COVID-19 but outstanding results for the mRNA based vaccines against SARS-CoV-2. Finally, we advocate that beyond antibody responses, the development of a robust cellular immunity against SARS-CoV-2 after infection or vaccination is of utmost importance for promoting immune memory and limiting disease severity, especially in case of (re)-infection by variant viruses.
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Affiliation(s)
- Stéphanie Pons
- DMU DREAM, Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière, Paris, France
- Université de Paris Cité, INSERM U976- Human Immunology, Pathophysiology, Immunotherapy (HIPI), Paris, France
| | - Fabrice Uhel
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France
- DMU ESPRIT, Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, 92700, Colombes, France
| | - Eric Frapy
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France
| | - Youssouf Sérémé
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France
| | - Lara Zafrani
- Université de Paris Cité, INSERM U976- Human Immunology, Pathophysiology, Immunotherapy (HIPI), Paris, France
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Hugues Aschard
- Department of Computational Biology, USR 3756 CNRS, Institut Pasteur, Paris, France
| | - David Skurnik
- INSERM, CNRS, Institut Necker Enfants Malades, Université de Paris Cité, Paris, France.
- Department of Clinical Microbiology, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris Cité, Paris, France.
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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17
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Dupont T, Darmon M, Mariotte E, Lemiale V, Fadlallah J, Mirouse A, Zafrani L, Azoulay E, Valade S. Etoposide treatment in secondary hemophagocytic syndrome: impact on healthcare-associated infections and survival. Ann Intensive Care 2022; 12:101. [DOI: 10.1186/s13613-022-01075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/15/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Etoposide remains the cornerstone of symptomatic management of critically ill patients with secondary hemophagocytic syndrome (sHS). Risk of healthcare-associated infections (HAIs) in this setting with etoposide has never been assessed. We sought to evaluate the association between etoposide administration, HAIs occurrence and survival in critically ill adult patients with sHS. In this retrospective single-center study conducted in a university hospital ICU between January 2007 and March 2020, all consecutive patients with sHS were included. HAIs were defined as any microbiologically documented infection throughout ICU stay. Competing risk survival analysis was performed to determine factors associated with HAIs. Propensity score-based overlap weighting was performed to adjust for factors associated with etoposide use.
Results
168 patients with a median age of 49 [38, 59] were included. Forty-three (25.6%) patients presented with at least 1 microbiologically documented HAI throughout ICU stay. After adjustment, cumulative incidence of HAI was higher in patients receiving etoposide (p = 0.007), while survival was unaffected by etoposide status (p = 0.824). By multivariable analysis, etoposide treatment was associated with a higher incidence of HAIs (sHR 3.75 [1.05, 6.67]), whereas no association with survival (sHR 0.53 [0.20, 1.98]) was found. Other factors associated with increased mortality after adjustment included age, immunodepression, male sex, SOFA score > 13, and occurrence of HAI.
Conclusions
In patients with sHS, etoposide treatment is independently associated with increased occurrence of HAIs, whereas no association with survival was found. Intensivists should be aware of increased infectious risk, to promptly detect and treat infections in this specific setting. Studies to assess benefits from prophylactic anti-infectious agents in this setting are warranted and the lack of benefit of etoposide on survival needs to be interpreted cautiously.
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18
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Sitbon A, Darmon M, Geri G, Jaubert P, Lamouche-Wilquin P, Monet C, Le Fèvre L, Baron M, Harlay ML, Bureau C, Joannes-Boyau O, Dupuis C, Contou D, Lemiale V, Simon M, Vinsonneau C, Blayau C, Jacobs F, Zafrani L. Accuracy of clinicians' ability to predict the need for renal replacement therapy: a prospective multicenter study. Ann Intensive Care 2022; 12:95. [PMID: 36242651 PMCID: PMC9569012 DOI: 10.1186/s13613-022-01066-w] [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] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Identifying patients who will receive renal replacement therapy (RRT) during intensive care unit (ICU) stay is a major challenge for intensivists. The objective of this study was to evaluate the performance of physicians in predicting the need for RRT at ICU admission and at acute kidney injury (AKI) diagnosis. METHODS Prospective, multicenter study including all adult patients hospitalized in 16 ICUs in October 2020. Physician prediction was estimated at ICU admission and at AKI diagnosis, according to a visual Likert scale. Discrimination, risk stratification and benefit of physician estimation were assessed. Mixed logistic regression models of variables associated with risk of receiving RRT, with and without physician estimation, were compared. RESULTS Six hundred and forty-nine patients were included, 270 (41.6%) developed AKI and 77 (11.8%) received RRT. At ICU admission and at AKI diagnosis, a model including physician prediction, the experience of the physician, SOFA score, serum creatinine and diuresis to determine need for RRT performed better than a model without physician estimation with an area under the ROC curve of 0.90 [95% CI 0.86-0.94, p < 0.008 (at ICU admission)] and 0.89 [95% CI 0.83-0.93, p = 0.0014 (at AKI diagnosis)]. In multivariate analysis, physician prediction was strongly associated with the need for RRT, independently of creatinine levels, diuresis, SOFA score and the experience of the doctor who made the prediction. CONCLUSION As physicians are able to stratify patients at high risk of RRT, physician judgement should be taken into account when designing new randomized studies focusing on RRT initiation during AKI.
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Affiliation(s)
- Alexandre Sitbon
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France. .,Sorbonne Université, Paris, France.
| | - Michael Darmon
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université Paris Cité, Paris, France
| | - Guillaume Geri
- Médecine Intensive et Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP) Sud, Boulogne Billancourt, France
| | - Paul Jaubert
- Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) Sud, Paris, France
| | | | - Clément Monet
- Département d'Anesthésie-Réanimation, Hôpital St-Eloi, CHRU, Montpellier, France
| | - Lucie Le Fèvre
- Médecine Intensive et Réanimation, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Paris, France
| | - Marie Baron
- Réanimation Polyvalente, Centre Hospitalier du Sud-Francilien, Corbeil-Essonnes, France
| | - Marie-Line Harlay
- Médecine Intensive et Réanimation, CHU Hautepierre, Strasbourg, France
| | - Côme Bureau
- Médecine Intensive et Réanimation, Hôpital de La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Olivier Joannes-Boyau
- Département d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Bordeaux, France
| | - Claire Dupuis
- Médecine Intensive et Réanimation, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Damien Contou
- Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Virginie Lemiale
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Marie Simon
- Médecine Intensive et Réanimation, CHU Edouard Herriot, Lyon, France
| | | | - Clarisse Blayau
- Médecine Intensive et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Frederic Jacobs
- Médecine Intensive et Réanimation, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Lara Zafrani
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université Paris Cité, Paris, France
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Rousseau A, Zafrani L. Acute kidney injury after CAR-T cell infusion. Bull Cancer 2022:S0007-4551(22)00353-8. [PMID: 36220698 DOI: 10.1016/j.bulcan.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
Chimeric antigen receptor T (CAR-T)-cell, an adaptive immune therapy is approved for patients with acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Its use and subsequent toxicities are expected to rise in the coming years. The main toxicities are cytokine release syndrome, hemophagocytic lymphohistiocytosis and immune effector cell associated neurotoxicity syndrome. Cytokine release syndrome is observed in up to 40% of patients. Almost 20% of patient suffer from acute kidney injury after CAR-T cell infusion. Associated factors are high-grade cytokine release syndrome, a prior autologous or allogeneic stem cell transplantation andrequirement of intensive care unit. Several mechanisms may contribute to the occurrence of acute kidney injury after CAR-T infusion: hypoperfusion during cytokine release syndrome, cytokine injury, T cell infiltration, tumor lysis syndrome and sepsis-induced injury. Kidney injury is associated with substantial increase in morbi-mortality.
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Affiliation(s)
- Adrien Rousseau
- Gustave Roussy, Department of Cancer Medicine, Villejuif, France.
| | - Lara Zafrani
- Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, Medical Intensive Care Unit, Paris, France
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Zafrani L, Arnaud M, Mooney N. Authors' Reply: Understanding the Multiple Roles of Extracellular Histones in Mediating Endothelial Dysfunction. J Am Soc Nephrol 2022; 33:1952-1953. [PMID: 35922134 PMCID: PMC9528337 DOI: 10.1681/asn.2022060687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Lara Zafrani
- Institut National de la Santé et de la Recherche Médicale (INSERM) U976, Saint Louis Hospital, University of Paris, Paris, France
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Marine Arnaud
- Institut National de la Santé et de la Recherche Médicale (INSERM) U976, Saint Louis Hospital, University of Paris, Paris, France
| | - Nuala Mooney
- Institut National de la Santé et de la Recherche Médicale (INSERM) U976, Saint Louis Hospital, University of Paris, Paris, France
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21
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Boudhabhay I, Lopez R, Zafrani L, Azoulay E, Darmon M, Mariotte E. Impact de l’hypertension artérielle au cours du purpura thrombotique thrombocytopénique chez les patients en réanimation. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Curtiaud A, Delmas C, Gantzer J, Zafrani L, Siegemund M, Meziani F, Merdji H. Cardiogenic shock among cancer patients. Front Cardiovasc Med 2022; 9:932400. [PMID: 36072868 PMCID: PMC9441759 DOI: 10.3389/fcvm.2022.932400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sophisticated cancer treatments, cardiovascular risk factors, and aging trigger acute cardiovascular diseases in an increasing number of cancer patients. Among acute cardiovascular diseases, cancer treatment, as well as the cancer disease itself, may induce a cardiogenic shock. Although increasing, these cardiogenic shocks are still relatively limited, and their management is a matter of debate in cancer patients. Etiologies that cause cardiogenic shock are slightly different from those of non-cancer patients, and management has some specific features always requiring a multidisciplinary approach. Recent guidelines and extensive data from the scientific literature can provide useful guidance for the management of these critical patients. Even if no etiologic therapy is available, maximal intensive supportive measures can often be justified, as most of these cardiogenic shocks are potentially reversible. In this review, we address the major etiologies that can lead to cardiogenic shock in cancer patients and discuss issues related to its management.
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Affiliation(s)
- Anais Curtiaud
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Clement Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine, University Hospital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Ferhat Meziani
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Hamid Merdji
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
- *Correspondence: Hamid Merdji
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Delafoy M, Goutines J, Fourmont AM, Birgy A, Chomton M, Levy M, Naudin J, Zafrani L, Le Mouel L, Yakouben K, Cointe A, Caseris M, Lafaurie M, Bonacorsi S, Mechinaud F, Pereyre S, Boissel N, Baruchel A. Case Report: Hyperammonemic Encephalopathy Linked to Ureaplasma spp. and/or Mycoplasma hominis Systemic Infection in Patients Treated for Leukemia, an Emergency Not to Be Missed. Front Oncol 2022; 12:912695. [PMID: 35875088 PMCID: PMC9304698 DOI: 10.3389/fonc.2022.912695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hyperammonemic encephalopathy caused by Ureaplasma spp. and Mycoplasma hominis infection has been reported in immunocompromised patients undergoing lung transplant, but data are scarce in patients with hematological malignancies. Case Presentation We describe the cases of 3 female patients aged 11–16 years old, developing initially mild neurologic symptoms, rapidly evolving to coma and associated with very high ammonia levels, while undergoing intensive treatment for acute leukemia (chemotherapy: 2 and hematopoietic stem cell transplant: 1). Brain imaging displayed cerebral edema and/or microbleeding. Electroencephalograms showed diffuse slowing patterns. One patient had moderate renal failure. Extensive liver and metabolic functions were all normal. Ureaplasma spp. and M. hominis were detected by PCR and specific culture in two patients, resulting in prompt initiation of combined antibiotics therapy by fluoroquinolones and macrolides. For these 2 patients, the improvement of the neurological status and ammonia levels were observed within 96 h, without any long-term sequelae. M. hominis was detected post-mortem in vagina, using 16S rRNA PCR for the third patient who died of cerebral edema. Conclusion Hyperammonemic encephalopathy linked to Ureaplasma spp. and M. hominis is a rare complication encountered in immunocompromised patients treated for acute leukemia, which can lead to death if unrecognized. Combining our experience with the few published cases (n=4), we observed a strong trend among female patients and very high levels of ammonia, consistently uncontrolled by classical measures (ammonia-scavenging agents and/or continuous kidney replacement therapy). The reversibility of the encephalopathy without sequelae is possible with prompt diagnosis and adequate combined specific antibiotherapy. Any neurological symptoms in an immunocompromised host should lead to the measurement of ammonia levels. If increased, and in the absence of an obvious cause, it should prompt to perform a search for Ureaplasma spp. and M. hominis by PCR as well as an immediate empirical initiation of combined specific antibiotherapy.
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Affiliation(s)
- Manon Delafoy
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- *Correspondence: Manon Delafoy,
| | - Juliette Goutines
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Aude-Marie Fourmont
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - André Birgy
- Department of Microbiology, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Maryline Chomton
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Michaël Levy
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jérôme Naudin
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Unité Mixte de Recherche 976, Institut National de la Santé Et de la Recherche Médicale, Paris, France
| | - Lou Le Mouel
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Karima Yakouben
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Aurélie Cointe
- Department of Microbiology, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Stéphane Bonacorsi
- Department of Microbiology, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Françoise Mechinaud
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sabine Pereyre
- Department of Bacteriology, National Reference Center for Bacterial Sexually Transmitted Infections, Bordeaux University Hospital, Bordeaux, France
- Unité Mixte de Recherche 5234, Fundamental Microbiology and Pathogenicity, Université de Bordeaux, Centre National de la Recherche Scientifique, Bordeaux, France
| | - Nicolas Boissel
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Research Unit EA-3518, Université Paris Cité, Paris, France
| | - André Baruchel
- Department of Hematology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Research Unit EA-3518, Université Paris Cité, Paris, France
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Fodil S, Chevret S, Rouzaud C, Valade S, Rabian F, Mariotte E, Raffoux E, Itzykson R, Boissel N, Sébert M, Adès L, Zafrani L, Azoulay E, Lengliné E. Post-remission outcomes in AML patients with high hyperleukocytosis and inaugural life-threatening complications. PLoS One 2022; 17:e0270744. [PMID: 35797337 PMCID: PMC9262217 DOI: 10.1371/journal.pone.0270744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/25/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Patients with hyperleukocytic (HL) acute myeloid leukemia (AML) are at higher risk of early death. Initial management of these patients is challenging, not fully codified and heterogenous. Retrospective studies showed that several symptomatic measures might decrease early death rate but long-term data are scarce. We aimed to analyze whether the therapeutic measures carried out urgently at diagnosis may influence the outcome among HL AML patients having achieved who survived inaugural complications. Methods We retrospectively reviewed all medical charts from patients admitted to Saint-Louis Hospital between January, 1st 1997 and December, 31st 2018 with newly diagnosed AML and white blood cell (WBC) count above 50x109/L. Outcome measures were cumulative incidence of relapse (CIR), treatment-related mortality (TRM) defined as relapse-free death, and overall survival. Univariate and multivariate analyses were performed using Cox proportional hazards models. Results A total of 184 patients with HL AML in complete remission (CR) were included in this study. At 2 years after CR. 62.5% of patients were alive, at 5 years, cumulated incidence of relapse was 55.8%. We found that every therapeutic measure, including life-sustaining therapies carried out in the initial phase of the disease, did not increase the relapse risk. The use of hydroxyurea for more than 4 days was associated with a higher risk of relapse. At the end of the study, 94 patients (51.1%) were still alive including 23 patients out of 44 aged less than 60 yo that were able to return to work. Conclusion We show that the use of emergency measures including life sustaining therapies does not come at the expense of a higher risk of relapse or mortality, except in the case of prolonged use of hydroxyurea. Patients with HL AML should be able to benefit from all available techniques, regardless of their initial severity.
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Affiliation(s)
- Sofiane Fodil
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Sorbonne Université, Paris, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, Paris, France
| | - Camille Rouzaud
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Florence Rabian
- Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Emmanuel Raffoux
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Raphael Itzykson
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Nicolas Boissel
- Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Marie Sébert
- Hématologie Seniors, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Université de Paris and INSERM U944, Paris, France
| | - Lionel Adès
- Hématologie Seniors, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Université de Paris and INSERM U944, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Etienne Lengliné
- Hématologie Adulte, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- * E-mail:
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Abstract
The vascular endothelium is crucial for the maintenance of vascular homeostasis. Moreover, in sepsis, endothelial cells can acquire new properties and actively participate in the host's response. If endothelial activation is mostly necessary and efficient in eliminating a pathogen, an exaggerated and maladaptive reaction leads to severe microcirculatory damage. The microcirculatory disorders in sepsis are well known to be associated with poor outcome. Better recognition of microcirculatory alteration is therefore essential to identify patients with the worse outcomes and to guide therapeutic interventions. In this review, we will discuss the main features of endothelial activation and dysfunction in sepsis, its assessment at the bedside, and the main advances in microcirculatory resuscitation.
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Affiliation(s)
- Lisa Raia
- Medical Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM UMR 976, University of Paris Cité, Paris, France
- *Correspondence: Lara Zafrani
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Mirouse A, Friol A, Moreau A, Jung B, Jullien E, Bureau C, Djibre M, De Prost N, Zafrani L, Argaud L, Reuter D, Calvet L, De Montmollin E, Benghanem S, Pichereau C, Pham T, Cacoub P, Biard L, Saadoun D. Pneumonie grave à SARS-Cov2 chez les patients vaccinés : une étude multicentrique. Rev Med Interne 2022. [PMCID: PMC9212737 DOI: 10.1016/j.revmed.2022.03.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction La vaccination contre le SARS-Cov2 réduit le risque d’infection, d’hospitalisation et de décès liés à l’infection. Cependant, certains patients peuvent développer une infection après une vaccination. L’objectif était de décrire les caractéristiques des patients vaccinés et qui développaient une infection grave à SARS-Cov2 nécessitant une admission en réanimation. Patients et méthodes Nous avons réalisé une étude de cohorte multicentrique incluant les patients vaccinés avec une infection grave à SARS-CoV2 et admis dans 15 réanimations françaises entre janvier et septembre 2021. Nous avons comparé ces patients à une cohorte publiée de patients non vaccinés avec une pneumonie grave à SARS-Cov2. Résultats Cent patients dont 68 (68 %) hommes avec un âge médian de 64 [57–71] ans ont été inclus. Une immunodépression était présente chez 3838 %) des patients. Parmi les patients ayant eu une sérologie à leur admission, 64 % avait un niveau d’anticorps anti-SARS-Cov2 efficace. À l’admission en réanimation, le score SOFA médian était de 4 [4–6,3] et le rapport PaO2/FiO2 médian de 84 [69–128]mmHg. Une oxygénothérapie humidifiée à haut débit a été initiée chez 79 (79 %) patients et une ventilation non invasive chez 18 (18 %) patients. Au cours de la prise en charge, 48 (48 %) patients ont nécessité le recours à l’intubation oro-trachéale avec une durée de ventilation de 11 [5–19] jours. Sur une durée de séjout médiane de 8 [4–20] jours, 31 patients sont décédés. L’âge (OR pour 5 années supplémentaires 1,38 [1,02–1,85], p = 0,035) et le score SOFA à l’admission (OR 1,40 [1,14–1,72] par point, p = 0,002) étaient indépendamment associés à la mortalité. En comparaison avec les patients non vaccinés, les patients vaccinés présentaient moins souvent du diabète (16 [16 %] vs. 351 [27 %], p = 0,029), étaient plus souvent immunodéprimés (38 [38 %] vs. 109 (8,3 %), p < 0,0001), insuffisants rénaux chroniques (24 [24 %] vs. 89 (6,8 %), p < 0,0001), insuffisants cardiaques chroniques (16 [16 %] vs. 58 [4,4 %], p < 0,0001), and insuffisants hépatiques chroniques chronic liver disease(3 [3 %] vs. 8 [0,6 %], p = 0,037). Malgré une gravit similaire à l’admission, les patients vaccinés nécessitaient moins souvent le recours à la ventilation invasive, que ce soit à l’admission ou au cours de la prise en charge en réanimation (23 [23 %] vs. 785 [59,7 %], p < 0,0001, et 48 [48 %] vs. 930 [70,7 %], p < 0,0001, respectivement). Il n’y avait pas de différence en terme de mortalité (31 [31 %] vs. 379 [28,8 %], p = 0,64). Conclusion Les infections sévères à SARS-Cov2 peuvent survenir chez des patients vaccinés, principalement ceux immunodéprimés ou avec des insuffisances rénale, hépatique ou cardiaque. L’âge et la gravité à l’admission sont associés à la mortalité.
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27
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Arnaud M, Loiselle M, Vaganay C, Pons S, Letavernier E, Demonchy J, Fodil S, Nouacer M, Placier S, Frère P, Arrii E, Lion J, Mooney N, Itzykson R, Djediat C, Puissant A, Zafrani L. Tumor Lysis Syndrome and AKI: Beyond Crystal Mechanisms. J Am Soc Nephrol 2022; 33:1154-1171. [PMID: 35523579 PMCID: PMC9161807 DOI: 10.1681/asn.2021070997] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/12/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The pathophysiology of AKI during tumor lysis syndrome (TLS) is not well understood due to the paucity of data. We aimed to decipher crystal-dependent and crystal-independent mechanisms of TLS-induced AKI. METHODS Crystalluria, plasma cytokine levels, and extracellular histones levels were measured in two cohorts of patients with TLS. We developed a model of TLS in syngeneic mice with acute myeloid leukemia, and analyzed ultrastructural changes in kidneys and endothelial permeability using intravital confocal microscopy. In parallel, we studied the endothelial toxicity of extracellular histones in vitro. RESULTS: The study provides the first evidence that previously described crystal-dependent mechanisms are insufficient to explain TLS-induced AKI. Extracellular histones that are released in huge amounts during TLS caused profound endothelial alterations in the mouse model. The mechanisms of histone-mediated damage implicates endothelial cell activation mediated by Toll-like receptor 4. Heparin inhibits extracellular histones and mitigates endothelial dysfunction during TLS. CONCLUSION This study sheds new light on the pathophysiology of TLS-induced AKI and suggests that extracellular histones may constitute a novel target for therapeutic intervention in TLS when endothelial dysfunction occurs.
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Affiliation(s)
- Marine Arnaud
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Maud Loiselle
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Camille Vaganay
- INSERM UMR 944, Saint Louis Hospital, University of Paris Cité, Paris, France
| | - Stéphanie Pons
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Emmanuel Letavernier
- INSERM UMR S 1155, Sorbonne University, Paris, France,Multidisciplinary Functional Explorations Department, Assistance Publique des Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Jordane Demonchy
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Sofiane Fodil
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Manal Nouacer
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | | | - Perrine Frère
- INSERM UMR S 1155, Sorbonne University, Paris, France
| | - Eden Arrii
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Julien Lion
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Nuala Mooney
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France
| | - Raphael Itzykson
- INSERM UMR 944, Saint Louis Hospital, University of Paris Cité, Paris, France,Department of Hematology, Assistance Publique des Hôpitaux de Paris, Saint Louis Hospital, Paris, France
| | - Chakib Djediat
- Electron Microscopy Department, UMR 7245, Museum National D’Histoire Naturelle, Paris, France
| | - Alexandre Puissant
- INSERM UMR 944, Saint Louis Hospital, University of Paris Cité, Paris, France
| | - Lara Zafrani
- Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France .,Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Saint Louis Hospital, Paris, France
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Arnaud M, Demonchy J, Arrii E, Luperto M, Lion J, Fodil S, Pons S, Mooney N, Zafrani L. Endothelial Cells Activated by Extracellular Histones Promote Foxp3 + Suppressive Treg Cells In Vitro. Int J Mol Sci 2022; 23:ijms23094527. [PMID: 35562918 PMCID: PMC9103825 DOI: 10.3390/ijms23094527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Histones are widely recognized as pro-inflammatory mediators upon their release from the nucleus into the extracellular space. However, their impact on endothelial cell immunogenicity is unknown. Endothelial cells, Human Microvascular Endothelial cells 1 (HMEC1), have been exposed to recombinant histones in order to study their effect on the endothelial phenotype. We then studied the differentiation of CD4+-T lymphocytes subpopulations after three days of interaction with endothelial cells in vitro and observed that histone-treated endothelial cells differentiate a suppressive FoxP3+ T regulator subpopulation that expressed Human Leucocyte Antigen DR (HLA-DR) and Cytotoxic T-Lymphocyte-Associated protein 4 (CTLA4). Toll-Like Receptor 4 (TLR4) inhibition significantly decreased the expansion of these Treg cells. Moreover, blockade of Interleukin (IL)-6 and Intercellular Adhesion Molecule (ICAM)-1 in cocultures significantly decreased the expansion of Tregs, suggesting an IL-6 and ICAM-1 dependent pathway. Thus, beyond their inflammatory effects, extracellular histones may induce an increase of immunosuppressive Treg population via their action on endothelial cells. Further studies are needed to evaluate the impact on immunosuppression of an increase of peripheral suppressive Treg via endothelial cell activation by histones in vivo.
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Affiliation(s)
- Marine Arnaud
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Jordane Demonchy
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Eden Arrii
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Marta Luperto
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Julien Lion
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Sofiane Fodil
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Stéphanie Pons
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Nuala Mooney
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
| | - Lara Zafrani
- Human Immunology, Pathophysiology and Immunotherapy, INSERM U 976, University Paris Cite, 75010 Paris, France; (M.A.); (J.D.); (E.A.); (M.L.); (J.L.); (S.F.); (S.P.); (N.M.)
- Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Saint Louis Hospital, 75010 Paris, France
- Correspondence:
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Abdel-Nabey M, Chaba A, Serre J, Lengliné E, Azoulay E, Darmon M, Zafrani L. Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy. Ann Intensive Care 2022; 12:15. [PMID: 35166948 PMCID: PMC8847484 DOI: 10.1186/s13613-022-00990-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background Tumor lysis syndrome (TLS) is a life-threatening complication during the treatment of malignant neoplasia. We sought to describe characteristics and predictors of acute kidney injury (AKI), remission and mortality in high-risk TLS patients. In this retrospective monocentric study, we included all patients with the diagnosis of biological and/or clinical TLS from 2012 to 2018. The primary outcome was the prevalence of AKI during the acute phase of TLS. Secondary outcomes were overall mortality and remission of the underlying malignancy at 1 year. Results Among 153 patients with TLS, 123 (80.4%) patients experienced AKI and 83 (54.2%) required renal replacement therapy. mSOFA score (OR = 1.15, IC 95% [1.02–1.34]), age (OR = 1.05, IC 95% [1.02–1.08]) and male gender (OR = 6.79, IC 95% [2.59–19.44]) were associated with AKI. Rasburicase use (HR = 2.45, IC 95% [1.17–5.15]) was associated with remission of the underlying malignancy at 1 year. Parameters associated with mortality at 1 year were mechanical ventilation (HR = 1.96, IC 95% [1.02–3.78]), vasopressors (HR = 3.13, IC 95% [1.59–6.15]), age (HR = 1.02, IC 95% [1–1.03]), spontaneous TLS (HR = 1.65, IC 95% [1.01–2.69]) and delay of chemotherapy administration (HR = 1.01, IC 95% [1–1.03]). Conclusions AKI is highly prevalent in TLS patients. Rasburicase is associated with better outcomes regarding remission of the underlying malignancy. As rasburicase may be an indirect marker of a high degree of tumor lysis and chemosensitivity, more studies are warranted to confirm the protective role of urate oxidase. Delaying chemotherapy may be deleterious in terms of long-term outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00990-1.
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Affiliation(s)
- Moustafa Abdel-Nabey
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Justine Serre
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Etienne Lengliné
- University of Paris, Paris, France.,Hematology Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France. .,University of Paris, Paris, France. .,INSERM UMR 976, University of Paris, Paris, France.
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Fodil S, Arnaud M, Vaganay C, Puissant A, Lengline E, Mooney N, Itzykson R, Zafrani L. Endothelial cells: major players in acute myeloid leukaemia. Blood Rev 2022; 54:100932. [DOI: 10.1016/j.blre.2022.100932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
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Mariette X, Hermine O, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Dalibey S, Raked N, Mameri L, Alary S, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Montlahuc C, Biard L, Charreteur R, Dupré C, Cardet K, Lehmann B, Baghli K, Madelaine C, D'Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Bulifon S, Jaïs X, Sitbon O, Pavy S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Noaillon M, Lefèvre E, Zaidan M, Le Tiec CLT, Verstuyft C, Roques AM, Grimaldi L, Molinari D, Leprun G, Fourreau A, Cylly L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y, Georgin-Lavialle S, Senet P, Pialoux G, Soria A, Parrot A, François H, Rozensztajn N, Blin E, Choinier P, Camuset J, Rech JS, Canellas A, Rolland-Debord C, Lemarié N, Belaube N, Nadal M, Siguier M, Petit-Hoang C, Chas J, Drouet E, Lemoine M, Phibel A, Aunay L, Bertrand E, Ravato S, Vayssettes M, Adda A, Wilpotte C, Thibaut P, Fillon J, Debrix I, Fellahi S, Bastard JP, Lefèvre G, Fallet V, Gottenberg JE, Hansmann Y, Andres E, Bayer S, Becker G, Blanc F, Brin S, Castelain V, Chatelus E, Chatron E, Collange O, Danion F, De Blay F, Demonsant E, Diemunsch P, Diemunsch S, Felten R, Goichot B, Greigert V, Guffroy A, Heger B, Hutt A, Kaeuffer C, Kassegne L, Korganow AS, Le Borgne P, Lefebvre N, Martin T, Mertes PM, Metzger C, Meyer N, Nisand G, Noll E, Oberlin M, Ohlmann-Caillard S, Poindron V, Pottecher J, Ruch Y, Sublon C, Tayebi H, Weill F, Mekinian A, Abisror N, Jachiet V, Chopin D, Fain O, Garnier M, Krause le Garrec J, Morgand M, Pacanowski J, Urbina T, McAvoy C, Pereira M, Aratus G, Berard L, Simon T, Daguenel-Nguyen A, Antignac M, Leplay C, Arlet JB, Diehl JL, Bellenfant F, Blanchard A, Buffet A, Cholley B, Fayol A, Flamarion E, Godier A, Gorget T, Hamada SR, Hauw-Berlemont C, Hulot JS, Lebeaux D, Livrozet M, Michon A, Neuschwander A, Penet MA, Planquette B, Ranque B, Sanchez O, Volle G, Briois S, Cornic M, Elisee V, Jesuthasan D, Djadi-Prat J, Jouany P, Junquera R, Henriques M, Kebir A, Lehir I, Meunier J, Patin F, Paquet V, Tréhan A, Vigna V, Sabatier B, Bergerot D, Jouve C, Knosp C, Lenoir O, Mahtal N, Resmini L, Lescure FX, Ghosn J, BACHELARD A, BIRONNE T, BORIE R, BOUNHIOL A, BOUSSARD C, CHAUFFiER J, CHALAL S, CHALAL L, CHANSOMBAT M, CRESPIN P, CRESTANI B, DACONCEICAO O, DECONINCK L, DIEUDE P, DOSSIER A, DUBERT M, DUCROCQ G, FUENTES A, GERVAIS A, GILBERT M, ISERNIA V, ISMAEL S, JOLY V, JULIA Z, LARIVEN S, LE GAC S, LE PLUART D, LOUNI F, NDIAYE A, PAPO T, PARISEY M, PHUNG B, POURBAIX A, RACHLINE A, RIOUX C, SAUTEREAU A, STEG G, TARHINI H, VALAYER S, VALLOIS D, VERMES P, VOLPE T, Nguyen Y, Honsel V, Weiss E, Codorniu A, Zarrouk V, De Lastours V, Uzzan M, Olivier O, Rossi G, Gamany N, Rahli R, Louis Z, Boutboul D, Galicier L, Amara Y, Archer G, Benattia A, Bergeron A, Bondeelle L, De Castro N, Clément M, Darmont M, Denis B, Dupin C, Feredj E, Feyeux D, Joseph A, Lengliné E, Le Guen P, Liégeon G, Lorillon G, Mabrouki A, Mariotte E, Martin de Frémont G, Mirouse A, Molina JM, Peffault de Latour R, Oksenhendler E, Saussereau J, Tazi A, Tudesq JJ, Zafrani L, Brindele I, Bugnet E, Celli Lebras K, Chabert J, Djaghout L, Fauvaux C, Jegu AL, Kozaliewicz E, Meunier M, Tremorin MT, Davoine C, Madeleine I, Caillat-Zucman S, Delaugerre C, Morin F, SENE D, BURLACU R, CHOUSTERMAN B, MEGARBANE B, RICHETTE P, RIVELINE JP, FRAZIER A, VICAUT E, BERTON L, HADJAM T, VASQUEZ-IBARRA MA, JOURDAINE C, JACOB A, SMATI J, RENAUD S, MANIVET P, PERNIN C, SUAREZ L, Semerano L, ABAD S, Benainous R, Bloch Queyrat C, Bonnet N, Brahmi S, Cailhol J, Cohen Y, Comparon C, Cordel H, Dhote R, Dournon N, Duchemann B, Ebstein N, Giroux-Leprieur B, Goupil de Bouille J, Jacolot A, Nunes H, Oziel J, Rathouin V, Rigal M, Roulot D, Tantet C, Uzunhan Y, COSTEDOAT-CHALUMEAU N, Ait Hamou Z, Benghanem S, BLANCHE P, CANOUI E, CARLIER N, CHAIGNE B, CONTEJEAN A, DUNOGUE B, DUPLAND P, DUREL - MAURISSE A, GAUZIT R, JAUBERT P, Joumaa H, Jozwiak M, KERNEIS S, LACHATRE M, Lafoeste H, LEGENDRE P, LUONG NGUYEN LB, MAREY J, MORBIEU C, MOUTHON L, NGUYEN L, Palmieri LJ, REGENT A, SZWEBEL TA, TERRIER B, GUERIN C, ZERBIT J, CHEREF K, CHITOUR K, CISSE MS, CLARKE A, CLAVERE G, DUSANTER I, GAUDEFROY C, JALLOULI M, KOLTA S, LE BOURLOUT C, MARIN N, MENAGE N, MOORES A, PEIGNEY I, PIERRON C, SALEH-MGHIR S, VALLET M, MICHEL M, MELICA G, LELIEVRE JD, FOIS E, LIM P, MATIGNON M, GUILLAUD C, THIEMELE A, SCHMITZ D, BOUHRIS M, BELAZOUZ S, LANGUILLE L, MEKONTSO-DESSAPS A, SADAOUI T, Mayaux J, Cacoub P, Corvol JC, Louapre C, Sambin S, Mariani LL, Karachi C, Tubach F, Estellat C, Gimeno L, Martin K, Bah A, Keo V, Ouamri S, Messaoudi Y, Yelles N, Faye P, Cavelot S, Larcheveque C, Annonay L, Benhida J, Zahrate-Ghoul A, Hammal S, Belilita R, Lecronier M, Beurton A, Haudebourg L, Deleris R, Le Marec J, Virolle S, Nemlaghi S, Bureau C, Mora P, De Sarcus M, Clovet O, Duceau B, Grisot PH, Pari MH, Arzoine J, Clarac U, Faure M, Delemazure J, Decavele M, Morawiec E, Demoule A, Dres M, Vautier M, Allenbach Y, Benveniste O, Leroux G, Rigolet A, Guillaume-Jugnot P, Domont F, Desbois AC, Comarmond C, Champtiaux N, Toquet S, Ghembaza A, Vieira M, Maalouf G, Boleto G, Ferfar Y, Charbonnier F, AGUILAR C, ALBY-LAURENT F, ALYANAKIAN MA, BAKOUBOULA P, BROISSAND C, BURGER C, CAMPOS-VEGA C, CHAVAROT N, CHOUPEAUX L, FOURNIER B, GRANVILLE S, ISSORAT E, ROUZAUD C, VIMPERE D, Geri G, Derridj N, Sguiouar N, Meddah H, Djadel M, Chambrin-Lauvray H, Duclos-Vallée JC, Saliba F, Sacleux SC, Koumis I, Michot JM, Stoclin A, Colomba E, Pommeret F, Willekens C, Sakkal M, Da Silva R, Dejean V, Mekid Y, Ben-Mabrouk I, Pradon C, Drouard L, Camara-Clayette V, Morel A, Garcia G, Mohebbi A, Berbour F, Dehais M, Pouliquen AL, Klasen A, Soyez-Herkert L, London J, Keroumi Y, Guillot E, Grailles G, El Amine Y, Defrancq F, Fodil H, Bouras C, Dautel D, Gambier N, Dieye T, Razurel A, Bienvenu B, Lancon V, Lecomte L, Beziriganyan K, Asselate B, Allanic L, Kiouris E, Legros MH, Lemagner C, Martel P, Provitolo V, Ackermann F, Le Marchand M, Clan Hew Wai A, Fremont D, Coupez E, Adda M, Duée F, Bernard L, Gros A, Henry E, Courtin C, Pattyn A, Guinot PG, Bardou M, Maurer A, Jambon J, Cransac A, Pernot C, Mourvillier B, Servettaz A, Deslée G, Wynckel A, Benoit P, Marquis E, Roux D, Gernez C, Yelnik C, Poissy J, Nizard M, Denies F, Gros H, Mourad JJ, Sacco E, Renet S. Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial. The Lancet Rheumatology 2022; 4:e24-e32. [PMID: 34812424 PMCID: PMC8598187 DOI: 10.1016/s2665-9913(21)00315-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 pneumonia can have increased inflammation and elevated cytokines, including interleukin (IL)-6, which might be deleterious. Thus, sarilumab, a high-affinity anti-IL-6 receptor antibody, might improve the outcome of patients with moderate-to-severe COVID-19 pneumonia. Methods We did a multicentric, open-label, Bayesian randomised, adaptive, phase 2/3 clinical trial, nested within the CORIMUNO-19 cohort, to test a superiority hypothesis. Patients 18 years or older hospitalised with COVID-19 in six French centres, requiring at least 3L/min of oxygen but without ventilation assistance and a WHO Clinical Progression Scale [CPS] score of 5 were enrolled. Patients were randomly assigned (1:1) via a web-based system, according to a randomisation list stratified on centre and with blocks randomly selected among 2 and 4, to receive usual care plus 400 mg of sarilumab intravenously on day 1 and on day 3 if clinically indicated (sarilumab group) or usual care alone (usual care group). Primary outcomes were the proportion of patients with WHO-CPS scores greater than 5 on the 10-point scale on day 4 and survival without invasive or non-invasive ventilation at day 14. This completed trial is closed to new participants and is registered with ClinicalTrials.gov, NCT04324073. Findings 165 patients were recruited from March 27 to April 6, 2020, and 148 patients were randomised (68 patients to the sarilumab group and 80 to the usual care group) and followed up for 90 days. Median age was 61·7 years [IQR 53·0–71·1] in the sarilumab group and 62·8 years [56·0–71·7] in the usual care group. In the sarilumab group 49 (72%) of 68 were men and in the usual care group 59 (78%) of 76 were men. Four patients in the usual care group withdrew consent and were not analysed. 18 (26%) of 68 patients in the sarilumab group had a WHO-CPS score greater than 5 at day 4 versus 20 (26%) of 76 in the usual care group (median posterior absolute risk difference 0·2%; 90% credible interval [CrI] −11·7 to 12·2), with a posterior probability of absolute risk difference greater than 0 of 48·9%. At day 14, 25 (37%) patients in the sarilumab and 26 (34%) patients in the usual care group needed ventilation or died, (median posterior hazard ratio [HR] 1·10; 90% CrI 0·69–1·74) with a posterior probability HR greater than 1 of 37·4%. Serious adverse events occurred in 27 (40%) patients in the sarilumab group and 28 (37%) patients in the usual care group (p=0·73). Interpretation Sarilumab treatment did not improve early outcomes in patients with moderate-to-severe COVID-19 pneumonia. Further studies are warranted to evaluate the effect of sarilumab on long-term survival. Funding Assistance publique—Hôpitaux de Paris
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Preau S, Vodovar D, Jung B, Lancel S, Zafrani L, Flatres A, Oualha M, Voiriot G, Jouan Y, Joffre J, Uhel F, De Prost N, Silva S, Azabou E, Radermacher P. Correction to: Energetic dysfunction in sepsis: a narrative review. Ann Intensive Care 2021; 11:185. [PMID: 34964067 PMCID: PMC8714609 DOI: 10.1186/s13613-021-00970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sebastien Preau
- U1167 - RID-AGE - Facteurs de Risque Et Déterminants Moléculaires Des Maladies Liées Au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France.
| | - Dominique Vodovar
- Centre AntiPoison de Paris, Hôpital Fernand Widal, APHP, 75010, Paris, France.,Faculté de Pharmacie, UMRS 1144, 75006, Paris, France.,Université de Paris, UFR de Médecine, 75010, Paris, France
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University Hospital and PhyMedExp, University of Montpellier, Montpellier, France
| | - Steve Lancel
- U1167 - RID-AGE - Facteurs de Risque Et Déterminants Moléculaires Des Maladies Liées Au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France
| | - Lara Zafrani
- Médecine Intensive Réanimation, Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France.,INSERMUMR 976,Hôpital Saint Louis, Université de Paris, Paris, France
| | | | - Mehdi Oualha
- Pediatric Intensive Care Unit, Necker Hospital, APHP, Centre - Paris University, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive Réanimation, CHRU Tours, Tours, France.,Faculté de Médecine de Tours, INSERM U1100 Centre d'Etudes Des Pathologies Respiratoires, Tours, France
| | - Jeremie Joffre
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, 94143, USA
| | - Fabrice Uhel
- Réanimation Médico-ChirurgicaleUniversité de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Nicolas De Prost
- Service de Réanimation MédicaleHôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010, Créteil, France
| | - Stein Silva
- Réanimation URM CHU Purpan, Cedex 31300, Toulouse, France.,Toulouse NeuroImaging Center INSERM1214, Cedex 31300, Toulouse, France
| | - Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, AP-HP, Inserm UMR 1173, Infection and Infammation (2I), University of Versailles (UVSQ), Paris-Saclay University, Paris, France
| | - Peter Radermacher
- Institut Für Anästhesiologische Pathophysiologie Und VerfahrensentwicklungUniversitätsklinikum, Ulm, Germany
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Pons S, Arrii E, Arnaud M, Loiselle M, Ferry J, Nouacer M, Lion J, Cohen S, Mooney N, Zafrani L. Immunomodulation of endothelial cells induced by macrolide therapy in a model of septic stimulation. Immun Inflamm Dis 2021; 9:1656-1669. [PMID: 34636179 PMCID: PMC8589380 DOI: 10.1002/iid3.518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 01/18/2023]
Abstract
Objectives Sepsis is defined as the host's inflammatory response to a life‐threatening infection. The endothelium is implicated in immunoregulation during sepsis. Macrolides have been proposed to display immunomodulatory properties. The goal of this study was to analyze whether macrolides can exert immunomodulation of endothelial cells (ECs) in an experimental model of sepsis. Methods Human ECs were stimulated by proinflammatory cytokines and lipopolysaccharide before exposure to macrolides. ECs phenotypes were analyzed by flow cytometry. Cocultures of ECs and peripheral blood mononuclear cells (PBMCs) were performed to study the ECs ability to alter T‐cell viability and differentiation in the presence of macrolides. Soluble factor production was assessed. Results ECs act as non‐professional antigen presenting cells and expressed human leukocyte antigen (HLA) antigens, the adhesion molecules CD54, CD106, and the coinhibitory molecule CD274 after septic stimulation. Incubation with macrolides induced a significant decrease of HLA class I and HLA class II HLA‐DR on septic‐stimulated ECs, but did not alter either CD54, CD106, nor CD274 expression. Interleukin‐6 (IL‐6) and IL‐8 production by stimulated ECs were unaltered by incubation with macrolides, whereas Clarithromycin exposure significantly decreased IL‐6 gene expression. In cocultures of septic ECs with PBMCs, neither the proportion of CD4 + , CD8 + T nor their viability was altered by macrolides. T‐helper lymphocyte subsets Th1, Th17, and Treg polarization by stimulated ECs were unaltered by macrolides. Conclusion This study reports phenotypic and gene expression changes in septic‐stimulated ECs exposed to macrolides, without resulting in altered immunogenicity of ECs in co‐cultures with PBMCs. In vivo studies may help to further understand the impact of macrolide therapy on ECs immune homeostasis during sepsis.
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Affiliation(s)
- Stéphanie Pons
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France.,Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, GRC 29, AP-HP, DMU DREAM, Sorbonne University, Paris, France
| | - Eden Arrii
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Marine Arnaud
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Maud Loiselle
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Juliette Ferry
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Manel Nouacer
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Julien Lion
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Shannon Cohen
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Nuala Mooney
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France
| | - Lara Zafrani
- Human Immunology, Pathophysiology, Immunotherapy (HIPI), INSERM U976, Université de Paris, Paris, France.,Medical Intensive Care Unit, AP-HP, Saint-Louis Teaching Hospital, Paris, France
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Maisonobe L, Bertinchamp R, Damian L, Gérard L, Berisha M, Guillet S, Fieschi C, Malphettes M, Fadlallah J, Hié M, Dunogué B, De Wilde V, Vandergheynst F, Zafrani L, Grall M, Saada N, Garzaro M, Oksenhendler E, Galicier L, Boutboul D. Characteristics of thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly syndrome: a retrospective study from a large Western cohort. Br J Haematol 2021; 196:599-605. [PMID: 34585382 DOI: 10.1111/bjh.17868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a non-clonal inflammatory lymphoproliferative disorder of unknown origin. Recently, TAFRO syndrome (thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly) emerged as a singular variant of iMCD in Asia and was associated with a severe course and a poor outcome. The present study describes the first large Western cohort of TAFRO syndrome patients (n = 25) meeting the All Japan TAFRO Syndrome Research Group diagnostic criteria. Characteristics of TAFRO patients were compared to iMCD-not otherwise specified (iMCD-NOS) patients used as a control group (n = 43). Our results show that despite baseline characteristics in accordance with previously reported series, Western TAFRO syndrome patients do not appear to present with a worse outcome than iMCD-NOS patients. There were no significant differences between the two groups regarding treatment choice, response to rituximab (71% vs. 67%) or tocilizumab (69% vs. 91%) in TAFRO and iMCD-NOS, respectively. The two-year overall survival was above 95% in both groups. Limits of inclusion and exclusion criteria for TAFRO definition are also discussed. Our findings raise the question of the singularity of the TAFRO entity in Western countries. The data should promote further research using unsupervised models to identify markers of disease severity in Western cohorts of iMCD patients.
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Affiliation(s)
- Lucas Maisonobe
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Rémi Bertinchamp
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Louise Damian
- Internal Medicine and Infectious Disease Department, Hôpital Jacques Monod, Le Havre, France
| | - Laurence Gérard
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Mirlinda Berisha
- National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Stéphanie Guillet
- Internal Medicine Department, Hôpital Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | - Claire Fieschi
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Marion Malphettes
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Jehane Fadlallah
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Miguel Hié
- Internal Medicine Department, Hôpital Pitié-Salpétrière, Université Paris Sorbonne, Paris, France
| | - Bertrand Dunogué
- Internal Medicine Department, Hôpital Cochin, Université de Paris, Paris, France
| | - Virginie De Wilde
- Hematology Department, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Frédéric Vandergheynst
- Internal Medicine Department, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Lara Zafrani
- Intensive Care Unit, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Maximilien Grall
- Internal Medicine Department, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Noémie Saada
- Post-Emergency Unit, Hôpital Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | - Margaux Garzaro
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Eric Oksenhendler
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Lionel Galicier
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France
| | - David Boutboul
- Clinical Immunology Department, Hôpital Saint Louis, Université de Paris, Paris, France.,National Reference Center for Castleman Disease, Hôpital Saint Louis, Université de Paris, Paris, France.,U976 HIPI, INSIGHT team, Hôpital Saint Louis, Université de Paris, Paris, France
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35
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Valade S, Zafrani L. CAR-T cells : what intensivists need to know. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Treatment with CAR-T cells represents an innovative therapeutic advance in patients with refractory hematological malignancies. Infectious complications must always be considered and empirically treated. Specific complications such as cytokine release syndrome (CRS) and neurotoxicity can be severe and patients often require intensive care unit admission. A close monitoring is necessary in these patients. While CRS treatment is based on the administration of anti-IL-6 receptor (tocilizumab) in mild forms, corticosteroids are recommended in severe CRS and/or neurotoxicity
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De la SRLF CRT, Merz T, Sarton B, Jouan Y, Bagate F, Bendib Le Lan I, Brassart B, Denoix N, Elabbadi A, Ferré F, Loiselle M, Masson G, Millot G, Salvador E, Trautwein B, Uhel F, Radermacher P, Voiriot G, Oualha M, Azabou E, Jung B, Silva S, Préau S, De Prost N, Zafrani L, Vodovar D. Reports from the 1st Young Investigator’s Day of the French Intensive Care Society. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Translational Research Committee of the French Intensive Care Society organized the first Young Investigator’s Day on October 18th 2019.
This seminar gave young Intensive Care students the opportunity to present their Master’s or PhD research work to a college of expert researchers.
For this first event, Professors Jean-Marc Cavaillon (Paris), Laurent Papazian (Marseille), Peter Radermacher (Ulm) et Hafid Ait-Oufella (Paris) kindly accepted to give young candidates their critical support.
The subjects of presentations, covering the fields of neuroscience, immunology, hemodynamics and pharmacology illustrated the richness and diversity of translational research in Intensive Care Medicine.
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Catano J, Sacleux SC, Gornet JM, Camus M, Bigé N, Saliba F, Azoulay E, Dumas G, Zafrani L. Gastrointestinal bleeding in critically ill immunocompromised patients. Ann Intensive Care 2021; 11:130. [PMID: 34420114 PMCID: PMC8380218 DOI: 10.1186/s13613-021-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute gastrointestinal bleeding (GIB) may be a severe condition in immunocompromised patients and may require intensive care unit (ICU) admission. We aimed to describe the clinical spectrum of critically ill immunocompromised patients with GIB and identify risk factors associated with mortality and severe GIB defined by hemorrhagic shock, hyperlactatemia and/or the transfusion of more than 5 red blood cells units. Finally, we compared this cohort with a control population of non-immunocompromised admitted in ICU for GIB. RESULTS Retrospective study in 3 centers including immunocompromised patients with GIB admitted in ICU from January, 1st 2010 to December, 31rd 2019. Risk factors for mortality and severe GIB were assessed by logistic regression. Immunocompromised patients were matched with a control group of patients admitted in ICU with GIB. A total of 292 patients were analyzed in the study, including 141 immunocompromised patients (compared to a control group of 151 patients). Among immunocompromised patients, upper GIB was more frequent (73%) than lower GIB (27%). By multivariate analysis, severe GIB was associated with male gender (OR 4.48, CI95% 1.75-11.42, p = 0.00), upper GIB (OR 2.88, CI95% 1.11-7.46, p = 0.03) and digestive malignant infiltration (OR 5.85, CI95% 1.45-23.56, p = 0.01). Conversely, proton pump inhibitor treatment before hospitalization was significantly associated with decreased risk of severe GIB (OR 0.25, IC95% 0.10-0.65, p < 0.01). Fifty-four patients (38%) died within 90 days. By multivariate analysis, mortality was associated with hemorrhagic shock (OR 2.91, IC95% 1.33-6.38, p = 0 .01), upper GIB (OR 4.33, CI95% 1.50-12.47, p = 0.01), and long-term corticosteroid therapy before admission (OR 2.98, CI95% 1.32-6.71, p = 0.01). Albuminemia (per 5 g/l increase) was associated with lower mortality (OR 0.54, IC95% 0.35-0.84, p = 0.01). After matching with a control group of non-immunocompromised patients, severity of bleeding was increased in immunocompromised patients, but mortality was not different between the 2 groups. CONCLUSION Mortality is high in immunocompromised patients with GIB in ICU, especially in patients receiving long term corticosteroids. Mortality of GIB is not different from mortality of non-immunocompromised patients in ICU. The prophylactic administration of proton pump inhibitors should be considered in this population.
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Affiliation(s)
- Jennifer Catano
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Sophie Caroline Sacleux
- Intensive Care Unit, Paul Brousse Hospital, INSERM N°1193, Assistance Publique Des Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Jean-Marc Gornet
- Gastroenterology Department, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Marine Camus
- Department of Digestive Endoscopy, Saint-Antoine Hospital, Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine and Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naike Bigé
- Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Faouzi Saliba
- Intensive Care Unit, Paul Brousse Hospital, INSERM N°1193, Assistance Publique Des Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France.
- INSERM UMR976, Paris University, Paris, France.
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Valade S, Joly BS, Veyradier A, Fadlallah J, Zafrani L, Lemiale V, Launois A, Stepanian A, Galicier L, Fieschi C, Mirouse A, Tudesq JJ, Lepretre AC, Azoulay E, Darmon M, Mariotte E. Coagulation disorders in patients with severe hemophagocytic lymphohistiocytosis. PLoS One 2021; 16:e0251216. [PMID: 34343182 PMCID: PMC8330932 DOI: 10.1371/journal.pone.0251216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/15/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background Coagulation disorders are common in patients with hemophagocytic lymphohistiocytosis (HLH), associated with an increased risk of bleeding and death. We aim to investigate coagulation disorders and their outcome implications in critically ill patients with HLH. Methods We prospectively evaluated 47 critically ill patients with HLH (median age of 54 years [42–67]) between April 2015 and December 2018. Coagulation assessments were performed at day 1. Abnormal standard coagulation was defined as prothrombin time (PT) <50% and/or fibrinogen <2g/L. HLH aetiology was mostly ascribed to haematological malignancies (74% of patients). Results Coagulation disorders and severe bleeding events were frequent, occurring in 30 (64%) and 11 (23%) patients respectively. At day 1, median fibrinogen level was 2∙65g/L [1.61–5.66]. Fibrinolytic activity was high as suggested by increased median levels of D-dimers, fibrin monomers, PAI-1 (plasminogen activator inhibitor) and tPA (tissue plasminogen activator). Forty-one (91%) patients had a decreased ADAMTS13 activity (A Disintegrin-like And Metalloproteinase with ThromboSpondin type 1 repeats, member 13). By multivariable analysis, the occurrence of a severe bleeding (OR 3.215 [1.194–8.653], p = 0∙021) and SOFA score (Sepsis-Related Organ Failure Assessment) at day 1 (OR 1.305 per point [1.146–1.485], p<0∙001) were independently associated with hospital mortality. No early biological marker was associated with severe bleeding. Conclusions Hyperfibrinolysis may be the primary mechanism responsible for hypofibrinogenemia and may also participate in ADAMTS13 degradation. Targeting the plasmin system appears as a promising approach in severe HLH-related coagulation disorders.
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Affiliation(s)
- Sandrine Valade
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
- * E-mail:
| | - Bérangère S. Joly
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Agnès Veyradier
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jehane Fadlallah
- EA3518, Université de Paris, Paris, France
- Department of Clinical Immunology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Lara Zafrani
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Virginie Lemiale
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Amélie Launois
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Alain Stepanian
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Lionel Galicier
- EA3518, Université de Paris, Paris, France
- Department of Clinical Immunology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Claire Fieschi
- EA3518, Université de Paris, Paris, France
- Department of Clinical Immunology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Adrien Mirouse
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Jean Jacques Tudesq
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Anne-Claire Lepretre
- Transfusion Department, Etablissement Français Du Sang, Hôpital Saint-Louis, Paris, France
| | - Elie Azoulay
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Michael Darmon
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Eric Mariotte
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
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Morel G, Mulier G, Ghrenassia E, Abdel Nabey M, Tandjaoui Y, Kouatchet A, Platon L, Pène F, Moreau AS, Seguin A, Contou D, Sonneville R, Rousset D, Picard M, Dumas G, Mokart D, Megarbane B, Voiriot G, Oddou I, Azoulay E, Biard L, Zafrani L. Non-C. difficile Clostridioides Bacteremia in Intensive Care Patients, France. Emerg Infect Dis 2021; 27:1840-1849. [PMID: 34153220 PMCID: PMC8237868 DOI: 10.3201/eid2707.203471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Article Summary: This multicenter study focusing on critically ill patients showed a strong relationship between hemolysis and mortality. Usually responsible for soft tissue infections, Clostridioides species can also cause bacteremia, life-threatening infections often requiring intensive care unit (ICU) admission. We conducted a multicenter retrospective study to investigate Clostridioides bacteremia in ICUs to describe the clinical and biologic characteristics and outcomes in critically ill patients. We identified 135 patients with Clostridioides bacteremia, which occurred almost exclusively (96%) in patients with underlying conditions. Septic shock and digestive symptoms were the hallmarks of Clostridioides bacteremia in the ICU. We identified 16 different species of Clostridioides, among which C. perfringens accounted for 31% of cases. Despite the high sensitivity of Clostridioides to common antimicrobial drugs, mortality rates were high: 52% for ICU patients and 71% overall at 3 months. In multivariate analysis, the most important factor associated with increased risk for death was the presence of hemolysis. Clostridioides bacteremia often leads to multiple organ failures, which have high mortality rates.
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Preau S, Vodovar D, Jung B, Lancel S, Zafrani L, Flatres A, Oualha M, Voiriot G, Jouan Y, Joffre J, Huel F, De Prost N, Silva S, Azabou E, Radermacher P. Energetic dysfunction in sepsis: a narrative review. Ann Intensive Care 2021; 11:104. [PMID: 34216304 PMCID: PMC8254847 DOI: 10.1186/s13613-021-00893-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background Growing evidence associates organ dysfunction(s) with impaired metabolism in sepsis. Recent research has increased our understanding of the role of substrate utilization and mitochondrial dysfunction in the pathophysiology of sepsis-related organ dysfunction. The purpose of this review is to present this evidence as a coherent whole and to highlight future research directions. Main text Sepsis is characterized by systemic and organ-specific changes in metabolism. Alterations of oxygen consumption, increased levels of circulating substrates, impaired glucose and lipid oxidation, and mitochondrial dysfunction are all associated with organ dysfunction and poor outcomes in both animal models and patients. The pathophysiological relevance of bioenergetics and metabolism in the specific examples of sepsis-related immunodeficiency, cerebral dysfunction, cardiomyopathy, acute kidney injury and diaphragmatic failure is also described. Conclusions Recent understandings in substrate utilization and mitochondrial dysfunction may pave the way for new diagnostic and therapeutic approaches. These findings could help physicians to identify distinct subgroups of sepsis and to develop personalized treatment strategies. Implications for their use as bioenergetic targets to identify metabolism- and mitochondria-targeted treatments need to be evaluated in future studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00893-7.
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Affiliation(s)
- Sebastien Preau
- U1167 - RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000, Lille, France.
| | - Dominique Vodovar
- Centre AntiPoison de Paris, Hôpital Fernand Widal, APHP, 75010, Paris, France.,Faculté de pharmacie, UMRS 1144, 75006, Paris, France.,Université de Paris, UFR de Médecine, 75010, Paris, France
| | - Boris Jung
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University Hospital and PhyMedExp, University of Montpellier, Montpellier, France
| | - Steve Lancel
- U1167 - RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000, Lille, France
| | - Lara Zafrani
- Médecine Intensive Réanimation, Hôpital Saint-Louis, AP-HP, Université de Paris, Paris, France.,INSERM UMR 976, Hôpital Saint Louis, Université de Paris, Paris, France
| | | | - Mehdi Oualha
- Pediatric Intensive Care Unit, Necker Hospital, APHP, Centre - Paris University, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive Réanimation, CHRU Tours, Tours, France.,Faculté de Médecine de Tours, INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Tours, France
| | - Jeremie Joffre
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, 94143, USA
| | - Fabrice Huel
- Réanimation médico-chirurgicale, Université de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Cedex 94010, Créteil, France
| | - Stein Silva
- Réanimation URM CHU Purpan, Cedex 31300, Toulouse, France.,Toulouse NeuroImaging Center INSERM1214, Cedex 31300, Toulouse, France
| | - Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, AP-HP, Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles (UVSQ), Paris-Saclay University, Paris, France
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany
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Gabarre P, Dumas G, Zafrani L. Insuffisance rénale aiguë chez les patients COVID-19 en soins intensifs. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
L’insuffisance rénale aigue au cours de l’infection sévère par le SARS-CoV2 est fréquente, et est associée à une surmortalité. Elle est multifactorielle, associant des mécanismes non spécifiques (défaillance hémodynamique, PEP, iatrogénie) et des mécanismes plus spécifiques au COVID-19 (invasion virale, endothélite et thrombose, activation du système rénine angiotensine aldostérone, et élévation de cytokines pro-inflammatoires). Les troubles ioniques observés au cours de l’infection par la COVID-19 sont des marqueurs de gravité. La lésion histologique la plus fréquemment rencontrée est la nécrose tubulaire aiguë mais elle peut révéler des glomérulopathies. Il n’existe à ce jour aucun traitement spécifique de l’atteinte rénale du COVID-19.
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42
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Geri G, Darmon M, Zafrani L, Fartoukh M, Voiriot G, Le Marec J, Nemlaghi S, Vieillard-Baron A, Azoulay E. Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study. Ann Intensive Care 2021; 11:86. [PMID: 34057648 PMCID: PMC8165682 DOI: 10.1186/s13613-021-00875-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 01/22/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors. METHODS Retrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model. RESULTS 379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98-18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26-10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05-4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78-2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49-2.10], 1.73 [0.81-3.68] and 1.42 [0.78-2.58]). CONCLUSION In this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.
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Affiliation(s)
- Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
- Paris Saclay University, Gif-sur-Yvette, France.
- INSERM UMR 1018, CESP, Villejuif, France.
- FHU SEPSIS, Saclay, France.
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U1153, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U976, Immunologie Humaine, Pathophysiologie et immunothérapie, Paris, France
| | - Muriel Fartoukh
- Medical Intensive Care Unit, Tenon Hospital, AP-HP, Paris, France
- Paris Sorbonne University, Paris, France
| | - Guillaume Voiriot
- Medical Intensive Care Unit, Tenon Hospital, AP-HP, Paris, France
- Paris Sorbonne University, Paris, France
- INSERM U955 (IMRB), Equipe GEIC2O, 94000, Créteil, France
| | - Julien Le Marec
- Paris Sorbonne University, Paris, France
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Saafa Nemlaghi
- Paris Sorbonne University, Paris, France
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
- Paris Saclay University, Gif-sur-Yvette, France
- INSERM UMR 1018, CESP, Villejuif, France
- FHU SEPSIS, Saclay, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U1153, Centre of Research in Epidemiology and Statistics, Paris, France
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Saade A, Moratelli G, Dumas G, Mabrouki A, Tudesq JJ, Zafrani L, Azoulay E, Darmon M. Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect. Ann Intensive Care 2021; 11:83. [PMID: 34036411 PMCID: PMC8148396 DOI: 10.1186/s13613-021-00873-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 03/05/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. METHODS Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. RESULTS We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18-35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8-13.9]. Incidence density of hospital-acquired infections was 125 [91-200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient's severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20-53] vs. 12% [4-20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18-52] vs. 13% [1-25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. CONCLUSIONS In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.
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Affiliation(s)
- Anastasia Saade
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France
| | - Giulia Moratelli
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Guillaume Dumas
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France
| | - Asma Mabrouki
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Jean-Jacques Tudesq
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Lara Zafrani
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France
| | - Elie Azoulay
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France
| | - Michael Darmon
- Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
- Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France.
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De la SRLF CRT, Silva S, Azabou E, Vodovar D, Voiriot G, Ouahla M, Uhel F, Zafrani L, Jung B, Radermacher P, De Prost N, Préau S. Le cerveau : une nouvelle frontière pour la réanimation. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Le séminaire annuel de la Commission de Recherche Translationnelle de la SRLF a eu lieu à Paris le 3 décembre 2019. Ce séminaire est un moment privilégié d’échange entre cliniciens et scientifiques autour des axes de recherche propres à la réanimation. La sixième édition a portée sur les défis et les promesses inhérents à la recherche translationnelle autour des agressions cérébrales aiguës. Illustrant les dernières avancées dans ce domaine, les chercheurs ont présenté et discuté leurs travaux basés sur des approches complémentaires, allant de l’étude des cellules nerveuses isolées à celui des réseaux cérébraux complexes, situés au carrefour des nombreuses modulations systémiques. Une part importante des présentations a été dédiée aux nouveautés dans le domaine de l’étude du coma et des troubles acquis de la conscience. Des pistes de recherche prometteuses concernant les pathologies neurologiques prises en charge en réanimation, comme le delirium, le traumatisme crânien, les encéphalopathies métaboliques ou auto-immunes ont été aussi discutées. Enfin, nombre d’orateurs ont pu souligner les promesses et les faiblesses des nouvelles technologies actuellement disponibles pour l’étude in vivo de du cerveau humain en état critique.
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Mariotte E, Zafrani L, Fadlallah J, Galicier L, Ghrenassia E, Kerhuel L, Calvet L, Jong AD, Lemiale V, Valade S, Joly BS, Stepanian A, Azoulay E, Darmon M. Performance of Diagnostic Scores in Thrombotic Microangiopathy Patients in the Intensive Care Unit: A Monocentric Study. Thromb Haemost 2021; 121:1427-1434. [PMID: 33512705 DOI: 10.1055/a-1378-3804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Early thrombotic thrombocytopenic purpura (TTP) recognition is critical as this disease is almost always lethal if not treated promptly with therapeutic plasma exchanges. Currently, as ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity is not widely available in emergency, scores have been developed to help differentiating TTP from other thrombotic microangiopathies (TMAs). The aim of this work was to study the accuracy of these diagnostic scores in the intensive care unit (ICU) setting. Performance of both Coppo and PLASMIC scores was studied in a cohort of adult TMA patients requiring admission to one university hospital ICU from 2006 to 2017. Receiver operating characteristic (ROC) curves were established, and confidence intervals of the area under the curve (AUC) were determined. Multivariate logistic regression analysis was performed to identify parameters specifically associated with TTP, to compare diagnostic scores and to elaborate more accurate diagnostic models. During the study period, 154 TMA patients required ICU admission, including 99 (64.2%) TTP and 55 (35.7%) non-TTP patients. AUC under the ROC curve in predicting TTP was 0.86 (95% confidence interval [CI]: 0.81-0.92) for the Coppo score, 0.67 (95% CI: 0.58-0.76) for the PLASMIC score, and 0.86 (95% CI: 0.81-0.92) for platelet count alone. Platelet count ≤20 G/L, determined as the best cut-off rate for thrombocytopenia, performed similarly to the Coppo score and better than the PLASMIC score to differentiate TTP from non-TTP patients, both using AUC ROC curve and logistic regression. In a monocentric cohort of TMA patients requiring ICU admission, the PLASMIC score had limited performance for the diagnosis of TTP. The performance of the Coppo score was good but similar to a single highly discriminant item: platelet count ≤20 G/L at admission.
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Affiliation(s)
- Eric Mariotte
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France
| | - Lara Zafrani
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France.,UFR Médecine, Université de Paris, Paris, France
| | - Jehane Fadlallah
- UFR Médecine, Université de Paris, Paris, France.,Département d'Immunopathologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Lionel Galicier
- Département d'Immunopathologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Etienne Ghrenassia
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France.,UFR Médecine, Université de Paris, Paris, France
| | - Lionel Kerhuel
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France.,UFR Médecine, Université de Paris, Paris, France
| | - Laure Calvet
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France
| | - Audrey De Jong
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France
| | - Virginie Lemiale
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France
| | - Sandrine Valade
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France
| | - Bérangère S Joly
- UFR Médecine, Université de Paris, Paris, France.,Service d'Hématologie Biologique, Hôpital Lariboisière, APHP, Paris, France
| | - Alain Stepanian
- UFR Médecine, Université de Paris, Paris, France.,Service d'Hématologie Biologique, Hôpital Lariboisière, APHP, Paris, France
| | - Elie Azoulay
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France.,UFR Médecine, Université de Paris, Paris, France.,UMR1153, Équipe ECSTRRA, INSERM, Université Paris Diderot, Paris, France
| | - Michael Darmon
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, APHP, Paris, France.,UFR Médecine, Université de Paris, Paris, France.,UMR1153, Équipe ECSTRRA, INSERM, Université Paris Diderot, Paris, France
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Dupont T, Caillat-Zucman S, Fremeaux-Bacchi V, Morin F, Lengliné E, Darmon M, Peffault de Latour R, Zafrani L, Azoulay E, Dumas G. Identification of Distinct Immunophenotypes in Critically Ill Coronavirus Disease 2019 Patients. Chest 2020; 159:1884-1893. [PMID: 33316234 PMCID: PMC7831685 DOI: 10.1016/j.chest.2020.11.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 01/11/2023] Open
Abstract
Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection causes direct lung damage, overwhelming endothelial activation, and inflammatory reaction, leading to acute respiratory failure and multi-organ dysfunction. Ongoing clinical trials are evaluating targeted therapies to hinder this exaggerated inflammatory response. Critically ill coronavirus disease 2019 (COVID-19) patients have shown heterogeneous severity trajectories, suggesting that response to therapies is likely to vary across patients. Research Question Are critically ill COVID-19 patients biologically and immunologically dissociable based on profiling of currently evaluated therapeutic targets? Study Design and Methods We did a single-center, prospective study in an ICU department in France. Ninety-six critically ill adult patients admitted with a documented SARS-CoV-2 infection were enrolled. We conducted principal components analysis and hierarchical clustering on a vast array of immunologic variables measured on the day of ICU admission. Results We found that patients were distributed in three clusters bearing distinct immunologic features and associated with different ICU outcomes. Cluster 1 had a “humoral immunodeficiency” phenotype with predominant B-lymphocyte defect, relative hypogammaglobulinemia, and moderate inflammation. Cluster 2 had a “hyperinflammatory” phenotype, with high cytokine levels (IL-6, IL-1β, IL-8, tumor necrosis factor-alpha [TNF⍺]) associated with CD4+ and CD8+ T-lymphocyte defects. Cluster 3 had a “complement-dependent” phenotype with terminal complement activation markers (elevated C3 and sC5b-9). Interpretation Patients with severe COVID-19 exhibiting cytokine release marks, complement activation, or B-lymphocyte defects are distinct from each other. Such immunologic variability argues in favor of targeting different mediators in different groups of patients and could serve as a basis for patient identification and clinical trial eligibility.
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Affiliation(s)
- Thibault Dupont
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Sophie Caillat-Zucman
- Immunology Laboratory, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Véronique Fremeaux-Bacchi
- Immunology Laboratory, European Hospital Georges Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Florence Morin
- Immunology Laboratory, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Etienne Lengliné
- Hematology Department, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Régis Peffault de Latour
- Bone Marrow Transplantation (BMT) Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Guillaume Dumas
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France.
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Schmidt J, Zafrani L, Lemiale V, Stepanian A, Joly B, Azoulay E, Mariotte E. The clinical picture of thrombotic microangiopathy in patients older than 60 years of age. Br J Haematol 2020; 192:e25-e28. [PMID: 33216950 DOI: 10.1111/bjh.17176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Julien Schmidt
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France
| | - Alain Stepanian
- Hematology and Hemostasis Laboratory, APHP, Lariboisière Hospital, Paris, France
| | - Bérangère Joly
- Hematology and Hemostasis Laboratory, APHP, Lariboisière Hospital, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France
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48
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Mousseaux C, Zafrani L. Hypercalcémie des patients d’onco-hématologie. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
L’hypercalcémie est un évènement fréquent chez les patients d’onco-hématologie. Elle est souvent le reflet d’une pathologie tumorale avancée, et peut s’accompagner de multiples d’atteintes d’organes, notamment neurologique et rénale nécessitant une prise en charge rapide. Les mécanismes associés à l’hypercalcémie dans ce contexte sont de deux types : sécrétion paranéoplasique de facteurs circulants (PTH-rp, 1,25 (OH) vitamine D et exceptionnellement la PTH) et ostéolyse locale du fait de métastases osseuses. La recherche de causes non néoplasiques reste cependant primordiale. Son traitement repose principalement en une expansion volémique, l’administration de bisphosphonates et le traitement de la néoplasie sous-jacente. En dépit de sa fréquence, la définition des formes sévères nécessitant l’admission en réanimation et la prise en charge thérapeutique ne font pas l’objet de recommandations. De nouvelles études sont nécessaires pour mieux identifier les patients susceptibles de bénéficier au mieux de la réanimation.
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Tabibzadeh N, Mullaert J, Zafrani L, Balagny P, Frija-Masson J, Marin S, Lefort A, Vidal-Petiot E, Flamant M. Knowledge self-monitoring, efficiency, and determinants of self-confidence statement in multiple choice questions in medical students. BMC Med Educ 2020; 20:445. [PMID: 33213443 PMCID: PMC7678098 DOI: 10.1186/s12909-020-02352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Multiple-choice question (MCQ) tests are commonly used to evaluate medical students, but they do not assess self-confidence nor penalize lucky guess or harmful behaviors. Based on a scoring method according to the appropriateness of confidence in answers, the study aimed at assessing knowledge self-monitoring and efficiency, and the determinants of self-confidence. METHODS A cross-sectional study of 842 s- and third-year medical students who were asked to state their level of confidence (A: very confident, B: moderately confident and C: not confident) during 12 tests (106,806 events). A bonus was applied if the level of confidence matched with the correctness of the answer, and a penalty was applied in the case of inappropriate confidence. RESULTS Level A was selected more appropriately by the top 20% students whereas level C was selected more appropriately by the lower 20% students. Efficiency of higher-performing students was higher when correct (among correct answers, rate of A statement), but worse when incorrect compared to the bottom 20% students (among incorrect answers, rate of C statement). B and C statements were independently associated with female and male gender, respectively (OR for male vs female = 0.89 [0.82-0.96], p = 0.004, for level B and 1.15 [1.01-1.32], p = 0.047, for level C). CONCLUSION While both addressing the gender confidence gap, knowledge self-monitoring might improve awareness of students' knowledge whereas efficiency might evaluate appropriate behavior in clinical practice. These results suggest differential feedback during training in higher versus lower-performing students, and potentially harmful behavior in decision-making during clinical practice in higher-performing students.
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Affiliation(s)
- Nahid Tabibzadeh
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France.
| | - Jimmy Mullaert
- Biostatistics, Epidemiology and Clinical Research Department, APHP Hôpital Bichat, Université de Paris, IAME, INSERM, F-75018, Paris, France
| | - Lara Zafrani
- Intensive Care Unit, APHP, Hôpital Saint-Louis, Université de Paris, UMR 976, INSERM, F-75010, Paris, France
| | - Pauline Balagny
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France
| | - Justine Frija-Masson
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, Neurodiderot, INSERM, F-75018, Paris, France
| | - Stéphanie Marin
- Department of Educational Sciences in the Dean's office, Faculté de Médecine, Paris Diderot University, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Université de Paris, iLumens Paris-Diderot Simulation Department, IAME, UMR 1137, INSERM, Paris, F-75018, France
| | - Emmanuelle Vidal-Petiot
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France
| | - Martin Flamant
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France.
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50
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Mirouse A, Darmon M, Zafrani L, Lengliné E, Azoulay E. Impact of immunosuppression on mortality in critically ill COVID-19 patients. Br J Haematol 2020; 191:394-395. [PMID: 33103761 DOI: 10.1111/bjh.17108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Adrien Mirouse
- Service de médecine intensive et réanimation, hôpital Saint-Louis, APHP, Paris, France
- Université de Paris, Paris, France
| | - Michaël Darmon
- Service de médecine intensive et réanimation, hôpital Saint-Louis, APHP, Paris, France
- Université de Paris, Paris, France
| | - Lara Zafrani
- Service de médecine intensive et réanimation, hôpital Saint-Louis, APHP, Paris, France
- Université de Paris, Paris, France
| | | | - Elie Azoulay
- Service de médecine intensive et réanimation, hôpital Saint-Louis, APHP, Paris, France
- Université de Paris, Paris, France
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