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Eduin B, Roubille C, Badiou S, Cristol JP, Fesler P. Association between Elevated Plasma Vitamin B12 and Short-Term Mortality in Elderly Patients Hospitalized in an Internal Medicine Unit. Int J Clin Pract 2023; 2023:6652671. [PMID: 38146346 PMCID: PMC10749720 DOI: 10.1155/2023/6652671] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/14/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Background The prognostic value of vitamin B12 blood levels remains controversial. An association between elevated vitamin B12 and mortality has been reported, particularly among elderly patients with cancers and liver or blood diseases. The present study explored the relationship between mortality and elevated vitamin B12 levels in a population of unscheduled inpatients in an internal medicine unit. Methods This retrospective observational analysis was conducted between August 2014 and December 2018. We compared 165 patients with elevated plasma vitamin B12 levels (>600 pmol/l) with a random sample of 165 patients with normal B12 levels who were hospitalized during the same period. Demographic, clinical, and biological characteristics were assessed during hospitalization. The primary endpoint was all-cause death at 1 year. Results Patients with elevated B12 were younger, with a lower body mass index and lower plasma albumin than those with normal B12 (75 ± 16 years vs 79 ± 13 years, p = 0.047; 23 ± 5 vs 26 ± 7 kg/m2, p < 0.001; and 33 ± 5 vs 35 ± 5 g/l, p < 0.001, respectively). The prevalence of auto-immune disease and referral from an intensive care unit was higher among patients with elevated B12 (11% vs 5%, p = 0.043 and 36% vs 10%, p < 0.001, respectively). After 1 year of follow-up, 64 (39%) patients with elevated B12 had died compared to 43 (26%) patients with normal B12 (p = 0.018). Multivariate analysis using the Cox proportional hazards regression model adjusted for age, gender, body mass index, intensive care unit hospitalization, albumin level, and the presence of solid cancer or autoimmune disease revealed elevated B12 to be associated with a significant risk of death in the first year of follow-up (hazard ratio: 1.71 [1.08-2.7], p = 0.022). Conclusion Elevated B12 is an early warning indicator of increased short-term mortality, such as independently of age, cancer, or comorbidities, in patients hospitalized in an internal medicine department.
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Affiliation(s)
- Benjamin Eduin
- Department of Internal Medicine, University Hospital of Montpellier, Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
| | - Stéphanie Badiou
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France
| | - Jean Paul Cristol
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
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Chaigne B, Chevalier K, Boucly A, Agard C, Baudet A, Bourdin A, Chabanne C, Cottin V, Fesler P, Goupil F, Jego P, Launay D, Lévesque H, Maurac A, Mohamed S, Tromeur C, Rottat L, Sitbon O, Humbert M, Mouthon L. In-depth characterization of pulmonary arterial hypertension in mixed connective tissue disease: a French national multicentre study. Rheumatology (Oxford) 2023; 62:3261-3267. [PMID: 36727465 DOI: 10.1093/rheumatology/kead055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/11/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a leading cause of death in MCTD. We aimed to describe PAH in well-characterized MCTD patients. METHODS MCTD patients enrolled in the French Pulmonary Hypertension Registry with a PAH diagnosis confirmed by right heart catheterization were included in the study and compared with matched controls: MCTD patients without PAH, SLE patients with PAH and SSc patients with PAH. Survival rates were estimated by the Kaplan-Meier method and risk factors for PAH in MCTD patients and risk factors for mortality in MCTD-PAH were sought using multivariate analyses. RESULTS Thirty-six patients with MCTD-PAH were included in the study. Comparison with MCTD patients without PAH and multivariate analysis revealed that pericarditis, polyarthritis, thrombocytopenia, interstitial lung disease (ILD) and anti-Sm antibodies were independent predictive factors of PAH/PH in MCTD. Estimated survival rates at 1, 5 and 10 years following PAH diagnosis were 83%, 67% and 56%, respectively. MCTD-PAH presentation and survival did not differ from SLE-PAH and SSc-PAH. Multivariate analysis revealed that tobacco exposure was an independent factor predictive of mortality in MCTD-PAH. CONCLUSION PAH is a rare and severe complication of MCTD associated with a 56% 10-year survival. We identified ILD, pericarditis, thrombocytopenia and anti-Sm antibodies as risk factors for PAH in MCTD and tobacco exposure as a predictor of mortality in MCTD-PAH.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Kevin Chevalier
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Athenaïs Boucly
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Christian Agard
- Service de Médecine Interne, Nantes Université, CHU Nantes, Nantes, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre de Compétence Maladies Auto-Immunes Systémiques Rares Annecy, CHR Annecy-Genevois, Annecy, France
| | - Arnaud Bourdin
- Physiologie et Médecine Expérimentale du Cœur et des Muscles, Université de Montpellier, Centre National de la Recherche Scientifique, INSERM, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Céline Chabanne
- Service de Cardiologie et Maladies Vasculaires, Centre Hospitalier Universitaire de Rennes, Université de Rennes-Institut National de la Santé et de la Recherche Médicale, Rennes, France
| | - Vincent Cottin
- Unité Mixte de Recherche 754: Infections Virales et Pathologie Comparée, Hospices Civils de Lyon, Université Lyon 1-Institut National de la Recherche Agronomique-Centre National de Référence des Maladies Pulmonaires Rares, Lyon, France
| | - Pierre Fesler
- Service de Médecine Interne, Hôpital Lapeyronie, Montpellier, France
| | | | - Patrick Jego
- Internal Medicine and Clinical Immunology Unit, CHU Rennes, Rennes, France
| | - David Launay
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France, Université of Lille, Inserm, CHU Lille, U1286 - Institute for Translational Research in Inflammation, Lille, France
| | - Hervé Lévesque
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
- INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen University Hospital, Rouen, France
| | - Arnaud Maurac
- Département de Pneumologie, Hôpital Haut Lévèque, CHU de Bordeaux, Pessac, France
| | - Shirine Mohamed
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Cécile Tromeur
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France
- INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale, University Brest, Brest, France
- F-CRIN INNOVTE, Saint-Etienne, France
| | - Laurence Rottat
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
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Bouvet J, Broner J, Arnaud E, Dumain C, Holubar J, Costa D, Fesler P, Fages M, Goulabchand R. [Easing the patients' trajectories from private practice to hospital: One-year experiment of the RAPIDO project]. Rev Med Interne 2023:S0248-8663(23)00128-5. [PMID: 37150638 DOI: 10.1016/j.revmed.2023.04.006] [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: 12/18/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Internal medicine departments manage patients referred by emergency departments or private practitioners. Considering the overcrowding of emergency departments and lack of beds for inpatients, this specialty must be part of an "ambulatory shift", particularly by strengthening the links between community and hospital medicine. Our objective was to evaluate a new care pathway in internal medicine at Nîmes university hospital. METHODS Our department has developed the RAPIDO project (Réseau d'Aide à la PrIse en Charge Diagnostique et d'Orientation). The referring general practitioner contacts a senior internist on a dedicated phone line. After careful evaluation, he may offer a consultation within 15 days. A summary report is then given to the patient. RESULTS Between November 2020 and November 2021, 254 patients were seen via RAPIDO. The average call-consultation time period was 6.4 (±4.5) days, for symptoms lasting for 2 weeks to 3 months in 43% (n=109) of cases. The reason for the call was a suspicion of systemic disease in 28% of cases (n=84), or a dysfunction of an organ in 16%. A diagnosis was made in 89% of cases. The budget of the whole procedure was balanced. CONCLUSION A quick internal medicine consultation pathway for general practitioners seems to be a relevant, feasible and economically viable healthcare trajectory, which can be transposed to any type of healthcare institution, as soon as sufficient human resources are dedicated.
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Affiliation(s)
- Julie Bouvet
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France.
| | - Jonathan Broner
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Erik Arnaud
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Cyril Dumain
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Jan Holubar
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - David Costa
- Département universitaire de médecine générale, université de Montpellier-Nîmes, Nîmes, France
| | - Pierre Fesler
- Département de médecine interne et hypertension artérielle, CHU de Montpellier, université de Montpellier, Montpellier, France
| | - Marion Fages
- Département d'information médicale, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Radjiv Goulabchand
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
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Berger M, Daubin D, Charriot J, Klouche K, Le Moing V, Morquin D, Halimi L, Jaussent A, Taourel P, Hayot M, Cristol JP, Nagot N, Fesler P, Roubille C. Mid-Term Sequelae of Surviving Patients Hospitalized in Intensive Care Unit for COVID-19 Infection: The REHCOVER Study. J Clin Med 2023; 12:jcm12031000. [PMID: 36769648 PMCID: PMC9917891 DOI: 10.3390/jcm12031000] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES The objective of this prospective, single-center study was to explore the mid-term outcomes 6 to 9 months after hospitalization in an Intensive Care Unit (ICU) for severe COVID-19 infection. METHODS Patients systematically underwent biological tests, pulmonary function tests, chest computed tomography (CT) scan, and psychological tests. RESULTS Among 86 patients, including 71 (82.6%) men, median age of 65.8 years (56.7; 72.4), 57 (71.3%) patients presented post-COVID-19 asthenia, 39 (48.1%) muscle weakness, and 30 (36.6%) arthralgia. Fifty-two (64.2%) patients had a decreased diffusion capacity for carbon monoxide (DLCO) <80% and 16 (19.8%) had DLCO <60%. Chest CT-scans showed ground glass opacities in 35 (40.7%) patients, and reticular changes in 28 patients (33.7%), including fibrosis-like changes in 18 (21.7%) patients. Reticular changes and DLCO <60% were associated with length of stay in ICU, and reticular changes with higher maximal CRP level. The psychological questionnaires found 37.7% suffered from depression, 23.5% from anxiety, 42.4% from insomnia, and 9.4% from post-traumatic stress. Being female was associated with a higher frequency of depression and anxiety, with depression scores being associated with obesity. CONCLUSIONS Many patients hospitalized in ICU for severe COVID-19 infection have mid-term sequelae. Additional studies on the prognostic factors seem necessary.
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Affiliation(s)
- Marie Berger
- Department of Internal Medicine, Montpellier University Hospital, 34090 Montpellier, France
| | - Delphine Daubin
- Critical Care Unit, Montpellier University Hospital, 34090 Montpellier, France
| | - Jeremy Charriot
- Department of Respiratory Diseases, Montpellier University Hospital, 34090 Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Kada Klouche
- Critical Care Unit, Montpellier University Hospital, 34090 Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
| | - Vincent Le Moing
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
- Department of Infectious Diseases, Montpellier University Hospital, 34090 Montpellier, France
| | - David Morquin
- Department of Infectious Diseases, Montpellier University Hospital, 34090 Montpellier, France
| | - Laurence Halimi
- Department of Respiratory Diseases, Montpellier University Hospital, 34090 Montpellier, France
| | - Audrey Jaussent
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, 34090 Montpellier, France
| | - Patrice Taourel
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
- Department of Medical Imaging, Montpellier University Hospital, 34090 Montpellier, France
| | - Maurice Hayot
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
- Department of Clinical Physiology, University Hospital of Montpellier, 34090 Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, 34090 Montpellier, France
| | - Nicolas Nagot
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, 34090 Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, Montpellier University Hospital, 34090 Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, Montpellier University Hospital, 34090 Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
- Faculty of Medicine, University of Montpellier, 34090 Montpellier, France
- Correspondence: ; Tel.: +33(0)-4-6733-8443; Fax: +33(0)-4-6733-8453
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Pisareva E, Badiou S, Mihalovičová L, Mirandola A, Pastor B, Kudriavtsev A, Berger M, Roubille C, Fesler P, Klouche K, Cristol J, Thierry AR. Persistence of neutrophil extracellular traps and anticardiolipin auto-antibodies in post-acute phase COVID-19 patients. J Med Virol 2023; 95:e28209. [PMID: 36226380 PMCID: PMC9874393 DOI: 10.1002/jmv.28209] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 07/25/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
In the early phase of the pandemic, we were among the first to postulate that neutrophil extracellular traps (NETs) play a key role in COVID-19 pathogenesis. This exploratory prospective study based on 279 individuals showed that plasma levels of neutrophil elastase, myeloperoxidase and circulating DNA of nuclear and mitochondrial origins in nonsevere (NS), severe (S) and postacute phase (PAP) COVID-19 patients were statistically different as compared to the levels in healthy individuals, and revealed the high diagnostic power of these NETs markers in respect to the disease severity. The diagnostic power of NE, MPO, and cir-nDNA as determined by the Area Under Receiver Operating Curves (AUROC) was 0.95, 097, and 0.64; 0.99, 1.0, and 0.82; and 0.94, 1.0, and 0.93, in NS, S, and PAP patient subgroups, respectively. In addition, a significant fraction of NS, S as well as of PAP patients exhibited aCL IgM/IgG and anti-B2GP IgM/IgG positivity. We first demonstrate persistence of these NETs markers in PAP patients and consequently of sustained innate immune response imbalance, and a prolonged low-level pro-thrombotic potential activity highlighting the need to monitor these markers in all COVID-19 PAP individuals, to investigate postacute COVID-19 pathogenesis following intensive care, and to better identify which medical resources will ensure complete patient recovery.
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Affiliation(s)
- Ekaterina Pisareva
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de MontpellierUniversité de MontpellierMontpellierFrance
| | - Stephanie Badiou
- Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of MontpellierUniversity of Montpellier, PhyMedExpMontpellierFrance
| | - Lucia Mihalovičová
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de MontpellierUniversité de MontpellierMontpellierFrance
- Faculty of Medicine, Institute of Molecular BiomedicineComenius UniversityBratislavaSlovakia
| | - Alexia Mirandola
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de MontpellierUniversité de MontpellierMontpellierFrance
| | - Brice Pastor
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de MontpellierUniversité de MontpellierMontpellierFrance
| | - Andrei Kudriavtsev
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de MontpellierUniversité de MontpellierMontpellierFrance
| | - Marie Berger
- Department of Internal Medicine, INSERM U1046, CNRS, Montpellier University Hospital, Montpellier, PhyMedExpUniversity of MontpellierMontpellierFrance
| | - Camille Roubille
- Department of Internal Medicine, INSERM U1046, CNRS, Montpellier University Hospital, Montpellier, PhyMedExpUniversity of MontpellierMontpellierFrance
| | - Pierre Fesler
- Department of Internal Medicine, INSERM U1046, CNRS, Montpellier University Hospital, Montpellier, PhyMedExpUniversity of MontpellierMontpellierFrance
| | - Kada Klouche
- Intensive Care Medicine Department, INSERM, CNRS, Lapeyronie HospitalUniversity Hospital of Montpellier, France, and PhyMedExp, University of MontpellierMontpellierFrance
| | - Jean‐Paul Cristol
- Department of Biochemistry and Hormonology, INSERM, CNRS, University Hospital Center of MontpellierUniversity of Montpellier, PhyMedExpMontpellierFrance
| | - Alain R. Thierry
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut Régional du Cancer de MontpellierUniversité de MontpellierMontpellierFrance
- Montpellier Cancer Institute (ICM)MontpellierFrance
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Coulon C, Lotierzo M, Fesler P, Roubille C, Badiou S, Dupuy AM, Cristol JP. Analytical evaluation and bioclinical validation of new aldosterone and renin immunoassays. Clin Chem Lab Med 2022; 60:1763-1771. [PMID: 36096492 DOI: 10.1515/cclm-2022-0576] [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: 06/14/2022] [Accepted: 08/30/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Aldosterone and renin determinations play an important role in the etiological diagnosis of secondary hypertension. The analytical performances of new aldosterone and renin immunoassays on the Lumipulse G600II® system (Fujierbio) were investigated and compared with those of the iSYS® system (IDS) on patients concerned by medical investigations in a context of suspected or proven Primary aldosteronism. METHODS By using the Lumipulse® G Aldosterone and Renin assays we performed imprecision study, linearity and method comparison (n=107). Accuracy of this new renin assay was tested using the International Standard (WHO IS 68/356). We also assessed the equivalence of the different samples types (n=29). RESULTS The imprecision evaluation showed all CVs <3% and <6% for Lumipulse® G Aldosterone and Renin assays respectively. The linearity was excellent over the clinical range and the comparison with the iSYS® assays (n=79) showed a strong correlation (R2=1) despite a slight tendency to underestimation (bias of -17.53 pg/mL or 48.56 pmol/L for aldosterone and -15.395 pg/mL for renin). Moreover, the contingency studies based on diagnostic criteria showed that Lumipulse® G results lead to the same clinical diagnosis that iSYS® results. A clear correlation was obtained between EDTA and heparin plasma as well as with the serum for all range of measures. CONCLUSIONS The Lumipulse® G Aldosterone and Renin assays present performances compatible with a routine use in medical laboratories. The precise quantification in the low range can be of interest in some clinical contexts especially standing/laying tests. However, the standardisation against the WHO International Standard Renin would be advisable.
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Affiliation(s)
- Caroline Coulon
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France
| | - Manuela Lotierzo
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France
| | - Pierre Fesler
- Internal Medicine Service, University Hospital of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Camille Roubille
- Internal Medicine Service, University Hospital of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Anne Marie Dupuy
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France.,Centre de Ressources Biologiques, University Hospital of Montpellier, Montpellier, France
| | - Jean Paul Cristol
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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Roubille C, Eduin B, Breuker C, Zerkowski L, Letertre S, Mercuzot C, Bigot J, Du Cailar G, Roubille F, Fesler P. Predictive risk factors for death in elderly patients after hospitalization for acute heart failure in an internal medicine unit. Intern Emerg Med 2022; 17:1661-1668. [PMID: 35460014 DOI: 10.1007/s11739-022-02982-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
To determine the predictive factors of mortality after hospitalization for acute heart failure (AHF) in an internal medicine department. Retrospective observational analysis conducted on 164 patients hospitalized for AHF in 2016-2017. Demographic, clinical and biological characteristics were assessed during hospitalization. The primary endpoint was the occurrence of all-cause death. Multivariate analysis was performed using the Cox model adjusted for age and renal function. The study population was mostly female (n = 106, 64.6%), elderly (82.9 years ± 10.0), with a preserved LVEF (86%). Mean Charlson comorbidity index was 6.5 ± 2.5. After a median follow-up of 17.5 months (IQR 6-38), 109 patients (65%) had died with a median time to death of 14 months (IQR 3-29). In univariate analysis, patients who died were significantly older, had lower BMI and renal function, and higher CCI and NT-proBNP levels (median of 4944 ng/l [2370-14403] versus 1740 ng/l [1119-3503], p < 0.001). In multivariate analysis, risk factors for death were lower BMI (HR 0.69, CI [0.53-0.90], p = 0.005), lower albuminemia (HR 0.77 [0.63-0.94], p = 0.009), higher ferritinemia (HR 1.38 [1.08-1.76], p = 0.010), higher uricemia (HR 1.28 [1.02-1.59], p = 0.030), higher NT-proBNP (HR 2.46 [1.65-3.67], p < 0.001) and longer hospital stay (HR 1.25 [1.05-1.49] p = 0.013). In elderly multimorbid patients, AHF prognosis appears to be influenced by nutritional criteria, including lower BMI, hypoalbuminemia, and hyperuricemia (independently of renal function). These results underline the importance of nutritional status, especially as therapeutic options are available. This consideration paves the way for further research in this field.
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Affiliation(s)
- Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France.
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France.
| | - Benjamin Eduin
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - Cyril Breuker
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France
- Clinical Pharmacy Department, CHRU de Montpellier, University of Montpellier, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - Simon Letertre
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - Cédric Mercuzot
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | | | - Guilhem Du Cailar
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France
- Department of Cardiology, CHU Montpellier, Montpellier University, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex 5, France
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8
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Fantone M, Broner J, Dumain C, Fesler P, Arnaud E, Gaujoux-Viala C, Jeanjean L, Goulabchand R. Étude des évènements cortico-induits chez des patients atteints d’Uvéite Chronique Non Infectieuse. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.299] [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: 10/18/2022]
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9
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Berger M, Daubin D, Charriot J, Klouche K, Le Moing V, Arnaud B, Morquin D, Jaussent A, Taourel P, Hayot M, Nagot N, Fesler P, Roubille C. Devenir des patients hospitalisés en soins critiques pour infection à SARS-COV2 : évaluation standardisée des séquelles à 6–9 mois. Rev Med Interne 2022. [PMCID: PMC9212689 DOI: 10.1016/j.revmed.2022.03.307] [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: 11/17/2022]
Abstract
Introduction Identifié en Chine en décembre 2019, le Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-COV2) s’est rapidement propagé au niveau mondial. Si les études se sont initialement concentrées sur la prise en charge de la phase aiguë de la COrona VIrus Disease (COVID), l’objectif de ce travail est de s’intéresser aux conséquences à distance d’une hospitalisation pour COVID sévère. Patients et méthodes Nous avons réalisé une étude prospective, monocentrique, incluant des patients 6 à 9 mois après leur hospitalisation en soins critiques (soins intensifs ou réanimation) pour une infection confirmée à SARS-COV2. Les patients étaient évalués au cours d’une hospitalisation de jour en médecine interne. L’entretien débutait par un recueil des antécédents du patient, des évènements et des symptômes post-COVID. L’examinateur procédait ensuite à un examen clinique détaillé et un test de marche des 6 minutes (TM6). Les patients réalisaient de manière systématique des explorations fonctionnelles respiratoires (EFR), une tomodensitométrie (TDM) thoracique non injectée, une échographie cardiaque trans-thoracique (ETT), et un bilan biologique complet. Une batterie de tests était réalisée, explorant la qualité de vie et les séquelles psychologiques. Résultats Quatre-vingt-six patients, dont 71 (82,6 %) hommes, d’âge médian 65,8 ans (56,7;72,4), ont été évalués dans un délai moyen de 7 mois (min 3,4; max 14,9). L’hypertension artérielle (46,5 %), le diabète (34,9 %) et la dyslipidémie (39,5 %) étaient les antécédents médicaux les plus représentés. Douze (14,0 %) patients avaient une pathologie pulmonaire sous-jacente, principalement une broncho-pneumopathie chronique obstructive (BPCO). L’indice de comorbidités de Charlson médian était de 1 (0,0; 2,0). La durée médiane du séjour en soins critiques était de 10,0 (6,0;17,0) jours. Cinquante-quatre (62,8 %) patients ont eu une ventilation invasive et 67 (77,9 %) patients ont reçu un traitement par corticothérapie. Cinquante-sept (71,3 %) patients ont présenté une asthénie post-COVID, 39 (48,1 %) une faiblesse musculaire, 30 (36,6 %) des arthralgies. Quinze patients ont développé un déséquilibre du diabète et 9 un déséquilibre de la pression artérielle. Dix-sept (21,3 %) patients avaient une distance au TM6 < 80 % de la théorique. Quarante-six patients53,5 %) avaient un score de dyspnée Medical Reaserch Council (MRC) de 0 et 24 (27,9 %) avaient un score MRC de 1. Treize (15,5 %) patients avaient une auscultation anormale à type de crépitants secs des bases. Cinquante-deux (64,2 %) patients ont présenté un déficit de la diffusion du CO défini par une DLCO < 80 % et 16 (19,8 %) avaient une DLCO < 60 %. Le scanner thoracique montrait chez 35 (40,7 %) patients des lésions de verre dépoli et 18 (21,7 %) de la fibrose. Trente-deux patients (37,6 %) avaient un score PHQ-9 significatif pour une dépression, 20 (23,5 %) un score GAD-7 significatif pour un trouble anxieux et 8 (9,4 %) patients avaient un score PCL5 supérieur au seuil évoquant un état de stress post-traumatique. Le niveau de qualité de vie à distance de l’épisode aigu était satisfaisant avec une médiane de l’EQ-5D-3L à 0,89 (0,64;1,00). En analyse univariée, la fibrose sur le scanner de réévaluation et une DLCO < 60 % étaient associées à la durée du séjour en soins critiques et au niveau maximal de CRP pendant l’épisode aigu. En analyse multivariée, la fibrose et la DLCO étaient associées à la durée de séjour. En analyse uni et multivariée, le PHQ-9 et le GAD-7 étaient associés au sexe féminin. Discussion À ce jour, rares sont les études qui ont étudié de manière systématisée les séquelles somatiques et psychologiques à long terme de la COVID chez les patients qui ont été pris en charge en soins critiques. Conformément à la littérature, la diminution de la DLCO est l’anomalie la plus fréquemment retrouvée aux EFR, les plages de verre dépoli persistent sur le scanner et des lésions fibrotiques sont retrouvées chez plus d’un patient sur 5 [1], [2]. Ces anomalies contrastent avec une plainte respiratoire modérée et un examen clinique rassurant. Les symptômes généraux (asthénie, faiblesse musculaire et arthralgies) sont au cœur de la plainte fonctionnelle. Les déséquilibres de la tension artérielle et du diabète observés justifient un suivi accru des pathologies chroniques au décours de l’épisode aigu. Enfin, nous avons noté une prévalence plus importante des troubles psychologiques que celles relevées rétrospectivement (dossier informatisé) dans une autre étude [3], renforçant, selon nous, la nécessité d’un dépistage systématique des troubles psychiatriques. Conclusion De nombreux patients présentent des séquelles à distance d’une COVID sévère nous incitant à un dépistage systématique afin de proposer une prise en charge adaptée.
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Dumain C, Broner J, Arnaud E, Dewavrin E, Holubar J, Fantone M, De Wazieres B, Fesler P, Guilpain P, Roubille C, Goulabchand R. Tocilizumab, corticothérapie et risque iatrogène chez des patients atteints d’une artérite à cellules géantes : comment identifier les patients à risque en « vraie-vie » ? Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.272] [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: 11/29/2022]
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11
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Dumain C, Broner J, Arnaud E, Dewavrin E, Holubar J, Fantone M, de Wazières B, Parreau S, Fesler P, Guilpain P, Roubille C, Goulabchand R. Patients' Baseline Characteristics, but Not Tocilizumab Exposure, Affect Severe Outcomes Onset in Giant Cell Arteritis: A Real-World Study. J Clin Med 2022; 11:jcm11113115. [PMID: 35683507 PMCID: PMC9181652 DOI: 10.3390/jcm11113115] [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: 04/18/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives: Giant cell arteritis (GCA) is associated with severe outcomes such as infections and cardiovascular diseases. We describe here the impact of GCA patients’ characteristics and treatment exposure on the occurrence of severe outcomes. Methods: Data were collected retrospectively from real-world GCA patients with a minimum of six-months follow-up. We recorded severe outcomes and treatment exposure. In the survival analysis, we studied the predictive factors of severe outcomes occurrence, including treatment exposure (major glucocorticoids (GCs) exposure (>10 g of the cumulative dose) and tocilizumab (TCZ) exposure), as time-dependent covariates. Results: Among the 77 included patients, 26% were overweight (BMI ≥ 25 kg/m2). The mean cumulative dose of GCs was 7977 ± 4585 mg, 18 patients (23%) had a major GCs exposure, and 40 (52%) received TCZ. Over the 48-month mean follow-up period, 114 severe outcomes occurred in 77% of the patients: infections—29%, cardiovascular diseases—18%, hypertension—15%, fractural osteoporosis—8%, and deaths—6%. Baseline diabetes and overweight were predictive factors of severe outcomes onset (HR, 2.41 [1.05−5.55], p = 0.039; HR, 2.08 [1.14−3.81], p = 0.018, respectively) independently of age, sex, hypertension, and treatment exposure. Conclusion: Diabetic and overweight GCA patients constitute an at-risk group requiring tailored treatment, including vaccination. The effect of TCZ exposure on the reduction of severe outcomes was not proved here.
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Affiliation(s)
- Cyril Dumain
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Jonathan Broner
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Erik Arnaud
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Emmanuel Dewavrin
- Intensive Care Medicine Department, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France;
| | - Jan Holubar
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Myriam Fantone
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Benoit de Wazières
- Department of Internal Medicine and Geriatrics, CHU Nîmes, University of Montpellier, 30029 Nîmes, France;
| | - Simon Parreau
- Department of Internal Medicine, Limoges University Hospital Center, 87042 Limoges, France;
| | - Pierre Fesler
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France; (P.F.); (C.R.)
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine and Multi-Organic Diseases, St. Eloi Hospital, CHU Montpellier, 34295 Montpellier, France;
- Institute for Regenerative Medicine & Biotherapy, St. Eloi Hospital, University of Montpellier, INSERM, 34295 Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France; (P.F.); (C.R.)
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
- Institute for Regenerative Medicine & Biotherapy, St. Eloi Hospital, University of Montpellier, INSERM, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-(0)4-66683241
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12
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Debourdeau E, Gardes G, Nocca D, Carriere I, Chiquet C, Villain M, Roubille C, Du Cailar G, Sardinoux M, Daien V, Fesler P. Longitudinal Effect of Bariatric Surgery on Retinal Microcirculation and Target Organ Damage: the BASTOD Study. Obes Surg 2022; 32:1-10. [PMID: 35469081 DOI: 10.1007/s11695-022-06064-2] [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: 12/02/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Obesity is associated with increased cardiovascular risk. Bariatric surgery (BS) improves the clinical and metabolic profile. Retinal caliber changes could precede cardiovascular events. Different studies have shown an improvement in retinal caliber after BS. The aim of this study was to examine retinal caliber and other cardiovascular target organ damage before and after BS. MATERIALS AND METHODS Monocentric, prospective cohort study at the Montpellier University Hospital. Biologic features, vessel stiffness, echocardiograph variables, and retinal caliber at baseline and 6 and 12 months were assessed in consecutive patients with class 2 or 3 obesity undergoing BS. A mixed linear model adjusted for age and sex was used. RESULTS We included 88 patients (75 women). The mean (SD) age was 43 years (11) and mean (SD) baseline weight 117 (21) Kg. Mean changes in the first year after BS were - 5.1 µm in central retinal vein equivalent (CRVE) (p < 0.0001), + 0.02 in arteriole-to-venule ratio (AVR) (p < 0.0001), - 1.4 mmol/L in glycemia (p < 0.0001), - 1.0 mg/L in natural logarithm of C-reactive protein (p < 0.0001), and - 54.0 g in left ventricular mass (p = 0.0005). We observed no significant improvement in arterial stiffness markers. Predictors of improvement in CRVE were high baseline weight (p = 0.030), male sex (p = 0.025), and no diabetes history (p Dynamic links between variations = 0.047). CONCLUSION The retinal microvascular phenotype improved during the first year after bariatric surgery, with decreased CRVE and increased AVR. Factors associated with retinal microvascular plasticity were male sex, high baseline weight, and absence of diabetes. Longitudinal assessment of retinal vascular calibers may offer new insights into the pathophysiology of subclinical vascular processes.
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Affiliation(s)
- Eloi Debourdeau
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France. .,Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, 34091, Montpellier, France.
| | - Gabriel Gardes
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - David Nocca
- Digestive Surgery Division A, CHU de Montpellier, F-34000, Montpellier, France
| | - Isabelle Carriere
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, 34091, Montpellier, France
| | - Christophe Chiquet
- Department of Ophthalmology, Grenoble Alpes University Hospital, 38048, Grenoble, France
| | - Max Villain
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 34000, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000, Montpellier, France
| | - Guilhem Du Cailar
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 34000, Montpellier, France
| | - Mathieu Sardinoux
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 34000, Montpellier, France
| | - Vincent Daien
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, 34091, Montpellier, France.,The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Pierre Fesler
- Department of Internal Medicine, CHU Montpellier, Montpellier University, 34000, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000, Montpellier, France
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13
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Goulabchand R, Roubille C, Montani D, Fesler P, Bourdin A, Malafaye N, Morel J, Arnaud E, Lattuca B, Barateau L, Guilpain P, Mura T. Cardiovascular Events, Sleep Apnoea, and Pulmonary Hypertension in Primary Sjögren's Syndrome: Data from the French Health Insurance Database. J Clin Med 2021; 10:jcm10215115. [PMID: 34768635 PMCID: PMC8584404 DOI: 10.3390/jcm10215115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/09/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is an autoimmune disease, associated with a high risk of lymphoma. Mounting evidence suggests that cardiovascular morbidity and mortality are higher in patients with pSS, although data are heterogeneous. The aim of this study was to assess whether pSS patients are at higher risk of hospitalisation for cardiovascular events (CVEs), venous thromboembolic events (VTEs), pulmonary hypertension (PH), and sleep apnoea syndrome (SAS). Through a nationwide population-based retrospective study using the French health insurance database, we selected new-onset pSS in-patients hospitalised between 2011 and 2018. We compared the incidence of CVEs (ischemic heart diseases (IHDs), strokes, and heart failure), SAS, VTEs, and PH with an age- and sex-matched (1:10) hospitalised control group. The calculations of adjusted hazard ratios (aHR) included available confounding factors. We studied 25,661 patients hospitalised for pSS compared with 252,543 matched patients. The incidence of hospitalisation for IHD, SAS, and PH was significantly higher in pSS patients (aHR: 1.20 (1.06–1.34); p = 0.003, aHR: 1.97 (1.70–2.28); p < 0.001, and aHR: 3.32 (2.10–5.25); p < 0.001, respectively), whereas the incidence of stroke, heart failure, and VTE was the same between groups. Further prospective studies are needed to confirm these results and to explore the pathophysiological mechanisms involved.
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Affiliation(s)
- Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University Montpellier, 30029 Nîmes, France;
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Correspondence: (R.G.); (P.G.); (T.M.); Tel.: +33-4-66-68-32-41 (R.G.)
| | - Camille Roubille
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34295 Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - David Montani
- Service de Pneumologie et Soins Intensifs Respiratoires, INSERM UMR_S 999, Hôpital Bicêtre, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France;
| | - Pierre Fesler
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34295 Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France
| | - Arnaud Bourdin
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France
- Department of Respiratory Diseases, Montpellier University Hospital, 34295 Montpellier, France
| | - Nicolas Malafaye
- Department of Medical Information, Montpellier University Hospital, 34295 Montpellier, France;
| | - Jacques Morel
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, France
- Department of Rheumatology, Montpellier University Hospital, 34295 Montpellier, France
| | - Erik Arnaud
- Internal Medicine Department, CHU Nîmes, University Montpellier, 30029 Nîmes, France;
| | - Benoit Lattuca
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Cardiology Department, CHU Nîmes, University Montpellier, 30029 Nîmes, France
| | - Lucie Barateau
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 34295 Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, 34295 Montpellier, France
- Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, 34295 Montpellier, France
| | - Philippe Guilpain
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Local Referral Center for Systemic and Autoimmune Diseases, Department of Internal Medicine and Multi-Organic Diseases, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France
- Correspondence: (R.G.); (P.G.); (T.M.); Tel.: +33-4-66-68-32-41 (R.G.)
| | - Thibault Mura
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (C.R.); (P.F.); (A.B.); (J.M.); (B.L.); (L.B.)
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University Montpellier, 30029 Nîmes, France
- Correspondence: (R.G.); (P.G.); (T.M.); Tel.: +33-4-66-68-32-41 (R.G.)
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Mercuzot C, Debien B, Riviere É, Martis N, Sanges S, Galland J, Kouchit Y, Fesler P, Roubille C. Impact of a simulation-based training on the experience of the beginning of residency. Rev Med Interne 2021; 42:756-763. [PMID: 34303548 DOI: 10.1016/j.revmed.2021.07.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 07/04/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION We aimed to evaluate the impact of an immersive simulation session on the experience of the beginning of residency. METHODS The interventional group consisted of newly recruited residents in 2019, who participated in the workshop presenting four emergency scenarios frequently encountered during night shifts; the control group comprised residents who had begun their internship in 2018, without having participated in the simulation workshop. The level of psychological stress and self-confidence were self-estimated in the simulation group before and immediately after the workshop. During the second semester of residency, stress, self-efficacy and anxiety were evaluated in both groups with the Perceived Stress Scale (PSS), General Self-efficacy Scale (GSES), and Generalized Anxiety Disorder-7 (GAD-7) scale. RESULTS In the second semester 2020, the PSS, GSES and GAD-7 were 20.71±8.15 and 22.44±5.68 (P=0.40); 26.88±6.30 and 27.11±3.95 (P=0.87); 6.94±5.25 and 8.89±4.78 (P=0.22) for the simulation (n=17, 89.5% of participation) and control (n=9, 75%) groups, respectively. In the simulation group, the level of self-confidence had significantly improved from 1.82±0.95 before the session to 2.29±1.16 after the session (P=0.05). Interestingly, this improvement in self-confidence was significantly correlated with GAD-7 (P=0.014) and PSS (P=0.05), and tended to be correlated with GSES (P=0.09). CONCLUSION Our study showed a significant improvement in self-confidence between before and after the simulation session. Residents who experienced an improvement in self-confidence saw their stress and anxiety levels decrease during the second semester reevaluation, in favor of a prolonged benefit from the session.
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Affiliation(s)
- C Mercuzot
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - B Debien
- Medical simulation training center, Montpellier University, Montpellier, France
| | - É Riviere
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, 33600 Pessac, France; Inserm U1034, Bordeaux University, 33604 Pessac cedex, France
| | - N Martis
- Côte d'Azur University, Nice, France; Department of Internal Medicine, University Hospital of Nice, Nice, France; CNRS UMR7275, Non Coding Genome & Lung Disorders, Institute of Molecular and Cellular Pharmacology, Valbonne, France
| | - S Sanges
- UFR Médecine, Centre de Simulation PRESAGE, University Lille, 59000 Lille, France; Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, CHU de Lille, University Lille, 59000 Lille, France; Département de Médecine Interne et Immunologie Clinique, CHU de Lille, 59037 Lille cedex, France
| | - J Galland
- Department of Internal medicine, Lariboisière Hospital, AP-HP, Paris, France; University of Paris, Paris, France
| | - Y Kouchit
- Côte d'Azur University, Nice, France; Department of Internal Medicine, University Hospital of Nice, Nice, France
| | - P Fesler
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; Inserm U1046, CNRS UMR 9214, PhyMedExp, University of Montpellier, Montpellier, cedex 5, France
| | - C Roubille
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; Inserm U1046, CNRS UMR 9214, PhyMedExp, University of Montpellier, Montpellier, cedex 5, France.
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15
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Roubille C, Henriquez S, Mercuzot C, Duflos C, Dunogue B, Briot K, Guillevin L, Terrier B, Fesler P. Impact of Cardiovascular Risk Factors on the Occurrence of Cardiovascular Events in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitides. J Clin Med 2021; 10:jcm10112299. [PMID: 34070514 PMCID: PMC8198638 DOI: 10.3390/jcm10112299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/11/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98–72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66–25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42–14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33–19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14–13.09). The occurrence of MACEs was associated with the number of CVRFs (p < 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.
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Affiliation(s)
- Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France; (C.M.); (P.F.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000 Montpellier, France
- Correspondence: ; Tel.: +46-733-8443; Fax: +46-733-8453
| | - Soledad Henriquez
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Cédric Mercuzot
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France; (C.M.); (P.F.)
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Medical Information Department, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France;
| | - Bertrand Dunogue
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Karine Briot
- Université de Paris, 75006 Paris, France;
- Department of Rheumatology, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France
| | - Loic Guillevin
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Benjamin Terrier
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris-Centre, Université de Paris, Hôpital Cochin, 75014 Paris, France; (S.H.); (B.D.); (L.G.); (B.T.)
- Université de Paris, 75006 Paris, France;
| | - Pierre Fesler
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, 34000 Montpellier, France; (C.M.); (P.F.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34000 Montpellier, France
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16
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Audurier Y, Roubille C, Manna F, Zerkowski L, Faucanie M, Macioce V, Castet-Nicolas A, Jalabert A, Villiet M, Fesler P, Lohan-Descamps L, Breuker C. Development and validation of a score to assess risk of medication errors detected during medication reconciliation process at admission in internal medicine unit: SCOREM study. Int J Clin Pract 2021; 75:e13663. [PMID: 32770845 DOI: 10.1111/ijcp.13663] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medication errors (ME) can be reduced through preventive strategies such as medication reconciliation. Such strategies are often limited by human resources and need targeting high risk patients. AIMS To develop a score to identify patients at risk of ME detected during medication reconciliation in a specific population from internal medicine unit. METHODS Prospective observational study conducted in an internal medicine unit of a French University Hospital from 2012 to 2016. Adult hospitalised patients were eligible for inclusion. Medication reconciliation was conducted by a pharmacist and consisted in comparing medication history with admission prescription to identify MEs. Risk factors of MEs were analysed using multivariate stepwise logistic regression model. A risk score was constructed using the split-sample approach. The split was done at random (using a fixed seed) to define a development data set (N = 1256) and a validation sample (N = 628). A regression coefficient-base scoring system was used adopting the beta-Sullivan approach (Sullivan's scoring). RESULTS Pharmacists detected 740 MEs in 368/1884 (19.5%) patients related to medication reconciliation. Female gender, number of treatments >7, admission from emergency department and during night or weekend were significantly associated with a higher risk of MEs. Risk score was constructed by attributing 1 or 2 points to these variables. Patients with a score ≥3 (OR [95% CI] 3.10 [1.15-8.37]) out of 5 (OR [95% CI] 8.11 [2.89-22.78]) were considered at high risk of MEs. CONCLUSIONS Risk factors identified in our study may help prioritising patients admitted in internal medicine units who may benefit the most from medication reconciliation (ClinicalTrials.gov number NCT03422484).
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Affiliation(s)
- Yohan Audurier
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Federico Manna
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
| | - Marie Faucanie
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, University Hospital, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- IRCM-INSERM U1194, University of Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, University Hospital, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine and Hypertension, Montpellier University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Laura Lohan-Descamps
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, University Hospital, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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Jauzelon B, Letertre S, Zerkowski L, Szwarc I, Fesler P, Roubille C. Granulomatose avec polyangéite et artérite à cellules géantes. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.203] [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: 10/22/2022]
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18
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Mercuzot C, Letertre S, Daien CI, Zerkowski L, Guilpain P, Terrier B, Fesler P, Roubille C. Comorbidities and health-related quality of life in Patients with Antineutrophil Cytoplasmic Antibody (ANCA) - associated vasculitis. Autoimmun Rev 2020; 20:102708. [PMID: 33212227 DOI: 10.1016/j.autrev.2020.102708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/26/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimization of immunosuppressive therapies has led to a marked improvement in the survival of ANCA-associated vasculitides (AAV). The main issue now appears to be the management of comorbidities and the improvement of quality of life. The objective of this review was to investigate the incidence and the impact of AAV-associated comorbidities, as well as the determinants of health-related quality of life (HRQoL). METHODS We performed a systematic literature review of articles published in Medline from 2001 to 04/28/2020. We selected relevant articles about AAV-associated comorbidities as well as HRQoL and fatigue. For each selected article, data on the incidence of comorbidity were extracted, and factors associated with the Mental component score (MCS) and the Physical component score (PCS) were identified. RESULTS Among the 10,993 references identified, 103 were retained for the final analysis. A significant increase in cardiovascular risk was evidenced, particularly for coronary artery disease and thromboembolic events, especially during the active phase of the disease. AAV was also associated with bronchiectasis, thyroid diseases and osteoporosis. A marked decrease in HRQoL and an increase in fatigue and anxiety were reported. Decrease in PCS and MCS was associated with fatigue, mood disorders, sleep disturbance, and/or unemployment. CONCLUSION The excess mortality of AAV is still a concern, partly in connection with cardiovascular and thromboembolic comorbidities. AAV patients also experiment a reduction in their HRQoL that requires integrated management. Patients with AAV need comorbidity management strategies to improve their quality of life and outcomes.
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Affiliation(s)
- Cédric Mercuzot
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Simon Letertre
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Claire I Daien
- Department of Rheumatology, Montpellier University Hospital, Montpellier, France
| | - Laetitia Zerkowski
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - Philippe Guilpain
- Internal Medicine: Multi-Organic Diseases, Local Referral Center for Systemic Autoimmune Diseases, Montpellier University Hospital, Montpellier, France; INSERM U 1183, IRMB, Universite Montpellier, INSERM, Montpellier, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin University Hospital, Paris, France; National Referral Centre for Systemic and Autoimmune Diseases, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Fesler
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, Cedex 5, France
| | - Camille Roubille
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, Cedex 5, France.
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19
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Roubille C, Ribstein J, Hurpin G, Fesler P, Fiat E, Roubille F. Confidence vanished or impaired until distrust in the doctor-patient relationship because of COVID-19: Confidence vanished or impaired until distrust: "COVID" in relationship. Rev Med Interne 2020; 42:58-60. [PMID: 33168352 PMCID: PMC7584432 DOI: 10.1016/j.revmed.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022]
Abstract
Since Hippocrates, the cornerstone of medical practice has been the doctor-patient relationship. The question here is whether these basic principles are still compatible with this unusual COVID-period. This pandemic represents a serious threat to human health, leading to profound changes in behavior in daily life but also in health care. Because of limited resources, health-managers must choose well-balanced solutions able to protect patients and citizens on the one hand and to provide maximal benefit for the society on the other hand. We are going through a moment of rupture that we must acknowledge. Here, we discussed how the doctor-patient relationship could be compromised. Doctors are focused on cares whereas patients are focused on scare. Profound changes occur presently, from the way we present ourselves to each other (including the masks), the poor conditions for physical examination, the mental suffering of both patient and caregiver until sometimes terrible end-of-life conditions. The historical point-of-view helps us to keep in mind previous experiences, and the philosophical perspective helps to contextualize this unedited situation. We should stop briefly our daily rush to put these considerations into perspective to overcome these challenges. Nothing is as effective as trust: let's rebuild it.
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Affiliation(s)
- C Roubille
- Department of internal medicine, Montpellier university hospital, Montpellier, France
| | - J Ribstein
- Department of internal medicine, Montpellier university hospital, Montpellier, France
| | - G Hurpin
- Comité des travaux historiques et scientifiques - Société de l'histoire de France, Paris, France
| | - P Fesler
- Department of internal medicine, Montpellier university hospital, Montpellier, France
| | - E Fiat
- LIPHA (EA 7373) Marne-la-Vallée, department of philosophy, Gustave-Eiffel university, France
| | - F Roubille
- Department of cardiology, Montpellier university hospital, Montpellier, France; Inserm U1046, CNRS UMR 9214, PhyMedExp, university of Montpellier, Montpellier, France.
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20
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Meszaros M, Meunier L, Morquin D, Klouche K, Fesler P, Malezieux E, Makinson A, Le Moing V, Reynes J, Pageaux G. Abnormal liver tests in patients hospitalized with Coronavirus disease 2019: Should we worry? Liver Int 2020; 40:1860-1864. [PMID: 32495496 PMCID: PMC7300742 DOI: 10.1111/liv.14557] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/23/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
While several studies from China have reported COVID-19-related liver injury, there are currently no data on liver dysfunction in hospitalized COVID-19 patients in Europe. The aim of this study was to describe the prevalence and predictive value of abnormal liver function in patients hospitalized with COVID-19. This was a retrospective cohort study of confirmed COVID-19 patients hospitalized in two referral hospitals in France. Clinical, biological and radiological data were collected and analysed. In all, 234 patients confirmed to have COVID-19 by RT-PCR were included. Liver function was abnormal in 66.6% of patients on admission. In multivariate logistic regression, abnormal liver test on admission were associated with in-hospital aggravation (OR = 4.1, 95% CI 1.5-10.8; P = .004) and mortality (OR 3.3; 95% CI = 1.04-10.5; P = .04). This study of liver tests in a European COVID-19 population confirms a high prevalence of abnormal liver tests on admission that are predictive of severe disease course and higher in-hospital mortality.
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Affiliation(s)
- Magdalena Meszaros
- Department of Hepatology, Gastroenterology and Liver TransplantationMontpellier University HospitalUniversity of MontpellierMontpellierFrance
- Department of Gastroenterology and HepatologyNarbonne HospitalNarbonneFrance
| | - Lucy Meunier
- Department of Hepatology, Gastroenterology and Liver TransplantationMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - David Morquin
- Department of Infectious DiseasesMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Kada Klouche
- Department of Intensive Care LapeyronieMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Pierre Fesler
- Department of Internal Medicine LapeyronieMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Emilie Malezieux
- Department of Hepatology, Gastroenterology and Liver TransplantationMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Alain Makinson
- Department of Infectious DiseasesMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Vincent Le Moing
- Department of Infectious DiseasesMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Jacques Reynes
- Department of Infectious DiseasesMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Georges‐Philippe Pageaux
- Department of Hepatology, Gastroenterology and Liver TransplantationMontpellier University HospitalUniversity of MontpellierMontpellierFrance
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21
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Villard O, Morquin D, Molinari N, Raingeard I, Nagot N, Cristol JP, Jung B, Roubille C, Foulongne V, Fesler P, Lamure S, Taourel P, Konate A, Maria ATJ, Makinson A, Bertchansky I, Larcher R, Klouche K, Le Moing V, Renard E, Guilpain P. The Plasmatic Aldosterone and C-Reactive Protein Levels, and the Severity of Covid-19: The Dyhor-19 Study. J Clin Med 2020; 9:jcm9072315. [PMID: 32708205 PMCID: PMC7408691 DOI: 10.3390/jcm9072315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/29/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background. The new coronavirus SARS-CoV-2, responsible for the Covid-19 pandemic, uses the angiotensin converting enzyme type 2 (ACE2), a physiological inhibitor of the renin angiotensin aldosterone system (RAAS), as a cellular receptor to infect cells. Since the RAAS can induce and modulate pro-inflammatory responses, it could play a key role in the pathophysiology of Covid-19. Thus, we aimed to determine the levels of plasma renin and aldosterone as indicators of RAAS activation in a series of consecutively admitted patients for Covid-19 in our clinic. Methods. Plasma renin and aldosterone levels were measured, among the miscellaneous investigations needed for Covid-19 management, early after admission in our clinic. Disease severity was assessed using a seven-category ordinal scale. Primary outcome of interest was the severity of patients’ clinical courses. Results. Forty-four patients were included. At inclusion, 12 patients had mild clinical status, 25 moderate clinical status and 7 severe clinical status. In univariate analyses, aldosterone and C-reactive protein (CRP) levels at inclusion were significantly higher in patients with severe clinical course as compared to those with mild or moderate course (p < 0.01 and p = 0.03, respectively). In multivariate analyses, only aldosterone and CRP levels remained positively associated with severity. We also observed a positive significant correlation between aldosterone and CRP levels among patients with an aldosterone level greater than 102.5 pmol/L. Conclusions. Both plasmatic aldosterone and CRP levels at inclusion are associated with the clinical course of Covid-19. Our findings may open new perspectives in the understanding of the possible role of RAAS for Covid-19 outcome.
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Affiliation(s)
- Orianne Villard
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34000 Montpellier, France
| | - David Morquin
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Nicolas Molinari
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34000 Montpellier, France
| | - Isabelle Raingeard
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
| | - Nicolas Nagot
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- IMAG, CNRS, University of Montpellier, Montpellier University Hospital, 34000 Montpellier, France
| | - Jean-Paul Cristol
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Laboratory of Biochemistry, Montpellier University Hospital, 34000 Montpellier, France
| | - Boris Jung
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Camille Roubille
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Vincent Foulongne
- Laboratory of Virology, Montpellier University Hospital, 34000 Montpellier, France;
| | - Pierre Fesler
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Sylvain Lamure
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Patrice Taourel
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Radiology, Montpellier University Hospital, 34000 Montpellier, France
| | - Amadou Konate
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- Department of Internal Medicine—‘DIAGORA Unit’, Montpellier University Hospital, 34000 Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- IRMB, INSERM U1183, Montpellier University Hospital, 34000 Montpellier, France
| | - Alain Makinson
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Ivan Bertchansky
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- Department of Internal Medicine—‘DIAGORA Unit’, Montpellier University Hospital, 34000 Montpellier, France
| | - Romaric Larcher
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Kada Klouche
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Intensive Care Medicine, Montpellier University Hospital, 34000 Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Vincent Le Moing
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, 34000 Montpellier, France;
| | - Eric Renard
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Endocrinology, Diabetes, Nutrition, and INSERM 1411 Clinical Investigation Centre, Montpellier University Hospital, INSERM, 34000 Montpellier, France;
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, 34000 Montpellier, France
| | - Philippe Guilpain
- Montpellier School of Medicine, University of Montpellier, 34000 Montpellier, France; (O.V.); (N.M.); (N.N.); (J.-P.C.); (B.J.); (C.R.); (P.F.); (S.L.); (P.T.); (A.T.J.M.); (A.M.); (R.L.); (K.K.); (V.L.M.); (E.R.)
- Department of Internal Medicine—Multi-Organ Diseases, Local Referral Center for Auto-Immune Diseases, Montpellier University Hospital, 34000 Montpellier, France; (A.K.); (I.B.)
- IRMB, INSERM U1183, Montpellier University Hospital, 34000 Montpellier, France
- Correspondence: ; Tel.: +33-4-67-33-73-32; Fax: +33-4-67-33-72-91
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22
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Huet F, Nicoleau J, Dupuy AM, Curinier C, Breuker C, Castet-Nicolas A, Lotierzo M, Kalmanovich E, Zerkowski L, Akodad M, Adda J, Agullo A, Leclercq F, Pasquie JL, Battistella P, Roubille C, Fesler P, Mercier G, Bourel G, Cristol JP, Roubille F. STADE-HF (sST2 As a help for management of HF): a pilot study. ESC Heart Fail 2020; 7:774-778. [PMID: 32168423 PMCID: PMC7160465 DOI: 10.1002/ehf2.12663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/16/2019] [Revised: 01/21/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022] Open
Abstract
Aims Biomarkers are not recommended until now to guide the management of patients with heart failure (HF). Soluble suppression of tumorigenicity 2 (sST2) appears as a promising biomarker. The current study considered pre‐discharged sST2 values as a guide for medical management in patients admitted for acute HF decompensation, in an attempt to reduce hospital readmission. Methods and results STADE‐HF was a blinded prospective randomized controlled trial and included 123 patients admitted for acute HF. They were randomized into the usual treatment group (unknown sST2 level) or the interventional treatment group, for whom sST2 level was known and used on Day 4 of hospitalization to guide the treatment. The primary endpoint was the readmission rate for any cause at 1 month. It occurred in 10 patients (19%) in the usual group and 18 (32%) in the sST2 group without statistical difference (P = 0.11). Post hoc analysis in the whole group shows that the mean duration of hospitalization was lower in patients with low sST2 (<37 ng/mL) at admission vs. high sST2 (8.5 ± 9.5 vs. 14.8 ± 14.9 days, respectively, P = 0.003). In addition, a decrease in sST2 greater than 18% is significantly associated with a lower readmission rate. Conclusions Soluble suppression of tumorigenicity 2‐guided therapy over a short period of time does not reduce readmissions. However, sST2 was clearly associated with duration of hospitalization, and the decrease in sST2 was associated with decreased rehospitalizations. Long‐term outcome using sST2‐guided therapy deserves further investigations.
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Affiliation(s)
- Fabien Huet
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Jean Nicoleau
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Anne-Marie Dupuy
- Laboratory of Biochemistry, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Corentin Curinier
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Cyril Breuker
- Department of Pharmacy, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Audrey Castet-Nicolas
- Department of Pharmacy, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Manuela Lotierzo
- Laboratory of Biochemistry, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Eran Kalmanovich
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Laetitia Zerkowski
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Mariama Akodad
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Jérôme Adda
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Audrey Agullo
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Florence Leclercq
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Jean-Luc Pasquie
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
| | - Pascal Battistella
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France
| | - Camille Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France.,Department of Internal Medicine, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Pierre Fesler
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France.,Department of Internal Medicine, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Grégoire Mercier
- Department of Statistics, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Guillaume Bourel
- Department of Statistics, Montpellier University Hospital, Montpellier, cedex 5, France
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France.,Laboratory of Biochemistry, Montpellier University Hospital, Montpellier, cedex 5, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34295, Montpellier, cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, cedex 5, France
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23
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Gerges C, Gerges M, Friewald R, Fesler P, Dorfmüller P, Sharma S, Karlocai K, Skoro-Sajer N, Jakowitsch J, Moser B, Taghavi S, Klepetko W, Lang IM. Microvascular Disease in Chronic Thromboembolic Pulmonary Hypertension. Circulation 2020; 141:376-386. [DOI: 10.1161/circulationaha.119.041515] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Pulmonary endarterectomy (PEA) is the gold standard treatment for patients with operable chronic thromboembolic pulmonary hypertension. However, persistent pulmonary hypertension (PH) after PEA remains a major determinant of poor prognosis. A concomitant small-vessel arteriopathy in addition to major pulmonary artery obstruction has been suggested to play an important role in the development of persistent PH and survival after PEA. One of the greatest unmet needs in the current preoperative evaluation is to assess the presence and severity of small-vessel arteriopathy. Using the pulmonary artery occlusion technique, we sought to assess the presence and degree of small-vessel disease in patients with chronic thromboembolic pulmonary hypertension undergoing PEA to predict postoperative outcome before surgery.
Methods:
Based on pulmonary artery occlusion waveforms yielding an estimate of the effective capillary pressure, we partitioned pulmonary vascular resistance in larger arterial (upstream resistance [R
up
]) and small arterial plus venous components (downstream resistance) in 90 patients before PEA. For validation, lung wedge biopsies were taken from nonobstructed and obstructed lung territories during PEA in 49 cases. Biopsy sites were chosen according to the pulmonary angiogram still frames that were mounted in the operating room. All vessels per specimen were measured in each patient. Percent media (%MT; arteries) and intima thickness (%IT; arteries, veins, and indeterminate vessels) were calculated relative to external vessel diameter.
Results:
Decreased R
up
was an independent predictor of persistent PH (odds ratio per 10%, 0.40 [95% CI, 0.23–0.69];
P
=0.001) and survival (hazard ratio per 10%, 0.03 [95% CI, 0.00–0.33];
p
=0.004). Arterial %MT and %IT of nonobstructed lung territories and venous %IT of obstructed lung territories were significantly increased in patients with persistent PH and nonsurvivors. R
up
correlated inversely with %MT (
r
=–0.72,
P
<0.001) and %IT (
r
=–0.62,
P
<0.001) of arteries from nonobstructed lung territories and with %IT (
r
=–0.44,
P
=0.024) of veins from obstructed lung territories. Receiver operating characteristic analysis disclosed that R
up
<66% predicted persistent PH after PEA, whereas R
up
<60% identified patients with poor prognosis after PEA.
Conclusions:
Pulmonary artery occlusion waveform analysis with estimation of R
up
seems to be a valuable technique for assessing the degree of small-vessel disease and postoperative outcome after PEA in chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- Christian Gerges
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Mario Gerges
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Richard Friewald
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Pierre Fesler
- PhyMedExp, University of Montpellier, CNRS, INSERM, and Department of Internal Medicine Lapeyronie, University Hospital of Montpellier, France (P.F.)
| | - Peter Dorfmüller
- Department of Pathology, University Hospital of Giessen and Marburg (UKGM), Germany (P.D.)
| | - Smriti Sharma
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | - Kristof Karlocai
- Department of Pulmonology, Semmelweis University, Budapest, Hungary (K.K.)
| | - Nika Skoro-Sajer
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
| | | | - Bernhard Moser
- Department of Thoracic Surgery, Division of Surgery (B.M., S.T., W.K.), Medical University of Vienna, Austria
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Division of Surgery (B.M., S.T., W.K.), Medical University of Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Division of Surgery (B.M., S.T., W.K.), Medical University of Vienna, Austria
| | - Irene M. Lang
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital (C.G., M.G., R.F., S.S. N.S.-S., I.M.L.), Medical University of Vienna, Austria
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24
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Nicoleau J, Huet F, Dupuy A, Curinier C, Breuker C, Castet-Nicolas A, Lotierzo M, Kalmanovich E, Zerkowski L, Akodad M, Adda J, Battistella P, Roubille C, Fesler P, Mercier G, Chapet N, Bourel G, Cristol J, Roubille F. STADE-HF: A Titration based on sST2 is safe but failed to decrease readmissions in patients admitted for acute heart failure. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.064] [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: 11/15/2022]
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25
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Roubille C, Fesler P, Combe B. Shifting from a Rheumatologic Point of View toward Patient-centered Care in Rheumatoid Arthritis with an Integrated Management of Comorbidities. J Rheumatol 2019; 46:545-547. [PMID: 31154441 DOI: 10.3899/jrheum.181379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Camille Roubille
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Montpellier, University of Montpellier, and Laboratoire Physiologie & Medecine Experimentale (PhyMedExp), INSERM U1046, Centre National de la Recherche Scientifique (CNRS) Unite Mixte de Recherche (UMR) 9214, Université de Montpellier;
| | - Pierre Fesler
- Department of Internal Medicine, CHU Montpellier, University of Montpellier, and Laboratoire PhyMedExp, INSERM U1046, CNRS UMR 9214, Université de Montpellier
| | - Bernard Combe
- Department of Rheumatology, CHU Montpellier, University of Montpellier, Montpellier, France
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26
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Daïen CI, Tubery A, Beurai-Weber M, du Cailar G, Picot MC, Jaussent A, Roubille F, Cohen JD, Morel J, Bousquet J, Fesler P, Combe B. Relevance and feasibility of a systematic screening of multimorbidities in patients with chronic inflammatory rheumatic diseases. Joint Bone Spine 2019; 86:49-54. [DOI: 10.1016/j.jbspin.2018.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
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27
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Letertre S, Fesler P, Zerkowski L, Ribstein J, Guilpain P, Le Moing V, Mariano-Goulart D, Roubille C. FDG PET/CT dans les fièvres prolongées inexpliquées : un examen de première ligne ? Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.352] [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: 11/28/2022]
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28
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Champéroux P, Fesler P, Judé S, Richard S, Le Guennec JY, Thireau J. High-frequency autonomic modulation: a new model for analysis of autonomic cardiac control. Br J Pharmacol 2018; 175:3131-3143. [PMID: 29723392 PMCID: PMC6031873 DOI: 10.1111/bph.14354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose Increase in high‐frequency beat‐to‐beat heart rate oscillations by torsadogenic hERG blockers appears to be associated with signs of parasympathetic and sympathetic co‐activation which cannot be assessed directly using classic methods of heart rate variability analysis. The present work aimed to find a translational model that would allow this particular state of the autonomic control of heart rate to be assessed. Experimental Approach High‐frequency heart rate and heart period oscillations were analysed within discrete 10 s intervals in a cohort of 200 healthy human subjects. Results were compared to data collected in non‐human primates and beagle dogs during pharmacological challenges and torsadogenic hERG blockers exposure, in 127 genotyped LQT1 patients on/off β‐blocker treatment and in subgroups of smoking and non‐smoking subjects. Key Results Three states of autonomic modulation, S1 (parasympathetic predominance) to S3 (reciprocal parasympathetic withdrawal/sympathetic activation), were differentiated to build a new model of heart rate variability referred to as high‐frequency autonomic modulation. The S2 state corresponded to a specific state during which both parasympathetic and sympathetic systems were coexisting or co‐activated. S2 oscillations were proportionally increased by torsadogenic hERG‐blocking drugs, whereas smoking caused an increase in S3 oscillations. Conclusions and Implications The combined analysis of the magnitude of high‐frequency heart rate and high‐frequency heart period oscillations allows a refined assessment of heart rate autonomic modulation applicable to long‐term ECG recordings and offers new approaches to assessment of the risk of sudden death both in terms of underlying mechanisms and sensitivity.
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Affiliation(s)
| | - Pierre Fesler
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France.,Laboratoire PHYMEDEXP,INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier Cedex 05, 34295, France
| | - Sebastien Judé
- Centre de Recherches Biologiques, CERB, Baugy, 18800, France
| | - Serge Richard
- Centre de Recherches Biologiques, CERB, Baugy, 18800, France
| | - Jean-Yves Le Guennec
- Laboratoire PHYMEDEXP,INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier Cedex 05, 34295, France
| | - Jérôme Thireau
- Laboratoire PHYMEDEXP,INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier Cedex 05, 34295, France
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29
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Gerges C, Gerges M, Fesler P, Pistritto AM, Konowitz NP, Jakowitsch J, Celermajer DS, Lang I. In-depth haemodynamic phenotyping of pulmonary hypertension due to left heart disease. Eur Respir J 2018; 51:13993003.00067-2018. [DOI: 10.1183/13993003.00067-2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/10/2018] [Indexed: 12/22/2022]
Abstract
The commonest cause of pulmonary hypertension (PH) is left heart disease (LHD). The current classification system for definitions of PH-LHD is under review. We therefore performed prospective in-depth invasive haemodynamic phenotyping in order to assess the site of increased pulmonary vascular resistance (PVR) in PH-LHD subsets.Based on pulmonary artery occlusion waveforms yielding an estimate of the effective capillary pressure, we partitioned PVR in larger arterial (Rup, upstream resistance) and small arterial plus venous components (Rds, downstream resistance). In the case of small vessel disease, Rup decreases and Rds increases. Inhaled nitric oxide (NO) testing was used to assess acute vasoreactivity.Right ventricular afterload (PVR, pulmonary arterial compliance and effective arterial elastance) was significantly higher in combined post- and pre-capillary PH (Cpc-PH, n=35) than in isolated post-capillary PH (Ipc-PH, n=20). Right ventricular afterload decreased during inhalation of NO in Cpc-PH and idiopathic pulmonary arterial hypertension (n=31), but remained unchanged in Ipc-PH. Rup was similar in Cpc-PH (66.8±10.8%) and idiopathic pulmonary arterial hypertension (65.0±12.2%; p=0.530) suggesting small vessel disease, but significantly higher in Ipc-PH (96.5±4.5%; p<0.001) suggesting upstream transmission of elevated left atrial pressure.Right ventricular afterload is driven by elevated left atrial pressure in Ipc-PH and is further increased by elevated small vessel resistance in Cpc-PH. Cpc-PH is responsive to inhaled NO. Our data support current definitions of PH-LHD subsets.
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30
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Curinier C, Solecki K, Dupuy AM, Breuker C, Lotierzo M, Zerkowski L, Kalmanovich E, Akodad M, Adda J, Battistella P, Castet-Nicolas A, Kuster N, Marques S, Soltani S, Chettouh M, Verchere A, Belloc C, Roubille C, Fesler P, Mercier G, Cristol JP, Audurier Y, Roubille F. Evaluation of the sST2-guided optimization of medical treatments of patients admitted for heart failure, to prevent readmission: Study protocol for a randomized controlled trial. Contemp Clin Trials 2018; 66:45-50. [PMID: 29414143 DOI: 10.1016/j.cct.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Corentin Curinier
- Cardiology Department, University Hospital of Montpellier, Montpellier, France.
| | - Kamila Solecki
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Cyril Breuker
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France; Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Manuela Lotierzo
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Laetitia Zerkowski
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France
| | - Eran Kalmanovich
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Mariama Akodad
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Jérôme Adda
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Pascal Battistella
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | | | - Nils Kuster
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Sandra Marques
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; Pharmacy Department, University Hospital of Montpellier, Montpellier, France; Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Sonia Soltani
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Marine Chettouh
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Verchere
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Claire Belloc
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Camille Roubille
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Pierre Fesler
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Grégoire Mercier
- Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Yohan Audurier
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
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Bargnoux AS, Beaufils O, Oguike M, Lopasso A, Dupuy AM, Sebbane M, Badiou S, Fesler P, Cristol JP. Point-of-care creatinine testing in patients receiving contrast-enhanced computed tomography scan. Clin Chim Acta 2018; 478:111-113. [DOI: 10.1016/j.cca.2017.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/17/2017] [Accepted: 12/17/2017] [Indexed: 12/01/2022]
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Daien V, Granados L, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber associated with cardiac and renal target organ damage in never-treated hypertensive patients. Microcirculation 2018; 24. [PMID: 27987377 DOI: 10.1111/micc.12344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between retinal vascular caliber and target organ damage in HT patients. METHODS Data were collected on cardiac, renal, vascular, and retinal variables in 88 consecutive never-treated HT subjects. Retinal vascular calibers were measured from fundus photographs by using a semi-automated computer-assisted program and summarized as CRAE and CRVE. RESULTS Mean CRAE and CRVE were significantly lower in patients with left ventricular hypertrophy (left ventricular mass ≥110 g/m² for women, 125 g/m² for men) than in those with normal left ventricular (CRAE: 129.4±3.7 vs 138.2±2.3 μm; P=.04; CRVE: 195.6±4.4 vs 209.8±2.7 μm; P=.008). CRAE and CRVE were negatively correlated with urinary albumin excretion (β±SE=-15.4±3.2, P<.0001 and β±SE=-11.9±4.4, P=.001, respectively) but were not correlated with estimated glomerular filtration rate (P=.21 and P=.75, respectively), carotid-to-femoral pulse wave velocity (P=.24 and P=.14), or carotid augmentation index (P=.43 and P=.16). CONCLUSION In never-treated HT patients, reduced CRAE and CRVE were associated with cardiac and renal preclinical damage, ie, left ventricular hypertrophy and albuminuria, but not estimated glomerular filtration rate or vascular stiffness.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1061, Montpellier, France
| | - Loic Granados
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Max Villain
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Jean Ribstein
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Guilhem Du Cailar
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Pierre Fesler
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier 34295 Montpellier Cedex 5, France
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Audurier Y, Breuker C, Villiet M, Jalabert A, Zerkowski L, Ribstein J, Fesler P, Roubille C. Identification des facteurs de risque de survenue d’erreurs médicamenteuses en service de médecine interne grâce à la conciliation médicamenteuse. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bousquet J, Bourret R, Camuzat T, Augé P, Bringer J, Noguès M, Jonquet O, de la Coussaye JE, Ankri J, Cesari M, Guérin O, Vellas B, Blain H, Arnavielhe S, Avignon A, Combe B, Canovas G, Daien C, Dray G, Dupeyron A, Jeandel C, Laffont I, Laune D, Marion C, Pastor E, Pélissier JY, Galan B, Reynes J, Reuzeau JC, Bedbrook A, Granier S, Adnet PA, Amouyal M, Alomène B, Bernard PL, Berr C, Caimmi D, Claret PG, Costa DJ, Cristol JP, Fesler P, Hève D, Millot-Keurinck J, Morquin D, Ninot G, Picot MC, Raffort N, Roubille F, Sultan A, Touchon J, Attalin V, Azevedo C, Badin M, Bakhti K, Bardy B, Battesti MP, Bobia X, Boegner C, Boichot S, Bonnin HY, Bouly S, Boubakri C, Bourrain JL, Bourrel G, Bouix V, Bruguière V, Cade S, Camu W, Carre V, Cavalli G, Cayla G, Chiron R, Coignard P, Coroian F, Costa P, Cottalorda J, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cros V, Cuisinier F, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dujols P, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fouletier M, Fraisse P, Gabrion P, Gellerat-Rogier M, Gelis A, Genis C, Giraudeau N, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Kouyoudjian P, Lamoureux R, Landreau L, Lapierre M, Larrey D, Laurent C, Léglise MS, Lemaitre JM, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert CM, Makinson A, Mandrick K, Mares P, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Mottet D, Nérin P, Nicolas P, Nouvel F, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Portejoie F, Pujol JLE, Quantin X, Quéré I, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Robine JM, Rolland C, Royère E, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Stephan Y, Strubel D, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Tribout V, Uziel A, Van de Perre P, Venail F, Vergne-Richard C, Vergotte G, Vian L, Vialla F, Viart F, Villain M, Viollet E, Ychou M, Mercier J. MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing. J Frailty Aging 2017; 5:233-241. [PMID: 27883170 DOI: 10.14283/jfa.2016.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.
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Affiliation(s)
- J Bousquet
- Professor Jean Bousquet, CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France, Tel +33 611 42 88 47,
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Daïen CI, Tubery A, Cailar GD, Mura T, Roubille F, Morel J, Bousquet J, Fesler P, Combe B. Application of the 2015/2016 EULAR recommendations for cardiovascular risk in daily practice: data from an observational study. Ann Rheum Dis 2017; 77:625-626. [DOI: 10.1136/annrheumdis-2017-211074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 12/31/2022]
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Bonnet B, Jourdan F, du Cailar G, Fesler P. Noninvasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension. Am J Physiol Heart Circ Physiol 2017; 313:H237-H243. [PMID: 28476921 DOI: 10.1152/ajpheart.00086.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
Abstract
End-systolic left ventricular (LV) elastance (Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection ("ejection P-V curve" method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship (r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance (Ea) was compensated by a parallel increase in Ees without change in Ea/Ees In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.NEW & NOTEWORTHY The use of real-time three-dimensional echocardiography-derived left ventricular volumes in conjunction with carotid tonometry was found to be reproducible and sensitive enough to detect expected differences in left ventricular elastance in arterial hypertension. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.
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Affiliation(s)
- Benjamin Bonnet
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.,Laboratoire de Mécanique et de Génie Civil (UMR 5508), Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules, Université de Montpellier, Montpellier, France; and
| | - Franck Jourdan
- Laboratoire de Mécanique et de Génie Civil (UMR 5508), Biomécanique des Interactions et de l'Organisation des Tissus et des Cellules, Université de Montpellier, Montpellier, France; and
| | - Guilhem du Cailar
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France;
| | - Pierre Fesler
- Departement de Médecine Interne, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, Institut National de la Santé et de la Recherche Médicale U1046, Centre National de la Recherche Scientifique, UMR 9214, Montpellier, France
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Witkowski P, Fesler P, Ducailar G, Ribstein J, Roubille C. Contribution du TEP scan au diagnostic de cancer colique chez une jeune patiente atteinte de fièvre prolongée inexpliquée. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.148] [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: 10/20/2022]
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Daien C, Tubery A, Du Cailar G, Mura T, Picot M, Bourret R, Roubille F, Bousquet J, Morel J, Fesler P, Combe B. FRI0122 Eular 2015 Recommendations for Cardiovascular Risk Could Radically Change Patients Care in Chronic Inflammatory Rheumatisms. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2967] [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: 11/04/2022]
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Tubery A, Fesler P, Du Cailar G, Morel J, Bousquet J, Combe B, Daien C. AB0986 A Systematic Screening of Comorbidities by The Rheumatologist in Inflammatory Rheumatisms Impacts Chronic Disease Care. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2758] [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: 11/04/2022]
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Bousquet J, Bourret R, Camuzat T, Augé P, Domy P, Bringer J, Best N, Jonquet O, de la Coussaye JE, Noguès M, Robine JM, Avignon A, Blain H, Combe B, Dray G, Dufour V, Fouletier M, Giraudeau N, Hève D, Jeandel C, Laffont I, Larrey D, Laune D, Laurent C, Mares P, Marion C, Pastor E, Pélissier JY, Radier-Pontal F, Reynes J, Royère E, Ychou M, Bedbrook A, Granier S, Abecassis F, Albert S, Adnet PA, Alomène B, Amouyal M, Arnavielhe S, Asteriou T, Attalin V, Aubas P, Azevedo C, Badin M, Bakhti, Baptista G, Bardy B, Battesti MP, Bénézet O, Bernard PL, Berr C, Berthe J, Bobia X, Bockaert J, Boegner C, Boichot S, Bonnin HY, Boulet P, Bouly S, Boubakri C, Bourdin A, Bourrain JL, Bourrel G, Bouix V, Breuker C, Bruguière V, Burille J, Cade S, Caimmi D, Calmels MV, Camu W, Canovas G, Carre V, Cavalli G, Cayla G, Chiron R, Claret PG, Coignard P, Coroian F, Costa DJ, Costa P, Cottalorda, Coulet B, Coupet AL, Courrouy-Michel MC, Courtet P, Cristol JP, Cros V, Cuisinier F, Daien C, Danko M, Dauenhauer P, Dauzat M, David M, Davy JM, Delignières D, Demoly P, Desplan J, Dhivert-Donnadieu H, Dujols P, Dupeyron A, Dupeyron G, Engberink O, Enjalbert M, Fattal C, Fernandes J, Fesler P, Fraisse P, Froger J, Gabrion P, Galano E, Gellerat-Rogier M, Gellis A, Goucham AY, Gouzi F, Gressard F, Gris JC, Guillot B, Guiraud D, Handweiler V, Hantkié H, Hayot M, Hérisson C, Heroum C, Hoa D, Jacquemin S, Jaber S, Jakovenko D, Jorgensen C, Journot L, Kaczorek M, Kouyoudjian P, Labauge P, Landreau L, Lapierre M, Leblond C, Léglise MS, Lemaitre JM, Le Moing V, Le Quellec A, Leclercq F, Lehmann S, Lognos B, Lussert JM, Makinson A, Mandrick K, Marmelat V, Martin-Gousset P, Matheron A, Mathieu G, Meissonnier M, Mercier G, Messner P, Meunier C, Mondain M, Morales R, Morel J, Morquin D, Mottet D, Nérin P, Nicolas P, Ninot G, Nouvel F, Ortiz JP, Paccard D, Pandraud G, Pasdelou MP, Pasquié JL, Patte K, Perrey S, Pers YM, Picot MC, Pin JP, Pinto N, Porte E, Portejoie F, Pujol JL, Quantin X, Quéré I, Raffort N, Ramdani S, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Riso JP, Rivier F, Rolland C, Roubille F, Sablot D, Savy JL, Schifano L, Senesse P, Sicard R, Soua B, Stephan Y, Strubel D, Sultan A, Taddei-Ologeanu, Tallon G, Tanfin M, Tassery H, Tavares I, Torre K, Touchon J, Tribout V, Uziel A, Van de Perre P, Vasquez X, Verdier JM, Vergne-Richard C, Vergotte G, Vian L, Viarouge-Reunier C, Vialla F, Viart F, Villain M, Villiet M, Viollet E, Wojtusciszyn A, Aoustin M, Bourquin C, Mercier J. Introduction. Presse Med 2015; 44 Suppl 1:S1-5. [DOI: 10.1016/j.lpm.2015.07.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Avignon A, Fesler P, Daien C, Costa D, Picot MC, Roubille F, Sultan A, Viarouge-Reunier C, Attalin V, Badin M, Boegner C, Demoly P, Dauzat M, David M, Lognos B, Morel J, Pasquié JL, Ribstein J, Granier S, Combe B, Mercier J, Bourret R, Bousquet J. [Living Lab MACVIA. Chronic diseases]. Presse Med 2015; 44 Suppl 1:S47-54. [PMID: 26476755 DOI: 10.1016/j.lpm.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Antoine Avignon
- CHRU de Montpellier, départment d'endocrinologie, 34295 Montpellier cedex 5, France.
| | - Pierre Fesler
- CHRU de Montpellier, département de médecine interne, 34295 Montpellier cedex 5, France
| | - Claire Daien
- CHRU de Montpellier, départment de rhumatologie, 34295 Montpellier cedex 5, France
| | - David Costa
- Faculté de médecine de Montpellier-Nîmes, département de médecine générale, 34060 Montpellier cedex 2, France
| | - Marie-Christine Picot
- CHRU de Montpellier, département de santé publique, 34295 Montpellier cedex 5, France
| | - François Roubille
- CHRU de Montpellier, département de cardiologie, 34295 Montpellier cedex 5, France
| | - Ariane Sultan
- CHRU de Montpellier, départment d'endocrinologie, 34295 Montpellier cedex 5, France
| | | | | | - Mélanie Badin
- CHRU de Nîmes, département de médecine générale, 30029 Nîmes, France
| | - Catherine Boegner
- CHRU de Montpellier, départment d'endocrinologie, 34295 Montpellier cedex 5, France
| | - Pascal Demoly
- CHRU de Montpellier, département des maladies respiratoires et addictologie, 34295 Montpellier cedex 5, France
| | - Michel Dauzat
- CHRU de Nîmes, département de physiologie, 30029 Nîmes, France
| | - Michel David
- Faculté de médecine de Montpellier-Nîmes, département de médecine générale, 34060 Montpellier cedex 2, France
| | | | - Jacques Morel
- CHRU de Montpellier, départment de rhumatologie, 34295 Montpellier cedex 5, France
| | - Jean-Luc Pasquié
- CHRU de Montpellier, département de cardiologie, 34295 Montpellier cedex 5, France
| | - Jean Ribstein
- CHRU de Montpellier, département de médecine interne, 34295 Montpellier cedex 5, France
| | | | - Bernard Combe
- CHRU de Montpellier, départment de rhumatologie, 34295 Montpellier cedex 5, France
| | | | | | - Jean Bousquet
- CHRU de Montpellier, MACVIA-LR, contre les maladies chroniques pour un vieillissement actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, 34295 Montpellier cedex 5, France; Inserm U1018, 94807 Villejuif cedex, France
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Tubery A, Fesler P, Cailar GD, Morel J, Bousquet J, Combe B, Daien C. Interest of a systematic screening of comorbidities in chronic inflammatory rheumatisms. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.289] [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: 12/01/2022]
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Daien C, Tubery A, Fesler P, Du Cailar G, Morel J, Bousquet J, Combe B. SAT0107 Interest of a Systematic Screening of Comorbidities in Chronic Inflammatory Rheumatisms. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4722] [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: 11/03/2022]
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Bargnoux AS, Vetromile F, Kuster N, Barberet J, Dupuy AM, Ribstein J, Mourad G, Cristol JP, Fesler P. Markers of bone remodeling are associated with arterial stiffness in renal transplanted subjects. J Nephrol 2015; 28:765-72. [PMID: 25920618 DOI: 10.1007/s40620-015-0201-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 01/02/2015] [Accepted: 04/17/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bone-vessel interaction in chronic renal failure remains poorly understood and could be driven by bone remodeling factors including osteoprotegerin (OPG), fibroblast growth factor 23 (FGF23), parathormone and vitamin D. Only few data are available in renal transplantation. The aim of this study was to investigate the relationship between bone remodeling factors and large artery function in renal transplant patients. METHODS 89 renal transplant patients were enrolled in this cross-sectional study. Carotid to femoral pulse wave velocity (PWV) and central augmentation index (AIx) were determined as an estimation of large artery function. Blood samples were collected for measurement of vascular risk markers. Independent predictors were identified by multivariate linear regression through backward feature selection using Akaike's information criteria. RESULTS At multivariate analysis, age (p < 0.001) and systolic arterial pressure (p = 0.003) were significantly associated with PWV but not AIx. In addition, both elevated blood concentrations of 1.25(OH)2 vitamin D (p = 0.013) and OPG (p = 0.047) were still significantly related to high PWV. CONCLUSIONS These results underline that age and mean arterial pressure are the main determinants of PWV following renal transplantation. Among bone remodeling biomarkers, plasma OPG and active vitamin D were the strongest determinants of arterial stiffness.
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Affiliation(s)
- Anne-Sophie Bargnoux
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France
| | - Fernando Vetromile
- Service de Néphrologie et Transplantation, CHRU Montpellier, Univ Montpellier 1, Montpellier, France
| | - Nils Kuster
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France
| | - Julie Barberet
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier, France
| | - Anne-Marie Dupuy
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier, France
| | - Jean Ribstein
- Service de Médecine Interne, CHRU Montpellier, Univ Montpellier 1, Montpellier, France
| | - Georges Mourad
- Service de Néphrologie et Transplantation, CHRU Montpellier, Univ Montpellier 1, Montpellier, France
| | - Jean-Paul Cristol
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier, France. .,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier Cedex 5, France. .,Department of Biochemistry, Lapeyronie University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
| | - Pierre Fesler
- Service de Médecine Interne, CHRU Montpellier, Univ Montpellier 1, Montpellier, France
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Fesler P, Mourad G, du Cailar G, Ribstein J, Mimran A. Arterial stiffness: an independent determinant of adaptive glomerular hyperfiltration after kidney donation. Am J Physiol Renal Physiol 2015; 308:F567-71. [PMID: 25568135 DOI: 10.1152/ajprenal.00524.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 12/18/2022] Open
Abstract
After kidney donation, the remaining kidney tends to hyperfiltrate, thus limiting the initial loss of renal function. The potential determinants of this adaptive glomerular hyperfiltration (GHF) and specifically the influence of arterial function are poorly known. In 45 normotensive healthy kidney donors [51 ± 10 yr (mean ± SD), 39 females], glomerular filtration rate (GFR) was measured as the clearance of continuously infused (99m)Tc-DTPA and timed urine collections at baseline, i.e., before donation, and 1 yr after donation. GHF was computed as postdonation GFR minus half of baseline GFR. Arterial function was assessed as baseline carotid-femoral pulse wave velocity (PWV) and carotid augmentation index (AIx). After kidney donation, no significant change in blood pressure (BP) was observed, but two subjects developed hypertension. GFR decreased from 107 ± 19 to 73 ± 15 ml·min(-1)·1.73 m(-2), and mean GHF was 20 ± 10 ml·min(-1)·1.73 m(-2). In univariate analysis, GHF was inversely correlated to age (r(2) = 0.24, P = 0.01), baseline PWV (r(2) = 0.23, P = 0.001), and Aix (r(2) = 0.11, P = 0.031). Nevertheless, GHF was not correlated to baseline peripheral or central BP. In multivariate analysis, baseline PWV, but not AIx, remained inversely correlated to GHF, independently of age, baseline mean BP, and GFR (model r(2) = 0.34, P < 0.001). In healthy subjects selected for renal donation, increased arterial stiffness is associated with decreased postdonation compensatory hyperfiltration.
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Affiliation(s)
- Pierre Fesler
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France; Université Montpellier 1, Montpellier, France
| | - Georges Mourad
- Department of Nephrology, Hôpital Lapeyronie, Montpellier, France; and Université Montpellier 1, Montpellier, France
| | - Guilhem du Cailar
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France
| | - Jean Ribstein
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France; Université Montpellier 1, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France; Université Montpellier 1, Montpellier, France
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Bousquet J, Bourquin C, Augé P, Domy P, Bringer J, Aoustin M, Camuzat T, Bourret R, Best N, Jonquet O, de la Coussaye J, Robine J, Avignon A, Blain H, Giraudeau N, Hève D, Jeandel C, Laffont I, Larrey D, Laurent C, Noguès M, Pélissier J, Radier-Pontal F, Royère E, Bedbrook A, Granier S, Abecassis F, Albert S, Adnet P, Alomène B, Amouyal M, Arnavieilhe S, Attalin V, Aubas P, Badin M, Baptista G, Bardy B, Battesti M, Bénézet O, Bernard P, Berr C, Berthe J, Bockaert J, Boubakri C, Bourdin A, Bourrain J, Bourrel G, Bouix V, Burille J, Cade S, Caimmi D, Calmels M, Camu W, Cavalli G, Cayla G, Chiron R, Combe B, Costa D, Costa P, Courrouy-Michel M, Courtet P, Cristol J, Cuisinier F, Daien C, Danko M, Dauenhauer P, Dauzat M, David M, Davy J, Delignières D, Demoly P, Dhivert-Donnadieu H, Dray G, Dujols P, Dupeyron A, Dupeyron G, Engberink O, Fesler P, Gellerat-Rogier M, Gouzi F, Gressard F, Hoa D, Jacquemin S, Gris J, Guillot B, Handweiler V, Hayot M, Jaber S, Jakovenko D, Jorgensen C, Journot L, Kaczorek M, Lapierre M, Laune D, Léglise M, Le Quellec A, Leclerc F, Lehmann S, Lognos B, Lussert J, Mandrick K, Marmelat V, Martin-Gousset P, Matheron A, Mathieu G, Mercier G, Messner P, Meunier C, Mondain M, Morel J, Morquin D, Nérin P, Ninot G, Nouvel F, Ortiz J, Pandraud G, Pasdelou M, Pasquié J, Pastor E, Perrey S, Pers Y, Picot M, Pin J, Pinto N, Portejoie F, Pujol J, Quantin X, Quéré I, Raffort N, Ramdani S, Reynes J, Ribstein J, Rédini-Martinez I, Richard S, Ritchie K, Rolland C, Roubille F, Roux E, Salvat A, Savy J, Stephan Y, Strubel D, Sultan A, Tallon G, Tassery H, Torre K, Uziel A, Van de Perre P, Vasquez X, Verdier J, Vergotte G, Vian L, Viarouge-Reunier C, Vialla F, Viart F, Villain M, Viollet E, Ankri J, Berrut G, Crooks G, Joël M, Michel J, Samolinski B, Strandberg T, Vellas B, Mercier J. MACVIA-LR, Reference site of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) in Languedoc Roussillon. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bargnoux AS, Barrot A, Fesler P, Kuster N, Badiou S, Dupuy AM, Ribstein J, Cristol JP. Evaluation of five immunoturbidimetric assays for urinary albumin quantification and their impact on albuminuria categorization. Clin Biochem 2014; 47:250-3. [PMID: 25072511 DOI: 10.1016/j.clinbiochem.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/10/2014] [Revised: 07/02/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The study was designed to evaluate the performance of five automated immunoturbidimetric assays to quantify urinary albumin, each corresponding to a combination of a reagent and an analyzer (Olympus on AU640, Roche on Cobas Integra, Abbott on Architect, Ortho-Clinical Diagnostics Vitros on Fusion and Siemens on Dimension). DESIGN AND METHODS To assess imprecision, albumin was measured in three urinary pools with a mean value of 25, 66 and 131 mg/L. One hundred and eight patient urine samples were then used to compare each turbidimetric method using the Passing-Bablok regression and Bland-Altman analyses. Concordance of the albumin/creatinine ratio (ACR), according to the albuminuria classifications proposed by the KDIGO, was calculated to test the agreement between the different assays. RESULTS All immunoturbidimetric methods evaluated in this study exhibited acceptable imprecision (CV<6%). Mean values for 108 urine samples varied from 0.5 to 762.2 mg/L. Significant differences were found (p<0.05) between all methods except between Olympus and Ortho (p=1.0) and between Abbott and Roche (p=0.12). Regarding the albuminuria categories based on the ACR proposed by the KDIGO, only the classification obtained with the Roche method was significantly different from the four other methods (p<0.001). CONCLUSIONS We demonstrated that all assays were not strictly equivalent which could affect ACR categories in clinical practice, suggesting the need for harmonization of commercial methods.
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Affiliation(s)
- Anne-Sophie Bargnoux
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Amandine Barrot
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Pierre Fesler
- Service de Médecine Interne, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Nils Kuster
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Stéphanie Badiou
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Anne-Marie Dupuy
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Jean Ribstein
- Service de Médecine Interne, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France
| | - Jean-Paul Cristol
- Laboratoire de Biochimie, CHRU Montpellier, Univ Montpellier 1, Montpellier F-34000, France.
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Daien V, Carriere I, Kawasaki R, Cristol JP, Villain M, Fesler P, Ritchie K, Delcourt C. Malnutrition and Retinal Vascular Caliber in the Elderly: The POLA Study. ACTA ACUST UNITED AC 2014; 55:4042-9. [DOI: 10.1167/iovs.13-13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Isabelle Carriere
- Inserm, U1061, Montpellier, France Université Montpellier 1, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Jean-Paul Cristol
- Department of Biochemistry, Lapeyronie Hospital, Montpellier, France
| | - Max Villain
- Department of Ophthalmology, Hôpital Gui De Chauliac, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier, France Université Montpellier 1, Montpellier, France Faculty of Medicine, Imperial College, London, United Kingdom
| | - Cecile Delcourt
- Inserm, CR Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France Université Bordeaux, ISPED, Bordeaux, France
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Bonnet B, Jourdan F, du Cailar G, Mimran A, Fesler P. [Left ventricular function in hypertension without left ventricular hypertrophy: echographic study with modelisation of left ventricular-aortic coupling]. Ann Cardiol Angeiol (Paris) 2014; 63:120-123. [PMID: 24952676 DOI: 10.1016/j.ancard.2014.05.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
Because the functional interaction between the LV and arterial systems, termed ventricular-arterial coupling, is recognized as a key determinant of LV performance, the objective of the present study was to assess the impact of uncomplicated HT without LVH on LV performance using simultaneously echocardiography and carotid tonometry. LV maximal power (PmaxVG), cardiac power output (CPO), LV efficiency (CPO/PmaxVG), input aortic and output LV elastance (Ea and Ees) were assessed in 20 normotensive control subjects (NT) and 10 patients with untreated HT. PmaxVG was calculated according to the integral of the product of LV wall stress with strain rate (as an index of gradient velocity). Cyclic variation of wall thickness and SR were measured by speckel-tracking. Ea and Ees were derived and modelized from the pressure-volume curve. No difference in age, BMI and sex ratio was observed between NT and HT. Systolic BP (160±18 vs. 119±10mmHg), LV mass (99±15 vs. 76±12g/m(2)), PWV (9.7±2 vs. 6.9±1m/s) were significantly higher (P<0.01) in HT when compared to NT. In HT increased of CPO and Ea was compensated by an increase of LV (15±4 vs. 12±3%, P<0.02) and Ees (5.5±2 vs. 4.5±1.5mmHg/mL), which are significantly elevated in HT (P<0.05). No difference was observed in Ea/Ees between NT and HT. In conclusion at the early phase of HT, in patients without LVH, LV performance and ventricular-arterial coupling were adapted to post-load elevation. This adaptation may be the result of an increased of LV contractility.
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Affiliation(s)
- B Bonnet
- Département de médecine interne, hôpital Lapeyronie, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
| | - F Jourdan
- Département de médecine interne, hôpital Lapeyronie, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - G du Cailar
- Département de médecine interne, hôpital Lapeyronie, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - A Mimran
- Département de médecine interne, hôpital Lapeyronie, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - P Fesler
- Département de médecine interne, hôpital Lapeyronie, CHU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
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Bousquet J, Jorgensen C, Dauzat M, Cesario A, Camuzat T, Bourret R, Best N, Anto J, Abecassis F, Aubas P, Avignon A, Badin M, Bedbrook A, Blain H, Bourdin A, Bringer J, Camu W, Cayla G, Costa D, Courtet P, Cristol JP, Demoly P, Coussaye JE, Fesler P, Gouzi F, Gris JC, Guillot B, Hayot M, Jeandel C, Jonquet O, Journot L, Lehmann S, Mathieu G, Morel J, Ninot G, Pelissier J, Picot MC, Radier-Pontal F, Robine JM, Rodier M, Roubille F, Sultan A, Wojtusciszyn A, Auffray C, Balling R, Barbara C, Cambon-Thomsen A, Chavannes N, Chuchalin A, Crooks G, Dedeu A, Fabbri L, Garcia-Aymerich J, Hajjam J, Gomes E, Palkonen S, Piette F, Pison C, Price D, Samolinski B, Schunemann H, Sterk P, Yiallouros P, Roca J, Perre P, Mercier J. Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies. Curr Pharm Des 2014; 20:5928-44. [DOI: 10.2174/1381612820666140314115505] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/12/2014] [Indexed: 11/22/2022]
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