1
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Azoulay E, Pochard F, Argaud L, Cariou A, Clere-Jehl R, Guisset O, Labbé V, Tamion F, Bruneel F, Jourdain M, Reuter D, Klouche K, Kouatchet A, Souppart V, Lautrette A, Bohé J, Vieillard Baron A, Dellamonica J, Papazian L, Reignier J, Barbier F, Dumas G, Kentish-Barnes N. Resilience and Mental-Health Symptoms in ICU Healthcare Professionals Facing Repeated COVID-19 Waves. Am J Respir Crit Care Med 2024; 209:573-583. [PMID: 38163380 PMCID: PMC10919111 DOI: 10.1164/rccm.202305-0806oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
Rationale: Psychological resilience (the ability to thrive in adversity) may protect against mental-health symptoms in healthcare professionals during coronavirus disease (COVID-19) waves. Objectives: To identify determinants of resilience in ICU staff members. Methods: In this cross-sectional survey in 21 French ICUs, staff members completed the 10-item Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised (for post-traumatic stress disorder [PTSD]). Factors independently associated with resilience were identified. Measurements and Main Results: The response rate was 73.1% (950 of 1,300). The median 10-item Connor-Davidson Resilience Scale score was 29 (interquartile range, 25-32). Symptoms of anxiety, depression, and PTSD were present in 61%, 39%, and 36% of staff members, respectively. Distress associated with the COVID-19 infodemic was correlated with symptoms of depression and PTSD. More resilient respondents less often had symptoms of anxiety, depression, and PTSD. Greater resilience was independently associated with male sex, having provided intensive care during the early waves, having managed more than 50 patients with COVID-19, and, compared with earlier waves, working longer hours, having greater motivation, and more often involving families in end-of-life decisions. Independent risk factors for lower resilience were having managed more than 10 patients who died of COVID-19, having felt frightened or isolated, and greater distress from the COVID-19 infodemic. Conclusions: This study identifies modifiable determinants of resilience among ICU staff members. Longitudinal studies are needed to determine whether prior resilience decreases the risk of mental ill health during subsequent challenges. Hospital and ICU managers, for whom preserving mental well-being among staff members is a key duty, should pay careful attention to resilience.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | - Frédéric Pochard
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France
| | | | - Olivier Guisset
- Medical Intensive Care Unit, Saint-André Hospital, Bordeaux, France
| | - Vincent Labbé
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, Paris, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Fabrice Bruneel
- Intensive Care Unit, André Mignot Hospital, Le Chesnay, France
| | - Mercé Jourdain
- Intensive Care Unit, Lille University Hospital-Roger Salengro Site, INSERM, Lille, France
| | - Danielle Reuter
- Medical-Surgical Intensive Care Unit, Sud Francilien Hospital, Corbeil, France
| | - Kada Klouche
- Medical Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | | | - Julien Bohé
- Medical Intensive Care Unit, Hôpital Lyon Sud, Lyon, France
| | - Antoine Vieillard Baron
- Intensive Care Unit, Ambroise-Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Jean Dellamonica
- Medical Intensive Care Unit, UR2CA Clinical Research Unit, Côte d'Azur University, Nice, France
- Nice University Hospital, Nice, France
| | - Laurent Papazian
- Respiratory and Infectious Diseases Intensive Care Unit, Marseille-Nord University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean Reignier
- Medical Intensive Care Unit, UR 4334 Movement-Interactions-Performance Research Unit, Nantes University Hospital, Nantes, France; and
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital, Orléans Regional Hospital, Orléans, France
| | - Guillaume Dumas
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
| | - Nancy Kentish-Barnes
- Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Cité University, Paris, France; FAMIREA study group
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2
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Arrestier R, Bastard P, Belmondo T, Voiriot G, Urbina T, Luyt CE, Gervais A, Bizien L, Segaux L, Ben Ahmed M, Bellaïche R, Pham T, Ait-Hamou Z, Roux D, Clere-Jehl R, Azoulay E, Gaudry S, Mayaux J, Fage N, Ait-Oufella H, Moncomble E, Parfait M, Dorgham K, Gorochov G, Mekontso-Dessap A, Canoui-Poitrine F, Casanova JL, Hue S, de Prost N. Auto-antibodies against type I IFNs in > 10% of critically ill COVID-19 patients: a prospective multicentre study. Ann Intensive Care 2022; 12:121. [PMID: 36586050 PMCID: PMC9803887 DOI: 10.1186/s13613-022-01095-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/06/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Auto-antibodies (auto-Abs) neutralizing type I interferons (IFN) have been found in about 15% of critical cases COVID-19 pneumonia and less than 1% of mild or asymptomatic cases. Determining whether auto-Abs influence presentation and outcome of critically ill COVID-19 patients could lead to specific therapeutic interventions. Our objectives were to compare the severity at admission and the mortality of patients hospitalized for critical COVID-19 in ICU with versus without auto-Abs. RESULTS We conducted a prospective multicentre cohort study including patients admitted in 11 intensive care units (ICUs) from Great Paris area hospitals with proven SARS-CoV-2 infection and acute respiratory failure. 925 critically ill COVID-19 patients were included. Auto-Abs neutralizing type I IFN-α2, β and/or ω were found in 96 patients (10.3%). Demographics and comorbidities did not differ between patients with versus without auto-Abs. At ICU admission, Auto-Abs positive patients required a higher FiO2 (100% (70-100) vs. 90% (60-100), p = 0.01), but were not different in other characteristics. Mortality at day 28 was not different between patients with and without auto-Abs (18.7 vs. 23.7%, p = 0.279). In multivariable analysis, 28-day mortality was associated with age (adjusted odds ratio (aOR) = 1.06 [1.04-1.08], p < 0.001), SOFA score (aOR = 1.18 [1.12-1.23], p < 0.001) and immunosuppression (aOR = 1.82 [1.1-3.0], p = 0.02), but not with the presence of auto-Abs (aOR = 0.69 [0.38-1.26], p = 0.23). CONCLUSIONS In ICU patients, auto-Abs against type I IFNs were found in at least 10% of patients with critical COVID-19 pneumonia. They were not associated with day 28 mortality.
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Affiliation(s)
- Romain Arrestier
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
| | - Paul Bastard
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Thibaut Belmondo
- grid.50550.350000 0001 2175 4109Département d’Hématologie et d’Immunologie Biologiques, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Créteil, 94010 Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive-Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tomas Urbina
- grid.412370.30000 0004 1937 1100Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Charles-Edouard Luyt
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France ,grid.477396.80000 0004 3982 4357INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Adrian Gervais
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Lucy Bizien
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Lauriane Segaux
- grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.50550.350000 0001 2175 4109Unité de Recherche Clinique AP-HP, Hôpitaux Henri-Mondor, 94010 Creteil, Cedex, France
| | - Mariem Ben Ahmed
- grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France
| | - Raphaël Bellaïche
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Taï Pham
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Zakaria Ait-Hamou
- grid.411784.f0000 0001 0274 3893Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre & Université de Paris, Paris, France
| | - Damien Roux
- grid.414205.60000 0001 0273 556XMédecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, 92700 Colombes, France
| | - Raphael Clere-Jehl
- grid.413328.f0000 0001 2300 6614Service de médecine intensive et réanimation, Hôpital Saint-Louis, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Elie Azoulay
- grid.413328.f0000 0001 2300 6614Service de médecine intensive et réanimation, Hôpital Saint-Louis, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Stéphane Gaudry
- grid.413780.90000 0000 8715 2621Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France
| | - Julien Mayaux
- grid.50550.350000 0001 2175 4109Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Paris, France
| | - Nicolas Fage
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France
| | - Hafid Ait-Oufella
- grid.412370.30000 0004 1937 1100Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elsa Moncomble
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
| | - Mélodie Parfait
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France
| | - Karim Dorgham
- grid.463810.8Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), 75013 Paris, France
| | - Guy Gorochov
- grid.463810.8Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), 75013 Paris, France ,grid.411439.a0000 0001 2150 9058Département d’Immunologie, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Armand Mekontso-Dessap
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
| | - Florence Canoui-Poitrine
- grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.50550.350000 0001 2175 4109Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Paris, France
| | - Jean-Laurent Casanova
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Sophie Hue
- grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.50550.350000 0001 2175 4109Département d’Hématologie et d’Immunologie Biologiques, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalo-Universitaire Chenevier Mondor, Créteil, 94010 Paris, France
| | - Nicolas de Prost
- grid.412116.10000 0004 1799 3934Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010 Paris, Cedex, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France ,grid.462410.50000 0004 0386 3258INSERM, IMRB, Université Paris Est Créteil, Créteil, 94010 Paris, Cedex, France
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Zerbit J, Detroit M, Chevret S, Pene F, Luyt CE, Ghosn J, Eyvrard F, Martin-Blondel G, Sarton B, Clere-Jehl R, Moine P, Cransac A, Andreu P, Labruyère M, Albertini L, Huon JF, Roge P, Bernard L, Farines-Raffoul M, Villiet M, Venet A, Dumont LM, Kaiser JD, Chapuis C, Goehringer F, Barbier F, Desjardins S, Benzidi Y, Abbas N, Guerin C, Batista R, Llitjos JF, Kroemer M. Remdesivir for Patients Hospitalized with COVID-19 Severe Pneumonia: A National Cohort Study (Remdeco-19). J Clin Med 2022; 11:6545. [PMID: 36362773 PMCID: PMC9654065 DOI: 10.3390/jcm11216545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/15/2022] [Accepted: 10/29/2022] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Given the rapidly evolving pandemic of COVID-19 in 2020, authorities focused on the repurposing of available drugs to develop timely and cost-effective therapeutic strategies. Evidence suggested the potential utility of remdesivir in the framework of an early access program. REMDECO-19 is a multicenter national cohort study assessing the ability of remdesivir to improve the outcome of patients hospitalized with COVID-19. METHODS We conducted a retrospective real-life study that included all patients from the early access program of remdesivir in France. The primary endpoint was the clinical course evolution of critically ill and hospitalized COVID-19 patients treated with remdesivir. Secondary endpoints were the SOFA score evolution within 29 days following the admission and mortality at 29 and 90 days. RESULTS Eighty-five patients were enrolled in 22 sites from January to April 2020. The median WHO and SOFA scores were respectively reduced by two and six points between days 1 and 29. Improvement in the WHO-CPS and the SOFA score were observed in 83.5% and 79.3% of patients, respectively, from day 10. However, there was no effect of remdesivir on the 90-day survival based on the control cohort for hospitalized COVID-19 patients with invasive ventilation. CONCLUSIONS SOFA score appeared to be an attractive approach to assess remdesivir efficacy and stratify its utilization or not in critically ill patients with COVID-19. This study brings a new clinical benchmark for therapeutic decision making and supports the use of remdesivir for some hospitalized COVID-19 patients.
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Affiliation(s)
- Jeremie Zerbit
- Department of Pharmacy, Hospital at Home, University Hospitals of Paris, 75014 Paris, France
| | - Marion Detroit
- Department of Pharmacy, University Hospital of Besançon, 25056 Besançon, France
| | - Sylvie Chevret
- Department of Biostatistics, Saint-Louis Hospital, AP-HP, Universite Paris Diderot, INSERM S717, 75010 Paris, France
| | - Frederic Pene
- Institut Cochin, Université de Paris, INSERM U1016, CNRS UMR 8104, 75014 Paris, France
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
- INSERM, UMRS_1166-ICA, Sorbonne Universités, 75005 Paris, France
| | - Jade Ghosn
- Infectious Diseases Department, Bichat-Claude Bernard University Hospital, AP-HP, 75018 Paris, France
| | - Frederic Eyvrard
- Pharmacy Department, Toulouse University Hospital, 31300 Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, 31300 Toulouse, France
- Inserm U1043—CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center, 31300 Toulouse, France
| | - Benjamine Sarton
- Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, 31300 Toulouse, France
- Toulouse NeuroImaging Center, Toulouse University, Inserm, UPS, 31300 Toulouse, France
| | - Raphael Clere-Jehl
- Service de Médecine Intensive—Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaire de Strasbourg, 67091 Strasbourg, France
| | - Pierre Moine
- Intensive Care Unit, Raymond Poincaré Hospital, AP-HP, 92033 Garches, France
- Université Paris-Saclay, UVSQ, INSERM, Infection et Inflammation, 78180 Montigny le Bretonneux, France
| | - Amelie Cransac
- Department of Pharmacy, Dijon University Hospital, 21231 Dijon, France
| | - Pascal Andreu
- Department of Intensive Care, Dijon Bourgogne University Hospital, 21231 Dijon, France
| | - Marie Labruyère
- Department of Intensive Care, Dijon Bourgogne University Hospital, 21231 Dijon, France
| | | | | | - Pauline Roge
- Pharmacie, CHRU Brest, Hôpital de La Cavale Blanche, 29200 Brest, France
| | - Lise Bernard
- Département de Pharmacie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | | | - Maxime Villiet
- Département de Pharmacie, Centre Hospitalier Universitaire de Montpellier, 34000 Montpellier, France
| | - Arnaud Venet
- Department of Pharmacy, Pellegrin Hospital, 33000 Bordeaux, France
| | - Louis Marie Dumont
- Medical Intensive Care Unit, Louis-Mourier Hospital, AP-HP, 92025 Colombes, France
| | - Jean-Daniel Kaiser
- Pharmacy Department, Hôpitaux Civils de Colmar, 68026 Colmar, France
- Clinical Research Unit, Hôpitaux Civils de Colmar, 68026 Colmar, France
| | - Claire Chapuis
- Unités Pharmacie Clinique et Médecine Intensive-Réanimation, Centre Hospitalier Universitaire de Grenoble Alpes, 38000 Grenoble, France
| | - François Goehringer
- Department of Infectious Diseases, University Hospital of Nancy, 54000 Nancy, France
| | - François Barbier
- Médecine Intensive—Réanimation, Centre Hospitalier Régional d’Orléans, 45000 Orléans, France
| | - Stephane Desjardins
- Département de Pharmacie, Centre Hospitalier Sud Francilien, 91100 Corbeil-Essonnes, France
| | - Younes Benzidi
- Critical Care Center, Ajaccio Hospital, 20000 Ajaccio, France
| | - Nora Abbas
- Department of Clinical Pharmacy, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Corinne Guerin
- Department of Clinical Pharmacy, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Rui Batista
- Department of Clinical Pharmacy, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Jean-François Llitjos
- Service de Médecine Intensive et Réanimation, Hôpital Cochin, AP-HP, 75014 Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR 8104, 75014 Paris, France
| | - Marie Kroemer
- Department of Pharmacy, University Hospital of Besançon, 25056 Besançon, France
- INSERM, EFS BFC, UMR 1098 RIGHT, University of Bourgogne Franche-Comté, 25056 Besançon, France
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Lafarge A, Mabrouki A, Yvin E, Bredin S, Binois Y, Clere-Jehl R, Azoulay E. Coronavirus disease 2019 in immunocompromised patients: a comprehensive review of coronavirus disease 2019 in hematopoietic stem cell recipients. Curr Opin Crit Care 2022; 28:83-89. [PMID: 34813523 PMCID: PMC8711307 DOI: 10.1097/mcc.0000000000000907] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Immunocompromised patients are notably vulnerable to severe coronavirus disease 2019. This review summarizes COVID-19 features and outcomes in autologous and allogeneic hematopoietic stem cell transplantation (HSCT) recipients. RECENT FINDINGS Recent findings suggest that HSCT recipients exhibit a high burden of comorbidities and COVID-19 clinical features almost similar to the general COVID population. Furthermore, HSCT recipients exhibit a protracted SARS-CoV-2 shedding, prolonging duration of symptoms and promoting the generation of highly mutated viruses. Last, most of studies report a higher COVID-19 mortality in HSCT recipients, mainly driven by age, comorbidities, time from transplantation, and immunosuppression because of both treatments and underlying hematological malignancy. SUMMARY Further studies are warranted to determine the proper impact of HSCT-related immune disorders on COVID-19 outcomes, and to evaluate specific treatments and vaccination strategy in this high-risk population. Taken together, those findings emphasize the need for more rigorous surveillance and preemptive measures for all HSCT recipients.
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Affiliation(s)
- Antoine Lafarge
- Medical Intensive Care Unit, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), University de Paris, Paris, France
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5
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Merdji H, Mayeur S, Schenck M, Oulehri W, Clere-Jehl R, Cunat S, Herbrecht JE, Janssen-Langenstein R, Nicolae A, Helms J, Meziani F, Chenard MP. Histopathological features in fatal COVID-19 acute respiratory distress syndrome. Med Intensiva 2021; 45:261-270. [PMID: 34059216 PMCID: PMC8161799 DOI: 10.1016/j.medine.2021.02.005] [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: 01/01/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022]
Abstract
Background COVID-19 acute respiratory distress syndrome (ARDS) shares the common histological hallmarks with other forms of ARDS. However, the chronology of the histological lesions has not been well established. Objective To describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS. Design A prospective cohort study was carried out. Setting Intensive Care Unit of a tertiary hospital. Patients The first 22 consecutive COVID-19 deaths. Measurements Lung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS. Clinical data and patient course were evaluated. Results The median patient age was 66 [63–74] years; 73% were males. The median duration of mechanical ventilation was 17 [8–24] days. COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease, followed by a proliferative/organizing phase in the second and third weeks, and finally an end-stage fibrosis phase after the third week. Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease, and were no longer detected after the second week. Limitation Limited sample size. Conclusions The chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS. In particular, lung lesions consistent with potentially corticosteroid-sensitive lesions are seen.
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Affiliation(s)
- H Merdji
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - S Mayeur
- Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Schenck
- Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - W Oulehri
- Service d'Anesthésie - Réanimation Chirurgicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - R Clere-Jehl
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - S Cunat
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J-E Herbrecht
- Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - R Janssen-Langenstein
- Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A Nicolae
- Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J Helms
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - F Meziani
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
| | - M-P Chenard
- Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Centre de Ressources biologiques, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Ader F, Peiffer-Smadja N, Poissy J, Bouscambert-Duchamp M, Belhadi D, Diallo A, Delmas C, Saillard J, Dechanet A, Mercier N, Dupont A, Alfaiate T, Lescure FX, Raffi F, Goehringer F, Kimmoun A, Jaureguiberry S, Reignier J, Nseir S, Danion F, Clere-Jehl R, Bouiller K, Navellou JC, Tolsma V, Cabié A, Dubost C, Courjon J, Leroy S, Mootien J, Gaci R, Mourvillier B, Faure E, Pourcher V, Gallien S, Launay O, Lacombe K, Lanoix JP, Makinson A, Martin-Blondel G, Bouadma L, Botelho-Nevers E, Gagneux-Brunon A, Epaulard O, Piroth L, Wallet F, Richard JC, Reuter J, Staub T, Lina B, Noret M, Andrejak C, Lê MP, Peytavin G, Hites M, Costagliola D, Yazdanpanah Y, Burdet C, Mentré F. An open-label randomized controlled trial of the effect of lopinavir/ritonavir, lopinavir/ritonavir plus IFN-β-1a and hydroxychloroquine in hospitalized patients with COVID-19. Clin Microbiol Infect 2021; 27:1826-1837. [PMID: 34048876 PMCID: PMC8149166 DOI: 10.1016/j.cmi.2021.05.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/18/2022]
Abstract
Objectives We evaluated the clinical, virological and safety outcomes of lopinavir/ritonavir, lopinavir/ritonavir–interferon (IFN)-β-1a, hydroxychloroquine or remdesivir in comparison to standard of care (control) in coronavirus 2019 disease (COVID-19) inpatients requiring oxygen and/or ventilatory support. Methods We conducted a phase III multicentre, open-label, randomized 1:1:1:1:1, adaptive, controlled trial (DisCoVeRy), an add-on to the Solidarity trial (NCT04315948, EudraCT2020-000936-23). The primary outcome was the clinical status at day 15, measured by the WHO seven-point ordinal scale. Secondary outcomes included quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in respiratory specimens and pharmacokinetic and safety analyses. We report the results for the lopinavir/ritonavir-containing arms and for the hydroxychloroquine arm, trials of which were stopped prematurely. Results The intention-to-treat population included 583 participants—lopinavir/ritonavir (n = 145), lopinavir/ritonavir–IFN–β-1a (n = 145), hydroxychloroquine (n = 145), control (n = 148)—among whom 418 (71.7%) were male, the median age was 63 years (IQR 54–71), and 211 (36.2%) had a severe disease. The day-15 clinical status was not improved with the investigational treatments: lopinavir/ritonavir versus control, adjusted odds ratio (aOR) 0.83, (95% confidence interval (CI) 0.55–1.26, p 0.39), lopinavir/ritonavir–IFN–β-1a versus control, aOR 0.69 (95%CI 0.45–1.04, p 0.08), and hydroxychloroquine versus control, aOR 0.93 (95%CI 0.62–1.41, p 0.75). No significant effect of investigational treatment was observed on SARS-CoV-2 clearance. Trough plasma concentrations of lopinavir and ritonavir were higher than those expected, while those of hydroxychloroquine were those expected with the dosing regimen. The occurrence of serious adverse events was significantly higher in participants allocated to the lopinavir/ritonavir-containing arms. Conclusion In adults hospitalized for COVID-19, lopinavir/ritonavir, lopinavir/ritonavir–IFN–β-1a and hydroxychloroquine improved neither the clinical status at day 15 nor SARS-CoV-2 clearance in respiratory tract specimens.
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Affiliation(s)
- Florence Ader
- Hospices Civils de Lyon, Département des maladies infectieuses et tropicales, F-69004, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.
| | - Nathan Peiffer-Smadja
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, F-75018 Paris, France; National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Julien Poissy
- Université de Lille, Inserm U1285, CHU Lille, Pôle de réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France
| | - Maude Bouscambert-Duchamp
- Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des Virus Respiratoires France Sud, Hospices Civils de Lyon, F-69317, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372, Lyon, France
| | - Drifa Belhadi
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - Alpha Diallo
- ANRS, France Recherche Nord & Sud Sida-hiv Hépatites, Agence autonome de l'INSERM, F-75013 Paris, France
| | - Christelle Delmas
- Institut de Santé Publique, Pôle Recherche Clinique, INSERM, F-75013 Paris, France
| | - Juliette Saillard
- Institut de Santé Publique, Pôle Recherche Clinique, INSERM, F-75013 Paris, France
| | - Aline Dechanet
- AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - Noémie Mercier
- ANRS, France Recherche Nord & Sud Sida-hiv Hépatites, Agence autonome de l'INSERM, F-75013 Paris, France
| | - Axelle Dupont
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - Toni Alfaiate
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - François-Xavier Lescure
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, F-75018 Paris, France
| | - François Raffi
- CHU de Nantes, Hôpital Hôtel-Dieu, Département des Maladies Infectieuses, Nantes, France; CIC-EC 1413, INSERM, Nantes, France
| | - François Goehringer
- Université de Lorraine, CHRU-Nancy, Service de Maladies Infectieuses et Tropicales, F-54000 Nancy, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Service de Médecine Intensive et Réanimation Brabois, Inserm U1116, F-CRIN INI CRCT, 54000 Nancy, France
| | - Stéphane Jaureguiberry
- AP-HP, Service des Maladies Infectieuses, Hôpital Bicêtre, F- 94270 Le Kremlin Bicêtre, France; AP-HP, Centre National de Référence du Paludisme, Paris, France
| | - Jean Reignier
- CHU Nantes, Médecine Intensive Réanimation, Université de Nantes, Nantes, France
| | - Saad Nseir
- Université de Lille, Inserm U1285, CHU Lille, Pôle de réanimation, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France
| | - François Danion
- Hôpitaux Universitaires de Strasbourg, Service des Maladies Infectieuses et Tropicales, F-67091 Strasbourg, France
| | - Raphael Clere-Jehl
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, F-67091 Strasbourg, Cedex, France; Université de Strasbourg, ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg, F-67091 Strasbourg, France
| | - Kévin Bouiller
- Centre Hospitalier Universitaire Besançon, Service des Maladies Infectieuses et Tropicales, F-25030 Besançon, France; UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Jean-Christophe Navellou
- Centre Hospitalier Universitaire Besançon, Service de Réanimation Médicale, F-25030 Besançon, France
| | - Violaine Tolsma
- Centre Hospitalier Annecy Genevois, Service des Maladies Infectieuses et Tropicales, F-74374 Annecy, France
| | - André Cabié
- PCCEI, Univ Montpellier, Univ Antilles, Inserm, EFS, Montpellier, France; CHU de Martinique, Service des Maladies Infectieuses et Tropicales, Inserm CIC1424, Martinique, France
| | - Clément Dubost
- Hôpital Militaire Bégin, Service de réanimation polyvalente, F-94160 Saint-Mandé, France; Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, F-91190 Gif-sur-Yvette, France
| | - Johan Courjon
- CHU de Nice, Service des Maladies Infectieuses et Tropicales, Nice, France; Université Côte d'Azur, U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Virulence Microbienne et Signalisation Inflammatoire, INSERM, Nice, France
| | - Sylvie Leroy
- Fédération Hospitalo-Universitaire OncoAge, Nice, France; CHU de Nice, Département de Pneumologie et d'Oncologie, F-06000 Nice, France; Université Côte d'Azur, CNRS UMR 7275, IPMC, Sophia Antipolis, France
| | - Joy Mootien
- Groupe Hospitalier de la région Mulhouse Sud-Alsace, Service de réanimation médicale, Mulhouse, France
| | - Rostane Gaci
- CHR Metz-Thionville, Service de Réanimation Polyvalente, Ars-Laquenexy, France
| | - Bruno Mourvillier
- CHU de Reims, Service de Réanimation Médicale, Reims, France; Université de Reims Champagne-Ardenne, France
| | - Emmanuel Faure
- Université de Lille Nord de France, Faculté de Médecine de Lille, Lille, France; CHRU Lille, Service des Maladies Infectieuses et Tropicales, F-59000, Lille, France
| | - Valérie Pourcher
- Sorbonne Université, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, INSERM, F-75013, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Département des Maladies Infectieuses et Tropicales, F-75013 Paris, France
| | - Sébastien Gallien
- AP-HP, Hôpital Henri Mondor, Service d'Immunologie et Maladies Infectieuses, F-94000 Créteil, France; Université Paris-Est Créteil, INSERM U955, F-94000 Créteil, France
| | | | - Karine Lacombe
- Sorbonne Université, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, INSERM, F-75013, Paris, France; APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, F-75012 Paris, France
| | - Jean-Philippe Lanoix
- CHU Amiens-Picardie, Service de Maladies Infectieuses et Tropicales, F-80000 Amiens, France; Université Picardie Jules Verne, AGIR UR UPJV 4294, CURS, F-80000 Amiens, France
| | - Alain Makinson
- CHU de Montpellier, Département des Maladies Infectieuses, UMI 233 Inserm U1175, F-34000 Montpellier, France; Inserm Clinical Investigation Centre 1411, Montpellier, France
| | - Guillaume Martin-Blondel
- Centre Hospitalier Universitaire de Toulouse, Service des Maladies Infectieuses et Tropicales, F-31320 Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291, CNRS UMR5051, Université Toulouse III, F-31320 Toulouse, France
| | - Lila Bouadma
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Réanimation Médicale et Infectieuse, F-75018 Paris, France
| | - Elisabeth Botelho-Nevers
- CHU de Saint-Etienne, Service d'Infectiologie, F- 42055 Saint-Etienne, France; CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F-42023 Saint-Etienne, France; CIC 1408, INSERM, F- 42055 Saint-Etienne, France
| | - Amandine Gagneux-Brunon
- CHU de Saint-Etienne, Service d'Infectiologie, F- 42055 Saint-Etienne, France; CIRI - Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, F-42023 Saint-Etienne, France; CIC 1408, INSERM, F- 42055 Saint-Etienne, France
| | - Olivier Epaulard
- CHU Grenoble Alpes, Service des Maladies Infectieuses, F-38000 Grenoble, France; Université Grenoble Alpes, Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin, F-38000 Grenoble, France; Institut de Biologie Structurale, 'Virus Humains Persistants' Team, UMR 5075 CEA-CNRS-UGA, F-38000 Grenoble, France
| | - Lionel Piroth
- CHU de Dijon, Département de maladies infectieuses, F-21000, Dijon, France; Université Bourgogne Franche-Comté, CIC 1432, INSERM, F-21000, Dijon, France
| | - Florent Wallet
- Hospices Civils de Lyon, Hôpital Lyon-Sud Pierre-Bénite, Département de Soins Intensifs, F-69000, Lyon, France
| | - Jean-Christophe Richard
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Réanimation Médicale, F-69000, Lyon, France; Université Lyon I, CREATIS, CNRS UMR5220, INSERM U1044, INSA, F-69000, Lyon, France
| | - Jean Reuter
- Centre Hospitalier de Luxembourg, Service de Réanimation-Soins Intensifs, L-1210 Luxembourg, Luxembourg
| | - Thérèse Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, L-1210 Luxembourg, Luxembourg
| | - Bruno Lina
- Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des Virus Respiratoires France Sud, Hospices Civils de Lyon, F-69317, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372, Lyon, France
| | - Marion Noret
- RENARCI, Réseau national de recherche clinique en infectiologie, France
| | - Claire Andrejak
- CHU d'Amiens, Département de Pneumologie, F-80000 Amiens, France
| | - Minh Patrick Lê
- AP-HP, Hôpital Bichat Claude Bernard, Laboratoire de Pharmacologie-toxicologie, F-75018 Paris, France; Université de Paris, INSERM, UMRS 1144, F-75006, Paris, France
| | - Gilles Peytavin
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Laboratoire de Pharmacologie-toxicologie, F-75018 Paris, France
| | - Maya Hites
- Cliniques Universitaires de Bruxelles-Hôpital Érasme, Université Libre de Bruxelles, Clinique des Maladies Infectieuses, Brussels, Belgium
| | - Dominique Costagliola
- Sorbonne Université, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, INSERM, F-75013, Paris, France
| | - Yazdan Yazdanpanah
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de maladies infectieuses et tropicales, F-75018 Paris, France
| | - Charles Burdet
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
| | - France Mentré
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; AP-HP, Hôpital Bichat, Unité de Recherche Clinique, F-75018 Paris, France; CIC-EC 1425, INSERM, F-75018 Paris, France
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Merdji H, Mayeur S, Schenck M, Oulehri W, Clere-Jehl R, Cunat S, Herbrecht JE, Janssen-Langenstein R, Nicolae A, Helms J, Meziani F, Chenard MP. Histopathological features in fatal COVID-19 acute respiratory distress syndrome. Med Intensiva 2021; 45:261-270. [PMID: 34054173 PMCID: PMC7914021 DOI: 10.1016/j.medin.2021.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022]
Abstract
Background COVID-19 acute respiratory distress syndrome (ARDS) shares the common histological hallmarks with other forms of ARDS. However, the chronology of the histological lesions has not been well established. Objective To describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS. Design A prospective cohort study was carried out. Setting Intensive Care Unit of a tertiary hospital. Patients The first 22 consecutive COVID-19 deaths. Measurements Lung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS. Clinical data and patient course were evaluated. Results The median patient age was 66 [63–74] years; 73% were males. The median duration of mechanical ventilation was 17 [8–24] days. COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease, followed by a proliferative/organizing phase in the second and third weeks, and finally an end-stage fibrosis phase after the third week. Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease, and were no longer detected after the second week. Limitation Limited sample size. Conclusions The chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS. In particular, lung lesions consistent with potentially corticosteroid-sensitive lesions are seen.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- AFOP, acute fibrinous and organizing pneumonia
- ARDS, acute respiratory distress syndrome
- COVID-19
- COVID-19 related acute respiratory distress syndrome
- COVID-19, coronavirus infectious disease
- DAD, diffuse alveolar damage
- HE, hematoxylin–eosin
- Histopathology
- ISH, in situ hybridization
- NMBD, neuromuscular blocking drugs
- RT-PCR, Reverse Transcriptase-Polymerase chain reaction
- SAPSII, simplified acute physiology score
- SARS-CoV-2
- SOFA, Sequential Organ Failure Assessment
- VILI, ventilator induced lung injury
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Affiliation(s)
- H Merdji
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - S Mayeur
- Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Schenck
- Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - W Oulehri
- Service d'Anesthésie - Réanimation Chirurgicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - R Clere-Jehl
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - S Cunat
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J-E Herbrecht
- Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - R Janssen-Langenstein
- Service de Médecine Intensive - Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A Nicolae
- Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J Helms
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - F Meziani
- Service de Médecine Intensive - Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - M-P Chenard
- Département de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Centre de Ressources biologiques, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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8
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Kaeuffer C, Le Hyaric C, Fabacher T, Mootien J, Dervieux B, Ruch Y, Hugerot A, Zhu YJ, Pointurier V, Clere-Jehl R, Greigert V, Kassegne L, Lefebvre N, Gallais F, Meyer N, Hansmann Y, Hinschberger O, Danion F. Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 33272355 PMCID: PMC7716399 DOI: 10.2807/1560-7917.es.2020.25.48.2000895] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization. Aim Our objective was to identify risk factors predictive of severe disease and death in France. Methods In this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation. Results Among 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20–100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI ≥ 25 kg/m2 (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase; 95% CrI (credible interval): 1.0–1.2), male sex (OR: 2.1; 95% CrI: 1.5–2.8), BMI of 25–29.9 kg/m2 (OR: 1.8; 95% CrI: 1.2–2.7) or ≥ 30 (OR: 2.2; 95% CrI: 1.5–3.3), dyspnoea (OR: 2.5; 95% CrI: 1.8–3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase; 95% CrI: 2.1–3.4), male sex (OR: 1.7; 95% CrI: 1.1–2.7), immunosuppression (OR: 3.8; 95% CrI: 1.6–7.7), diabetes (OR: 1.7; 95% CrI: 1.0–2.7), chronic kidney disease (OR: 2.3; 95% CrI: 1.3–3.9), dyspnoea (OR: 2.1; 95% CrI: 1.2–3.4) and inflammatory parameters. Conclusions Overweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management.
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Affiliation(s)
- Charlotte Kaeuffer
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Coralie Le Hyaric
- These authors contributed equally.,CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Thibaut Fabacher
- Université de Strasbourg, ICube, équipe IMAGeS, UMR7357, Strasbourg, France.,These authors contributed equally
| | - Joy Mootien
- Groupe Hospitalier Régional Mulhouse Sud Alsace, Intensive Care Unit, Mulhouse, France
| | - Benjamin Dervieux
- Groupe Hospitalier Régional Mulhouse Sud Alsace, Department of Internal Medicine, Mulhouse, France
| | - Yvon Ruch
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Antonin Hugerot
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Yves-Jean Zhu
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Valentin Pointurier
- Groupe Hospitalier Régional Mulhouse Sud Alsace, Intensive Care Unit, Mulhouse, France
| | - Raphael Clere-Jehl
- CHU de Strasbourg, Medical Intensive Care Unit, Nouvel Hôpital Civil, Strasbourg, France
| | - Valentin Greigert
- CHU de Strasbourg, Department of Internal Medicine, Nouvel Hôpital Civil, Strasbourg, France
| | - Loic Kassegne
- CHU de Strasbourg, Department of Pneumology, Strasbourg
| | - Nicolas Lefebvre
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Floriane Gallais
- CHU de Strasbourg, Department of Virology, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
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- The members of the Covid Alsace Study Group are listed at the end of the article
| | - Nicolas Meyer
- CHU de Strasbourg, Department of Public Health, GMRC, Strasbourg, France.,Université de Strasbourg, ICube, équipe IMAGeS, UMR7357, Strasbourg, France
| | - Yves Hansmann
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Olivier Hinschberger
- Groupe Hospitalier Régional Mulhouse Sud Alsace, Department of Internal Medicine, Mulhouse, France
| | - François Danion
- CHU de Strasbourg, Department of Infectious and Tropical Diseases; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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Clere-Jehl R, Merdji H, Derhy D, Helms J. Blindness as an uncommon complication of Streptococcus pneumoniae systemic infection. Intensive Care Med 2018; 45:263-265. [DOI: 10.1007/s00134-018-5486-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
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Levy B, Clere-Jehl R, Legras A, Morichau-Beauchant T, Leone M, Frederique G, Quenot JP, Kimmoun A, Cariou A, Lassus J, Harjola VP, Meziani F, Louis G, Rossignol P, Duarte K, Girerd N, Mebazaa A, Vignon P, Mattei M, Thivilier C, Perez P, Auchet T, Fritz C, Boisrame-Helme J, Mercier E, Garot D, Perny J, Gette S, Hammad E, Vigne C, Dargent A, Andreu P, Guiot P. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2018; 72:173-182. [DOI: 10.1016/j.jacc.2018.04.051] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/09/2018] [Accepted: 04/15/2018] [Indexed: 12/28/2022]
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Merdji H, Clere-Jehl R, Dargent A, Andreu P, Large A, Lefebvre F, Schenck M, Helms J, Quenot JP, Meziani F. Out of the ICU shifting as a significant workload. Intensive Care Med 2018; 44:1582-1583. [PMID: 29947882 DOI: 10.1007/s00134-018-5240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Affiliation(s)
- H Merdji
- Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - R Clere-Jehl
- Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - A Dargent
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipnes Team, INSERM Research Center LNC-UMR 1231 and LabExLipSTIC, Dijon, France
| | - P Andreu
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - A Large
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - F Lefebvre
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - M Schenck
- Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Hôpital de Hautepierre, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - J Helms
- Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - J P Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipnes Team, INSERM Research Center LNC-UMR 1231 and LabExLipSTIC, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - F Meziani
- Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Réanimation, Université de Strasbourg (UNISTRA), Nouvel Hôpital Civil 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France. .,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
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Merdji H, Clere-Jehl R, Monnier A, Meziani F. Yellow urticaria following plasma transfusion. Intensive Care Med 2018; 44:100-101. [DOI: 10.1007/s00134-017-4931-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
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Clere-Jehl R, Sauleau E, Ciuca S, Vogel T, Goichot B, Bouvard E, Pasquali JL, Bergmann JF, Andres E, Sereni D, Bourgarit A. Anémie ferriprive sans étiologie après procédure endoscopique standard chez des patients de plus de 65ans : évolution clinique et diagnostique d’une cohorte rétrospective multicentrique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.074] [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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