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Yager H, Tauzin M, Durrmeyer X, Todorova D, Storme L, Debillon T, Casagrande F, Jung C, Audureau E, Layese R, Caeymaex L. Respiratory outcomes and survival after unplanned extubation in the NICU: a prospective cohort study from the SEPREVEN trial. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326679. [PMID: 38636983 DOI: 10.1136/archdischild-2023-326679] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To compare reintubation rates after planned extubation and unplanned extubation (UE) in patients in neonatal intensive care units (NICUs), to analyse risk factors for reintubation after UE and to compare outcomes in patients with and without UE. DESIGN Prospective, observational study nested in a randomised controlled trial (SEPREVEN/Study on Epidemiology and PRevention of adverse EVEnts in Neonates). Outcomes were expected to be independent of the intervention tested. SETTING 12 NICUs in France with a 20-month follow-up, starting November 2015. PATIENTS n=2280 patients with a NICU stay >2 days, postmenstrual age ≤42 weeks on admission. INTERVENTIONS/EXPOSURE Characteristics of UE (context, timing, sedative administration in the preceding 6 hours, weaning from ventilation at time of UE) and patients. MAIN OUTCOME MEASURES Healthcare professional-reported UE rates, reintubation/timing after extubation, duration of mechanical ventilation, mortality and bronchopulmonary dysplasia (BPD). RESULTS There were 162 episodes of UE (139 patients, median gestational age (IQR) 27.3 (25.6-31.7) weeks). Cumulative reintubation rates within 24 hours and 7 days of UE were, respectively, 50.0% and 57.5%, compared with 5.5% and 12.3% after a planned extubation. Independent risk factors for reintubation within 7 days included absence of weaning at the time of UE (HR, 95% CI) and sedatives in the preceding 6 hours (HR 1.93, 95% CI 1.04 to 3.60). Mortality at discharge did not differ between patients with planned extubation or UE. UE was associated with a higher risk of BPD. CONCLUSION In the SEPREVEN trial, reintubation followed UE in 58% of the cases, compared with 12% after planned extubation. TRIAL REGISTRATION NUMBER NCT02598609.
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Affiliation(s)
- Helene Yager
- Faculty of Health, Paris Est Creteil University, 94000 Creteil, Val de Marne, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
- Délégation de Recherche en Santé et Innovation, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, France
| | - Xavier Durrmeyer
- Faculty of Health, Paris Est Creteil University, 94000 Creteil, Val de Marne, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
| | - Darina Todorova
- Service de Néonatologie, Centre Hospitalier René-Dubos, 95300 Pontoise, France
| | - Laurent Storme
- Clinique de Médecine Néonatale, Hopital Jeanne de Flandres, CHRU de Lille, Pôle Femme Mère et Nouveau-né, Lille, 59000, France
- Centre d'Investigation Clinique Pédiatrique, Hopital Jeanne de Flandres CHRU de Lille, 59000 Lille, France
| | - Thierry Debillon
- Service de Néonatologie, CHU de Grenoble, Grenoble, France
- Université Grenoble Alpes, Grenoble, France
| | - Florence Casagrande
- Service de Néonatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Camille Jung
- Délégation de Recherche en Santé et Innovation, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, France
| | - Etienne Audureau
- Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), Assistance Publique-Hôpitaux de Paris AP-HP, Hopital Henri Mondor, F-94010 Creteil, France
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France
| | - Richard Layese
- Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), Assistance Publique-Hôpitaux de Paris AP-HP, Hopital Henri Mondor, F-94010 Creteil, France
| | - Laurence Caeymaex
- Faculty of Health, Paris Est Creteil University, 94000 Creteil, Val de Marne, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, 94000 Creteil, Val de Marne, France
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Nahon P, Layese R, Ganne-Carrié N, Moins C, N'Kontchou G, Chaffaut C, Ronot M, Audureau E, Durand-Zaleski I, Natella PA. The clinical and financial burden of nonhepatocellular carcinoma focal lesions detected during the surveillance of patients with cirrhosis. Hepatology 2024; 79:813-828. [PMID: 37774387 DOI: 10.1097/hep.0000000000000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND AIMS HCC surveillance is challenged by the detection of hepatic focal lesions (HFLs) of other types. This study aimed to describe the incidence, characteristics, outcomes, and costs of non-HCC HFL detected during surveillance. APPROACH AND RESULTS We retrospectively analyzed nonstandardized workup performed in French patients included in HCC surveillance programs recruited in 57 French tertiary centers (ANRS CirVir and CIRRAL cohorts, HCC 2000 trial). The overall cost of workup was evaluated, with an estimation of an average cost per patient for the entire population and per lesion detected. A total of 3295 patients were followed up for 59.8 months, 391 (11.9%) patients developed HCCs (5-year incidence: 12.1%), and 633 (19.2%) developed non-HCC HFLs (5-year incidence: 21.8%). Characterization of non-HCC HFL required a median additional of 0.7 exams per year. A total of 11.8% of non-HCC HFLs were not confirmed on recall procedures, and 19.6% of non-HCC HFLs remained undetermined. A definite diagnosis of benign liver lesions was made in 65.1%, and malignant tumors were diagnosed in 3.5%. The survival of patients with benign or undetermined non-HCC HFL was similar to that of patients who never developed any HFL (5-year survival 92% vs. 88%, p = 0.07). The average cost of the diagnostic workup was 1087€ for non-HCC HFL and €1572 for HCC. CONCLUSIONS Non-HCC HFLs are frequently detected in patients with cirrhosis, and do not impact prognosis, but trigger substantial costs. This burden must be considered in cost-effectiveness analyses of future personalized surveillance strategies.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Department, Bobigny; Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1138 Functional Genomics of Solid Tumors department, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Public health department, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nathalie Ganne-Carrié
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Department, Bobigny; Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1138 Functional Genomics of Solid Tumors department, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Cécile Moins
- Clinical Research Department, ANRS | Emerging Infectious Diseases, Paris, France
| | - Gisèle N'Kontchou
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Department, Bobigny; Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1138 Functional Genomics of Solid Tumors department, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRA department, Paris, France
| | - Maxime Ronot
- APHP, Hôpital Beaujon, Radiology department, Hôpital Beaujon, APHP. Nord, Clichy-Sous-Bois, & Université Paris Cité, Paris, France
| | - Etienne Audureau
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Public health department, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCECo department, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
| | - Pierre-André Natella
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Public health department, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
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Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf 2023; 32:589-599. [PMID: 36918264 DOI: 10.1136/bmjqs-2022-015247] [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: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 03/16/2023]
Abstract
IMPORTANCE Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER NCT02598609.
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Affiliation(s)
- Loïc Passini
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Marie-Laurence Keller
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Lefebvre
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR 3571 CNRS, University Paris Diderot, Paris, France
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Therese Katty
- Health Law Manager, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Jean-Marc Baleyte
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| | - Richard Layese
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Etienne Audureau
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
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Bizos A, Hostalrich A, Chaufour X, Desgranges P, Layese R, Cochennec F, Canoui-Poitrine F. Comparison of Fenestrated Stentgrafts and Open Repair for Juxtarenal Aortic Aneurysms Using a Propensity Score Matching. Ann Vasc Surg 2023; 95:50-61. [PMID: 37270093 DOI: 10.1016/j.avsg.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The purpose of this study was to compare postoperative morbi-mortality and medium-term follow-up of fenestrated stent grafting and open repair (OR) for patients with juxtarenal aortic aneurysms (JRAAs). METHODS All consecutive patients who underwent custom-made fenestrated endovascular aortic repair (FEVAR) or OR for complex abdominal aortic aneurysm between 2005 and 2017 in 2 tertiary centers were scrutinized. Patients with JRAA constituted the study group. Suprarenal and thoracoabdominal aortic aneurysms were excluded. The groups were made comparable through the use of a propensity score matching. RESULTS 277 patients with JRAAs were included, 102 (36.8%) in the FEVAR group and 175 (63.2%) in the OR group, respectively. After propensity score matching, 54 FEVAR patients (52.9%) and 103 OR patients (58.9%) were included for analysis. In-hospital mortality rates were 1.9% (n = 1) in the FEVAR group versus 6.9% (n = 7) in the OR group (P = 0.483). Postoperative complications were less common in the FEVAR group (14.8% vs. 30.7%; P = 0.033). Mean follow-up was 42.1 months in the FEVAR group and 40 months in the OR group. Overall mortality rates at 12 and 36 months were 11.5% and 24.5% in the FEVAR group versus 9.1 % (P = 0.691) and 11.6% (P = 0.067) in the OR group. Late reinterventions were more frequent in the FEVAR group (11.3% vs. 2.9%; P = 0.047). However, freedom from reintervention rates were not significantly different at 12 months (FEVAR: 86% vs. OR: 90%; P = 0.560) and 36 months (FEVAR: 86% vs. OR: 88.4%, P = 0.690). In the FEVAR group, persistent endoleak during follow-up was identified in 11.3% of cases. CONCLUSIONS In the present study, there was no statistical difference in terms of mortality in-hospital at 12 or 36 months between FEVAR and OR groups for JRAA. FEVAR for JRAA was associated with a significant reduction of overall postoperative major complications compared with OR. There were significantly more late reinterventions in the FEVAR group.
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Affiliation(s)
- Alia Bizos
- Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France.
| | - Aurélien Hostalrich
- Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Xavier Chaufour
- Department of Vascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Henri-Mondor University Hospital (Assistance Publique-Hopitaux de Paris - APHP), Créteil, France
| | - Richard Layese
- Department of Vascular Surgery, Henri-Mondor University Hospital (Assistance Publique-Hopitaux de Paris - APHP), Créteil, France
| | - Frédéric Cochennec
- Department of Vascular Surgery, Henri-Mondor University Hospital (Assistance Publique-Hopitaux de Paris - APHP), Créteil, France
| | - Florence Canoui-Poitrine
- Department of Vascular Surgery, Henri-Mondor University Hospital (Assistance Publique-Hopitaux de Paris - APHP), Créteil, France
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Jaloustre M, Cohen R, Biran V, Decobert F, Layese R, Audureau E, Le Saché N, Chevallier M, Boukhris MR, Bolot P, Caeymaex L, Tauzin M. Determinants of morbidity and mortality related to health care-associated primary bloodstream infections in neonatal intensive care units: a prospective cohort study from the SEPREVEN trial. Front Pediatr 2023; 11:1170863. [PMID: 37325351 PMCID: PMC10264575 DOI: 10.3389/fped.2023.1170863] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Background Health care-associated primary bloodstream infections (BSIs), defined as not secondary to an infection at another body site, including central line-associated BSI, are a leading cause of morbidity and mortality in patients in neonatal intensive care units (NICUs). Our objective was to identify factors associated with severe morbidity and mortality after these infections in neonates in NICUs. Methods This ancillary study of the SEPREVEN trial included neonates hospitalized ≥2 days in one of 12 French NICUs and with ≥ 1 BSI during the 20-month study period. BSIs (all primary and health care-associated) were diagnosed in infants with symptoms suggestive of infection and classified prospectively as possible (one coagulase-negative staphylococci (CoNS)-growing blood culture) or proven (two same CoNS, or ≥1 recognized pathogen-growing blood culture). BSI consequences were collected prospectively as moderate morbidity (antibiotic treatment alone) or severe morbidity/mortality (life-saving procedure, permanent damage, prolonged hospitalization, and/or death). Results Of 557 BSIs identified in 494 patients, CoNS accounted for 378/557 (67.8%) and recognized bacterial or fungal pathogens for 179/557 (32.1%). Severe morbidity/mortality was reported in 148/557 (26.6%) BSIs. Independent factors associated with severe morbidity/mortality were corrected gestational age <28 weeks (CGA) at infection (P < .01), fetal growth restriction (FGR) (P = .04), and proven pathogen-related BSI vs. CoNS-related BSI (P < .01). There were no differences in severe morbidity and mortality between proven and possible CoNS BSIs. In possible BSI, S. epidermidis was associated with a lower risk of severe morbidity than other CoNS (P < .01), notably S. capitis and S. haemolyticus. Conclusions In BSIs in the NICU, severe morbidity/mortality was associated with low CGA at infection, FGR, and proven pathogen-related BSIs. When only one blood culture was positive, severe morbidity/mortality were less frequent if it grew with S. epidermidis compared to other CoNS. Further studies to help distinguish real CoNS BSIs from contaminations are needed. Study registration ClinicalTrials.gov (NCT02598609).
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Affiliation(s)
- Morgane Jaloustre
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Robert Cohen
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Medicine, University Paris Est Creteil, Creteil, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, APHP, CHU Robert Debré, Paris, France
| | - Fabrice Decobert
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Richard Layese
- Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France
- University Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France
| | - Etienne Audureau
- Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France
- University Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France
| | - Nolwenn Le Saché
- Pediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Marie Chevallier
- Neonatal Intensive Care Unit, CHU Grenoble Alpes, Grenoble, France
| | | | - Pascal Bolot
- Neonatal Intensive Care Unit, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Laurence Caeymaex
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Medicine, University Paris Est Creteil, Creteil, France
| | - Manon Tauzin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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Celante H, Oubaya N, Fourati S, Beaune S, Khellaf M, Casalino E, Ricard JD, Vieillard-Baron A, Heming N, Dessap AM, de Montmollin E, Benghanem S, Epaillard N, Layese R, de Prost N. Prognosis of hospitalized adult patients with respiratory syncytial virus infection: a multicenter retrospective cohort study. Clin Microbiol Infect 2023:S1198-743X(23)00117-9. [PMID: 36914069 DOI: 10.1016/j.cmi.2023.03.003] [Citation(s) in RCA: 2] [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] [Received: 11/16/2022] [Revised: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is a common agent of viral respiratory infections with significant morbidity and mortality in adults. The objective of this study is to determine risk factors for mortality, invasive mechanical ventilation and to describe the characteristics of patients who received ribavirin. METHODS Retrospective multicenter observational cohort study conducted in Great Paris area hospitals, including patients hospitalized between January 1, 2015 and December 31, 2019 for documented RSV infection. Data were extracted from the AP-HP Health Data Warehouse. The primary endpoint was in-hospital mortality. RESULTS 1168 patients were hospitalized for RSV infection, including 288 (24.6%) patients who required ICU admission. The median [interquartile range] age of patients was 75 [63-85] years, 54% (n=631/1168) of them were women. In-hospital mortality was 6.6% (n=77/1168) in the whole cohort and 12.8% (n=37/288) in ICU patients. Factors associated with hospital mortality were age>85 years (adjusted odds ratio (aOR)=6.29 95% confidence interval [2.47-15.98]), acute respiratory failure (aOR=2.83 [1.19-6.72]), non-invasive (aOR=12.60 [1.41-112.36]) and invasive mechanical ventilation support (aOR=30.13 [3.17-286.27]) and neutropenia (aOR=13.19 [3.27-53.27]). Factors associated with invasive mechanical ventilation were chronic heart (aOR=1.98 [1.20-3.26]) or respiratory failure (aOR=2.83 [1.67-4.80]), and co-infection (aOR=2.62 [1.60-4.30]). Patients who were treated with ribavirin were significantly younger than others (62 [55-69] vs 75 [63-86] years; p<0.001), more frequently males (n=34/48 (70.8%) vs n=503/1120 (44.9%); p=0.001), and almost exclusively immunocompromised (n=46/48 (95.8%) vs n=299/1120 (26.7%); p<0.001). CONCLUSIONS The mortality rate of patients hospitalized with RSV infections was 6.6%. Twenty-five percent of patients required ICU admission.
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Affiliation(s)
- Héloïse Celante
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - Nadia Oubaya
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Department of Public Health, F-94010 Créteil, France
| | - Slim Fourati
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France; INSERM U955, Team « Viruses, Hepatology, Cancer », Créteil, France
| | - Sébastien Beaune
- Service D'Accueil des Urgences, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne Billancourt, France
| | - Mehdi Khellaf
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France; Service D'Accueil des Urgences, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Enrique Casalino
- Service D'Accueil des Urgences, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; CESP, UMR 1018, Université Paris-Saclay
| | - Nicholas Heming
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France; Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Etienne de Montmollin
- Service Médecine Intensive Réanimation, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sara Benghanem
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nicolas Epaillard
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Clinical Research Unit, F-94010 Créteil, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor- Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.
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Aparicio T, Layese R, Hemery F, Tournigand C, Paillaud E, De Angelis N, Quero L, Ganne N, Prat F, Pachev A, Galula G, Benderra MA, Canouï-Poitrine F. The 10-month mortality rate among older patients treated for digestive system cancer during the first wave of the COVID-19 pandemic: The CADIGCOVAGE multicentre cohort study. J Geriatr Oncol 2023; 14:101443. [PMID: 36709553 PMCID: PMC9883010 DOI: 10.1016/j.jgo.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/11/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and care pathways. Here, we assessed the mid-term impact of the COVID-19 pandemic on older adults with cancer before, during and after the lockdown period in 2020. MATERIALS AND METHODS We performed a retrospective, observational, multicentre cohort study of prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer in our institution between January 2018 until August 2020 were enrolled. RESULTS Data on 7,881 patients were analyzed. Although the overall 10-month mortality rate was similar in 2020 vs. 2018-2019, the mortality rate among for patients newly treated in the 2020 post-lockdown period was (after four months of follow-up) significantly higher. A subgroup analysis revealed higher mortality rates for (i) patients diagnosed in the emergency department during the pre-lockdown period, (ii) patients with small intestine cancer newly treated during the post-lockdown period, and (iii) patients having undergone surgery with curative intent during the post-lockdown period. However, when considering individuals newly treated during the lockdown period, we observed lower mortality rates for (i) patients aged 80 and over, (ii) patients with a biliary or pancreatic cancer, and (iii) patients diagnosed in the emergency department. DISCUSSION There was no overall increase in mortality among patients newly treated in 2020 vs. 2018-2019. Longer follow-up is needed to assess the consequences of the pandemic. A subgroup analysis revealed significant intergroup differences in mortality.
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Affiliation(s)
- Thomas Aparicio
- AP-HP, Saint Louis Hospital, Gastroenterology and Digestive Oncology Department, F-75010 Paris, France; Université de Paris, F-75000 Paris, France.
| | - Richard Layese
- AP-HP, Henri-Mondor Hospital, Public Health and Clinical Research department (URC Mondor), F-94010 Créteil, France; Univ Paris Est Creteil, INSERM, IMRB U955, F-94000 Creteil, France
| | - François Hemery
- AP-HP, Henri-Mondor Hospital, Medical Information Departement, F-94010 Créteil, France
| | | | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB U955, F-94000 Creteil, France; AP-HP, Paris Cancer Institute CARPEM, Georges Pompidou Hospital, Geriatric Department, F-75015 Paris, France
| | - Nicola De Angelis
- AP-HP, Henri-Mondor Hospital, Digestive Surgery, F-94010 Créteil, France
| | - Laurent Quero
- Université de Paris, F-75000 Paris, France; AP-HP, Saint Louis Hospital, Radiotherapy Department, F-75010 Paris, France
| | - Nathalie Ganne
- AP-HP, Avicenne Hospital, Hepatology Department, F-93000 Bobigny, France
| | - Fredéric Prat
- Université de Paris, F-75000 Paris, France; AP-HP, Beaujon Hospital, Endoscopy Department, F-92110 Clichy, France
| | - Atanas Pachev
- AP-HP, Saint Louis Hospital, Radiology Department, F-75010 Paris, France
| | - Gilles Galula
- AP-HP, Tenon Hospital, Medical Oncology, F-75020 Paris, France
| | | | - Florence Canouï-Poitrine
- AP-HP, Henri-Mondor Hospital, Public Health and Clinical Research department (URC Mondor), F-94010 Créteil, France; Univ Paris Est Creteil, INSERM, IMRB U955, F-94000 Creteil, France
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8
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Nahon P, Bamba-Funck J, Layese R, Trépo E, Zucman-Rossi J, Cagnot C, Ganne-Carrié N, Chaffaut C, Guyot E, Ziol M, Sutton A, Audureau E. Integrating genetic variants into clinical models for hepatocellular carcinoma risk stratification in cirrhosis. J Hepatol 2023; 78:584-595. [PMID: 36427656 DOI: 10.1016/j.jhep.2022.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/06/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS Identifying individuals at higher risk of developing hepatocellular carcinoma (HCC) is pivotal to improve the performance of surveillance strategies. Herein, we aimed to evaluate the ability of single nucleotide polymorphisms (SNPs) to refine HCC risk stratification. METHODS Six SNPs in PNPLA3, TM6SF2, HSD17B13, APOE, and MBOAT7 affecting lipid turnover and one variant involved in the Wnt-β-catenin pathway (WNT3A-WNT9A rs708113) were assessed in patients with alcohol-related and/or HCV-cured cirrhosis included in HCC surveillance programmes (prospective CirVir and CIRRAL cohorts). Their prognostic value for HCC occurrence was assessed using Fine-Gray models combined into a 7-SNP genetic risk score (GRS). The predictive ability of two clinical scores (a routine non-genetic model determined by multivariate analysis and the external aMAP score) with/without the GRS was evaluated by C-indices. The standardised net benefit was derived from decision curves. RESULTS Among 1,145 patients, 86 (7.5%) developed HCC after 43.7 months. PNPLA3 and WNT3A-WNT9A variants were independently associated with HCC occurrence. The GRS stratified the population into three groups with progressively increased 5-year HCC incidence (Group 1 [n = 627, 5.4%], Group 2 [n = 276, 10.7%], and Group 3 [n = 242, 15.3%]; p <0.001). The multivariate model identified age, male sex, diabetes, platelet count, gamma-glutamyltransferase levels, albuminemia and the GRS as independent risk factors. The clinical model performance for 5-year HCC prediction was similar to that of the aMAP score (C-Index 0.769). The addition of the GRS to both scores modestly improved their performance (C-Indices of 0.786 and 0.783, respectively). This finding was confirmed by decision curve analyses showing only fair clinical net benefit. CONCLUSIONS Patients with cirrhosis can be stratified into HCC risk classes by variants affecting lipid turnover and the Wnt-β-catenin pathway. The incorporation of this genetic information modestly improves the performance of clinical scores. IMPACT AND IMPLICATIONS The identification of patients at higher risk of developing liver cancer is pivotal to improve the performance of surveillance. Risk assessment can be achieved by combining several clinical and biological parameters used in routine practice. The addition of patients' genetic characteristics can modestly improve this prediction and will ultimately pave the way for precision medicine in patients eligible for HCC surveillance, allowing physicians to trigger personalised screening strategies.
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Affiliation(s)
- Pierre Nahon
- APHP, Liver Unit, Bobigny, Université Sorbonne Paris Nord, F-93000 Bobigny, France; Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, Paris, France.
| | - Jessica Bamba-Funck
- APHP, Biochemistry Unit, Bobigny, Université Sorbonne Paris Nord, and Inserm, UMR-1148 "Laboratory for Vascular Translational Science" Université Sorbonne Paris Nord, F-93000 Bobigny, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
| | - Eric Trépo
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hopital Erasme, and Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jessica Zucman-Rossi
- Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Carole Cagnot
- Clinical Research Department, ANRS|Emerging Infectious Diseases, Paris, France
| | | | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Erwan Guyot
- APHP, Biochemistry Unit, Bobigny, Université Sorbonne Paris Nord, and Inserm, UMR-1148 "Laboratory for Vascular Translational Science" Université Sorbonne Paris Nord, F-93000 Bobigny, France
| | - Marianne Ziol
- APHP, Pathology Unit, Bobigny, Université Sorbonne Paris Nord, F-93000 Bobigny, France; Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Angela Sutton
- APHP, Biochemistry Unit, Bobigny, Université Sorbonne Paris Nord, and Inserm, UMR-1148 "Laboratory for Vascular Translational Science" Université Sorbonne Paris Nord, F-93000 Bobigny, France
| | - Etienne Audureau
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
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9
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Schlemmer F, Valentin S, Boyer L, Guillaumot A, Chabot F, Dupin C, Le Guen P, Lorillon G, Bergeron A, Basille D, Delomez J, Andrejak C, Bonnefoy V, Goussault H, Assié JB, Choinier P, Ruppert AM, Cadranel J, Mennitti MC, Roumila M, Colin C, Günther S, Sanchez O, Gille T, Sésé L, Uzunhan Y, Faure M, Patout M, Morelot-Panzini C, Laveneziana P, Zysman M, Blanchard E, Raherison-Semjen C, Giraud V, Giroux-Leprieur E, Habib S, Roche N, Dinh-Xuan AT, Sifaoui I, Brillet PY, Jung C, Boutin E, Layese R, Canoui-Poitrine F, Maitre B. Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study. Eur Respir J 2023; 61:13993003.01532-2022. [PMID: 36669777 PMCID: PMC10066566 DOI: 10.1183/13993003.01532-2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Survivors of severe-to-critical COVID-19 may have functional impairment, radiological sequelae and persistent symptoms requiring prolonged follow-up. This pragmatic study aimed to describe their clinical follow-up and determine their respiratory recovery trajectories, and factors that could influence them and their health-related quality of life. METHODS Adults hospitalised for severe-to-critical COVID-19 were evaluated at 3 months and up to 12 months post-hospital discharge in this prospective, multicentre, cohort study. RESULTS Among 485 enrolled participants, 293 (60%) were reassessed at 6 months and 163 (35%) at 12 months; 89 (51%) and 47 (27%) of the 173 ones initially managed with standard oxygen were reassessed at 6 and 12 months, respectively. At 3 months, 34%, 70% and 56% of the participants had a restrictive lung defect, impaired DLCO and significant radiological sequelae, respectively. During extended follow-up, DLCO and FVC (% of predicted value) increased by means of +4 points at 6 months, and +6 points at 12 months. Sex, body mass index, chronic respiratory disease, immunosuppression, pneumonia extent or corticosteroid use during acute COVID-19 and prolonged invasive mechanical ventilation (IMV) were associated with DLCO at month 3, but not its trajectory thereafter. Among 475 (98%) patients with at least one chest computed-tomography scan during follow-up, 196 (41%) had significant sequelae on their last images. CONCLUSION Although pulmonary function and radiological abnormalities improved up to 1 year post-acute-COVID-19, high percentages of severe-to-critical disease survivors, including a notable proportion of those managed with standard oxygen, had significant lung sequelae and residual symptoms justifying prolonged follow-up.
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Affiliation(s)
- Frédéric Schlemmer
- Unité de Pneumologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Créteil, France .,Univ Paris Est-Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France
| | - Simon Valentin
- CHRU de Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Vandœuvre-lès-Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, INSERM UMR_S 1116, Vandœuvre-lès-Nancy, France
| | - Laurent Boyer
- Univ Paris Est-Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France.,APHP, Hôpitaux Universitaires Henri-Mondor, Service des Explorations Fonctionnelles, Créteil, France
| | - Anne Guillaumot
- CHRU de Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Vandœuvre-lès-Nancy, France
| | - François Chabot
- CHRU de Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Vandœuvre-lès-Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, INSERM UMR_S 1116, Vandœuvre-lès-Nancy, France
| | - Clairelyne Dupin
- APHP, Hôpital Saint-Louis, Service de Pneumologie, Université de Paris, Paris, France
| | - Pierre Le Guen
- APHP, Hôpital Saint-Louis, Service de Pneumologie, Université de Paris, Paris, France
| | - Gwenael Lorillon
- APHP, Hôpital Saint-Louis, Service de Pneumologie, Université de Paris, Paris, France
| | - Anne Bergeron
- Hôpitaux Universitaires de Genève, Service de Pneumologie, Genève, Switzerland
| | - Damien Basille
- CHU Amiens-Picardie, Service de Pneumologie, UR 4294 AGIR, Université Picardie Jules-Verne, Amiens, France
| | - Julia Delomez
- CHU Amiens-Picardie, Service de Pneumologie, UR 4294 AGIR, Université Picardie Jules-Verne, Amiens, France
| | - Claire Andrejak
- CHU Amiens-Picardie, Service de Pneumologie, UR 4294 AGIR, Université Picardie Jules-Verne, Amiens, France
| | - Valentine Bonnefoy
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
| | - Hélène Goussault
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
| | - Jean-Baptiste Assié
- Unité de Pneumologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Pascaline Choinier
- APHP, Service de Pneumologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Anne-Marie Ruppert
- APHP, Service de Pneumologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- APHP, Service de Pneumologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | | | - Mehdi Roumila
- Département de Pneumologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Charlotte Colin
- Département de Pneumologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Sven Günther
- APHP, Hôpital Européen Georges-Pompidou, Service de Physiologie, Université de Paris, Paris, France
| | - Olivier Sanchez
- APHP, Hôpital Européen Georges-Pompidou, Service de Pneumologie, Université de Paris, Paris, France
| | - Thomas Gille
- APHP, Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles, Bobigny, France.,Université Sorbonne Paris Nord, UFR SMBH Léonard de Vinci, Inserm UMR 1272 "Hypoxie et Poumon", Bobigny, France
| | - Lucile Sésé
- APHP, Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles, Bobigny, France.,Université Sorbonne Paris Nord, UFR SMBH Léonard de Vinci, Inserm UMR 1272 "Hypoxie et Poumon", Bobigny, France
| | - Yurdagul Uzunhan
- Université Sorbonne Paris Nord, UFR SMBH Léonard de Vinci, Inserm UMR 1272 "Hypoxie et Poumon", Bobigny, France.,APHP, Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Pneumologie, Centre de Reference Maladies Pulmonaires Rares de l'Adulte (site constitutif), Bobigny, France
| | - Morgane Faure
- Service de Pneumologie (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Maxime Patout
- Service de Pneumologie (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Capucine Morelot-Panzini
- Service de Pneumologie (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, hôpitaux Pitié-Salpêtrière, Saint-Antoine et Tenon, Paris, France
| | - Maeva Zysman
- Département de Pneumologie, CHU Haut-Lévèque, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-thoracique, INSERM U1045, Pessac, France
| | - Elodie Blanchard
- Département de Pneumologie, CHU Haut-Lévèque, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-thoracique, INSERM U1045, Pessac, France
| | - Chantal Raherison-Semjen
- Département de Pneumologie, CHU Guadeloupe, Guadeloupe, France.,Univ. Bordeaux, Centre de Recherche Cardio-thoracique, INSERM 1219 Epicene Team, Pessac, France
| | - Violaine Giraud
- APHP, Hôpital Ambroise-Paré, Service de Pneumologie et Oncologie thoracique, Boulogne, France
| | - Etienne Giroux-Leprieur
- APHP, Hôpital Ambroise-Paré, Service de Pneumologie et Oncologie thoracique, Boulogne, France.,Univ Paris-Saclay, Université de Versailles-Saint-Quentin (UVSQ), Boulogne, France
| | - Stéfanie Habib
- APHP, Hôpital Cochin, Service de Pneumologie, Université Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Nicolas Roche
- APHP, Hôpital Cochin, Service de Pneumologie, Université Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Anh Tuan Dinh-Xuan
- APHP, Hôpital Cochin, Service de Physiologie et Explorations Fonctionnelles, Université de Paris, Paris, France
| | - Islem Sifaoui
- Département d'Imagerie Médicale, APHP, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | | | - Camille Jung
- Centre Hospitalier Intercommunal, CRC, Créteil, France
| | - Emmanuelle Boutin
- APHP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France.,Univ Paris-Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Richard Layese
- APHP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France.,Univ Paris-Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Florence Canoui-Poitrine
- APHP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France.,Univ Paris-Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France.,APHP, Hôpitaux Universitaires Henri-Mondor, Unité de Recherche Clinique (URC Mondor), Créteil, France.,These two authors contributed equally to this work
| | - Bernard Maitre
- Univ Paris Est-Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France.,Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France.,These two authors contributed equally to this work
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10
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Windsor C, Hua C, De Roux Q, Harrois A, Anguel N, Montravers P, Vieillard-Baron A, Mira JP, Urbina T, Gaudry S, Turpin M, Damoisel C, Annane D, Ricard JD, Hersant B, Dessap AM, Chosidow O, Layese R, de Prost N. Healthcare trajectory of critically ill patients with necrotizing soft tissue infections: a multicenter retrospective cohort study using the clinical data warehouse of Greater Paris University Hospitals. Ann Intensive Care 2022; 12:115. [PMID: 36538244 PMCID: PMC9768077 DOI: 10.1186/s13613-022-01087-5] [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: 09/26/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Necrotizing skin and soft tissue infections (NSTIs) are rare but serious and rapidly progressive infections characterized by necrosis of subcutaneous tissue, fascia and even muscle. The care pathway of patients with NSTIs is poorly understood. A better characterization of the care trajectory of these patients and a better identification of patients at risk of a complicated evolution, requiring prolonged hospitalization, multiple surgical re-interventions, or readmission to the intensive care unit (ICU), is an essential prerequisite to improve their care. The main objective of this study is to obtain large-scale data on the care pathway of these patients. We performed a retrospective multicenter observational cohort study in 13 Great Paris area hospitals, including patients hospitalized between January 1, 2015 and December 31, 2019 in the ICU for surgically confirmed NSTIs. RESULTS 170 patients were included. The median duration of stay in ICU and hospital was 8 (3-17) and 37 (14-71) days, respectively. The median time from admission to first surgical debridement was 1 (0-2) day but 69.9% of patients were re-operated with a median of 1 (0-3) additional debridement. Inter-hospital transfer was necessary in 52.4% of patients. 80.2% of patients developed organ failures during the course of ICU stay with 51.8% of patients requiring invasive mechanical ventilation, 77.2% needing vasopressor support and 27.7% renal replacement therapy. In-ICU and in-hospital mortality rates were 21.8% and 28.8%, respectively. There was no significant difference between patients with abdomino-perineal NSTIs (n = 33) and others (n = 137) in terms of in-hospital or ICU mortality. Yet, immunocompromised patients (n = 43) showed significantly higher ICU and in-hospital mortality rates than non-immunocompromised patients (n = 127) (37.2% vs. 16.5%, p = 0.009, and 53.5% vs. 20.5%, p < 0.001). Factors associated with a complicated course were the presence of a polymicrobial infection (adjusted odds ratio [aOR = 3.18 (1.37-7.35); p = 0.007], of a bacteremia [aOR = 3.29 (1.14-9.52); p = 0.028] and a higher SAPS II score [aOR = 1.05 (1.02-1.07); p < 0.0001]. 62.3% of patients were re-hospitalized within 6 months. CONCLUSION In this retrospective multicenter study, we showed that patients with NSTI required complex management and are major consumers of care. Two-thirds of them underwent a complicated hospital course, associated with a higher SAPS II score, a polymicrobial NSTI and a bacteremia.
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Affiliation(s)
- Camille Windsor
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Camille Hua
- grid.50550.350000 0001 2175 4109Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Quentin De Roux
- grid.412116.10000 0004 1799 3934Département d’anesthésie-Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Anatole Harrois
- grid.413784.d0000 0001 2181 7253Département d’anesthésie-Réanimation, Université Paris Saclay, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Nadia Anguel
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care Medicine, Université Paris Cité, AP-HP, Hôpital Bichat-Claude Bernard; DMU PARABOL, Paris, France ,grid.7429.80000000121866389PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Antoine Vieillard-Baron
- grid.413756.20000 0000 9982 5352Service de Médecine Intensive Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France ,grid.460789.40000 0004 4910 6535CESP, UMR 1018, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Jean-Paul Mira
- grid.411784.f0000 0001 0274 3893Service de Médecine Intensive Réanimation, Hôpital Cochin, 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
| | - Stéphane Gaudry
- grid.413780.90000 0000 8715 2621Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Avicenne, Bobigny, France
| | - Matthieu Turpin
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive Réanimation, Sorbonne Université, AP-HP. Hôpital Tenon, DMU APPROCHES, Paris, France
| | - Charles Damoisel
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Djillali Annane
- grid.413738.a0000 0000 9454 4367Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Jean-Damien Ricard
- grid.414205.60000 0001 0273 556XService de Médecine Intensive Réanimation, Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
| | - Barbara Hersant
- grid.50550.350000 0001 2175 4109Service de Chirurgie Plastique Esthétique et Reconstructrice, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Armand Mekontso Dessap
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Olivier Chosidow
- grid.50550.350000 0001 2175 4109Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Richard Layese
- grid.50550.350000 0001 2175 4109Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.462410.50000 0004 0386 3258Equipe CEpiA (Clinical Epidemiology and Ageing), Université Paris-Est Créteil, INSERM, IMRB, Créteil, France
| | - Nicolas de Prost
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
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11
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Youssov K, Audureau E, Vandendriessche H, Morgado G, Layese R, Goizet C, Verny C, Bourhis ML, Bachoud-Lévi AC. The burden of Huntington's disease: A prospective longitudinal study of patient/caregiver pairs. Parkinsonism Relat Disord 2022; 103:77-84. [DOI: 10.1016/j.parkreldis.2022.08.023] [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] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
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12
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Bataille P, Layese R, Claudepierre P, Paris N, Dubiel J, Amiot A, Sbidian E. Paradoxical reactions and biologic agents: a French cohort study of 9,303 patients. Br J Dermatol 2022; 187:676-683. [PMID: 35770735 DOI: 10.1111/bjd.21716] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/20/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paradoxical reactions (PRs) are defined as the occurrence during biologic therapy of a pathological condition that usually responds to these drugs. OBJECTIVE To estimate the incidence of PRs and identify risk factors. METHODS Multicenter study of the database for the Greater Paris University Hospitals including biological-naïve patients receiving anti-tumor necrosis factor-α, anti-interleukin-12/23, anti-interleukin-17 or anti-α4ß7-integrin agents for psoriasis, inflammatory rheumatism or inflammatory bowel disease (IBD). We used natural language processing algorithms to extract data. A cohort and a case-control study nested in the cohort with controls selected by incidence density sampling was used to identify risk factors. RESULTS Most of the 9,303 included patients (median age 43.0; 53.8% women) presented an IBD (3,773 [40.6%]) or a chronic inflammatory rheumatic disease (3,708 [39.9%]), and 8,487 (91.2%) received anti-TNF-α agents. A total of 293 (3.1%) had a PR. The global incidence rate was 7.6 per 1,000 person-years (95%CI 6.7-8.4). Likelihood of PR was associated with IBD (adjusted OR [aOR] 1.9, 95%CI 1.1-3.2, p=0.021) and a combination of two inflammatory diseases (aOR 6.1, 95%CI 3.6-10.6, p<0.001) and was reduced with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and corticosteroids (aOR 0.6, 95%CI 0.4-0.8, p=0.003; 0.4, 0.2-0.7, p<0.001). CONCLUSION Likelihood of PRs was associated with IBD or a combination of a least two inflammatory diseases. More studies are needed to assess the benefit of systematically adding csDMARDs for such high-risk patients.
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Affiliation(s)
| | - Richard Layese
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010 Creteil, France.,AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, F-94010, France
| | - Pascal Claudepierre
- AP-HP, Hopital Henri-Mondor, Department of Rheumatology, F-94010 Creteil, France
| | - Nicolas Paris
- WIND Department APHP Greater Paris University Hospital
| | - Julien Dubiel
- WIND Department APHP Greater Paris University Hospital
| | - Aurélien Amiot
- AP-HP, Hopital Henri-Mondor, Department of Gastroenterology, F-94010 Creteil, France
| | - Emilie Sbidian
- Univ Paris Est Creteil, EpiDermE, F-94010 Creteil, France.,AP-HP, Hopital Henri-Mondor, Department of Dermatology, F-94010 Creteil, France
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13
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Caeymaex L, Astruc D, Biran V, Marcus L, Flamein F, Le Bouedec S, Guillois B, Remichi R, Harbi F, Durrmeyer X, Casagrande F, Le Saché N, Todorova D, Bilal A, Olivier D, Reynaud A, Jacquin C, Rozé JC, Layese R, Danan C, Jung C, Decobert F, Audureau E. An educational programme in neonatal intensive care units (SEPREVEN): a stepped-wedge, cluster-randomised controlled trial. Lancet 2022; 399:384-392. [PMID: 35065786 DOI: 10.1016/s0140-6736(21)01899-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients in neonatal intensive care units (NICUs) are at high risk of adverse events. The effects of medical and paramedical education programmes to reduce these have not yet been assessed. METHODS In this multicentre, stepped-wedge, cluster-randomised controlled trial done in France, we randomly assigned 12 NICUs to three clusters of four units. Eligible neonates were inpatients in a participating unit for at least 2 days, with a postmenstrual age of 42 weeks or less on admission. Each cluster followed a 4-month multifaceted programme including education about root-cause analysis and care bundles. The primary outcome was the rate of adverse events per 1000 patient-days, measured with a retrospective trigger-tool based chart review masked to allocation of randomly selected files. Analyses used mixed-effects Poisson modelling that adjusted for time. This trial is registered with ClinicalTrials.gov, NCT02598609. FINDINGS Between Nov 23, 2015, and Nov 2, 2017, event rates were analysed for 3454 patients of these 12 NICUs for 65 830 patient-days. The event rate per 1000 patient-days reduced significantly from the control to the intervention period (33·9 vs 22·6; incidence rate ratio 0·67; 95% CI 0·50-0·88; p=0·0048). INTERPRETATION A multiprofessional safety-promoting programme in NICUs reduced the rate of adverse events and severe and preventable adverse events in highly vulnerable patients. This programme could significantly improve care offered to critically ill neonates. FUNDING Solidarity and Health Ministry, France.
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Affiliation(s)
- Laurence Caeymaex
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France; Faculty of Medicine, University Paris Est Creteil, Creteil, France.
| | - Dominique Astruc
- Department of Neonatal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, APHP, CHU Robert Debré, Paris, France; Inserm U1141, Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Leila Marcus
- Neonatal Intensive Care Unit, Centre Hospitalier Universitaire Grenoble, Grenoble, France
| | - Florence Flamein
- Neonatal Intensive Care Unit, CHU Lille, Lille, France; Clinical Investigation Centre, CIC 1403, Lille, France
| | - Stephane Le Bouedec
- Neonatal Intensive Care Unit, Centre Hospitalier Universitaire de Angers, Angers, France
| | - Bernard Guillois
- Neonatal Intensive Care Unit, Centre Hospitalier Universitaire de Caen, Caen, France; Université de Caen Normandie, Caen, France
| | - Radia Remichi
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal Poissy St Germain, Poissy, France
| | - Faiza Harbi
- Neonatal Intensive Care Unit, Centre Hospitalier Delafontaine, St Denis, France
| | - Xavier Durrmeyer
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France; Faculty of Medicine, University Paris Est Creteil, Creteil, France
| | - Florence Casagrande
- Neonatal Intensive Care Unit,Centre Hospitalier Universitaire de Nice, Nice France
| | - Nolwenn Le Saché
- Pediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France; Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Darina Todorova
- Neonatal Intensive Care Unit, Centre Hospitalier René Dubos, Cergy Pontoise, France
| | - Ali Bilal
- Neonatal Intensive Care Unit, Centre Hospitalier de Troyes, Troyes, France
| | - Damien Olivier
- Neonatal Intensive Care Unit, CHU Lille, Lille, France; Neonatal Intensive Care Unit, Centre Hospitalier de Luxembourg, Luxembourg
| | | | - Cécile Jacquin
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | | | - Richard Layese
- INSERM, IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France; Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France
| | - Claude Danan
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Fabrice Decobert
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Etienne Audureau
- INSERM, IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France; Assistance Publique-Hôpitaux de Paris AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), Creteil, France
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14
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Nahon P, Najean M, Layese R, Zarca K, Segar LB, Cagnot C, Ganne-Carrié N, N'Kontchou G, Pol S, Chaffaut C, Carrat F, Ronot M, Audureau E, Durand-Zaleski I. Early hepatocellular carcinoma detection using magnetic resonance imaging is cost-effective in high-risk patients with cirrhosis. JHEP Rep 2022; 4:100390. [PMID: 34977518 PMCID: PMC8683591 DOI: 10.1016/j.jhepr.2021.100390] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022]
Abstract
Background & Aims Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. In this study, we aimed to evaluate the cost-effectiveness of MRI for the detection of very early HCC (Barcelona Clinic Liver Cancer [BCLC] 0) in patients with an annual HCC risk >3%. Methods French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs. ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs. Results Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective. Conclusions In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection. Lay summary The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.
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Key Words
- AFP, alpha-fetoprotein
- AMRI, abbreviated magnetic resonance imaging
- BCLC, Barcelona Clinic Liver Cancer
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- ICER, incremental cost-effectiveness ratio
- LY, life years
- LYG, life years gained
- MRI
- MRI, magnetic resonance imaging
- NAFLD, non-alcoholic fatty liver disease
- QALY, quality-adjusted life year
- RFA, radiofrequency ablation
- SHR, subdistribution hazard ratio
- TACE, transarterial chemoembolization
- US, ultrasound
- cirrhosis
- cost-effectiveness
- liver cancer risk
- surveillance
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny, France.,Université Sorbonne Paris Nord, F-93000 Bobigny, France.,Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Marie Najean
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
| | - Kevin Zarca
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
| | - Laeticia Blampain Segar
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
| | - Carole Cagnot
- Clinical Research Department, ANRS
- Emerging Infectious Diseases, Paris, France
| | - Nathalie Ganne-Carrié
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny, France.,Université Sorbonne Paris Nord, F-93000 Bobigny, France.,Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Gisèle N'Kontchou
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny, France.,Université Sorbonne Paris Nord, F-93000 Bobigny, France.,Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Stanislas Pol
- Université de Paris, département d'hépatologie/Addictologie, Hôpital Cochin, APHP, Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, France.,Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Maxime Ronot
- AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy, France
| | - Etienne Audureau
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
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15
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Aparicio T, Layese R, Hemery F, Tournigand C, Paillaud E, De Angelis N, Quero L, Ganne N, Prat F, Pachev A, Galula G, Benderra MA, Canouï-Poitrine F. Effect of lockdown on digestive system cancer care amongst older patients during the first wave of COVID-19: The CADIGCOVAGE multicentre cohort study. Dig Liver Dis 2022; 54:10-18. [PMID: 34654679 PMCID: PMC8487788 DOI: 10.1016/j.dld.2021.09.017] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and treatment. Most patients newly diagnosed with digestive system cancer are aged 65 and over. METHODS We performed a retrospective, observational, multicentre cohort study based on prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. RESULTS Data on 7882 patients were analysed. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. We do not observe a higher 3-month mortality rate in 2020, relative to the corresponding calendar periods in 2018 and 2019. CONCLUSION To avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. Although 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality.
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Affiliation(s)
- Thomas Aparicio
- AP-HP, Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France,Université de Paris, Paris F-75010, France,Corresponding author at: AP-HP, Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, 1 avenue Claude Vellefaux, Paris F-75010, France
| | - Richard Layese
- AP-HP, Public Health and Clinical Research Department, Henri-Mondor Hospital, Créteil F-94010, France,INSERM, IMRB U955, CEpiA Team, University Paris-Est Créteil, Créteil F-94000, France
| | - François Hemery
- AP-HP, Medical Information Department, Henri-Mondor Hospital, Créteil F-94010, France
| | | | - Elena Paillaud
- INSERM, IMRB U955, CEpiA Team, University Paris-Est Créteil, Créteil F-94000, France,AP-HP, Georges Pompidou Hospital, Geriatric Department, Paris Cancer Institute CARPEM, Paris F-75015, France
| | - Nicola De Angelis
- AP-HP, Henri-Mondor Hospital, Digestive Surgery, Créteil F-94010, France
| | - Laurent Quero
- Université de Paris, Paris F-75010, France,AP-HP, Radiotherapy Department, Saint Louis Hospital, Paris F-75010, France
| | - Nathalie Ganne
- AP-HP, Hepatology Department, Avicenne Hospital, Bobigny F-93000, France
| | - Fredéric Prat
- Université de Paris, Paris F-75010, France,AP-HP, Endoscopy Department, Beaujon Hospital, Clichy F-92110, France
| | - Atanas Pachev
- AP-HP, Radiology Department, Saint Louis Hospital, Paris F-75010, France
| | - Gilles Galula
- AP-HP, Medical Oncology, Tenon Hospital, Paris F-75020, France
| | | | - Florence Canouï-Poitrine
- AP-HP, Public Health and Clinical Research Department, Henri-Mondor Hospital, Créteil F-94010, France,INSERM, IMRB U955, CEpiA Team, University Paris-Est Créteil, Créteil F-94000, France
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16
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Dubois S, Layese R, Languille L, Limal N, guillet S, Crickx E, Guillaud C, Lascu-Dubos G, Khellaf M, Mahevas M, Kini Matondo W, Michel M, Audureau E, Godeau B. Evaluation de la pertinence de la prescription des immunoglobulines par voie intraveineuse dans le purpura thrombopénique immunologique de l’adulte: résultat d’une étude pilote monocentrique portant sur 264 traitements. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.266] [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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17
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Lim P, Delmas C, Sanchez O, Meneveau N, Rosario R, Bouvaist H, Bernard A, Mansourati J, Couturaud F, Sebbane M, Coste P, Rohel G, Tardy B, Biendel C, Lairez O, Ivanes F, Gallet R, Dubois-Rande JL, Fard D, Chatelier G, Simon T, Paul M, Natella PA, Layese R, Bastuji-Garin S. Diuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial. Eur Heart J Acute Cardiovasc Care 2021; 11:2-9. [PMID: 34632490 DOI: 10.1093/ehjacc/zuab082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/01/2021] [Indexed: 11/12/2022]
Abstract
AIMS The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned normotensive patients with intermediate-risk PE to receive either a single 80 mg bolus of furosemide or a placebo. METHODS AND RESULTS Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all sPESI items. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine. A total of 276 patients underwent randomization; 135 were assigned to receive the diuretic, and 141 to receive the placebo. The primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group (relative risk = 1.30, 95% confidence interval 1.04-1.61; P = 0.021). Major adverse outcome at 48 h occurred in 1 (0.8%) patients in the diuretic group and 4 patients (2.9%) in the placebo group (P = 0.19). Increase in serum creatinine level was greater in diuretic than placebo group [+4 µM/L (-2; 14) vs. -1 µM/L (-11; 6), P < 0.001]. CONCLUSION In normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation.ClinicalTrials.gov identifier NCT02268903.
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Affiliation(s)
- Pascal Lim
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | | | - Olivier Sanchez
- Université de Paris, Paris, France.,Division of Respiratory and Intensive Care, AP-HP, Hôpital Europèen Georges Pompidou, Paris, France.,INSERM UMR-S 1140, Innovative Therapies in Haemostasis, Paris, France
| | - Nicolas Meneveau
- Cardiology Department, Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Roger Rosario
- Cardiology Department, Hôpital Saint-Joseph, Marseille, France
| | | | - Anne Bernard
- Cardiology Department, CHU, Tours, France and EA4245, Université de Tours, France
| | - Jacques Mansourati
- Respiratory Department, CHRU de la Cavale Blanche, Brest, France and University Hospital of Brest and UBO (Université de Bretagne Occidentale)
| | - Francis Couturaud
- Respiratory Department, CHRU de la Cavale Blanche, Brest, France and University Hospital of Brest and UBO (Université de Bretagne Occidentale)
| | | | - Pierre Coste
- Cardiology Department, Bordeaux University Hospital, France
| | - Gwenole Rohel
- Cardiology Department, Military Hospital of Clermont Tonnerre, Brest, France
| | - Bernard Tardy
- Emergency Department, CHU Saint Etienne, Saint Pirest en Jarez, France
| | | | | | - Fabrice Ivanes
- Cardiology Department, CHU, Tours, France and EA4245, Université de Tours, France
| | - Romain Gallet
- Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Emergency Department, CHRU Lapeyronie, Montpellier, France
| | - Jean-Luc Dubois-Rande
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Damien Fard
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Gilles Chatelier
- Clinical Research Department, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Tabassome Simon
- Cinical Pharmacology, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Muriel Paul
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,AP-HP Hôpitaux Universitaires Henri-Mondor, Clinical Pharmacology, Créteil F-94010, France
| | - Pierre-André Natella
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Public Health, AP-HP Hôpitaux Universitaires Henri-Mondor, Creteil F-94010, France
| | - Richard Layese
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France
| | - Sylvie Bastuji-Garin
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Public Health, AP-HP Hôpitaux Universitaires Henri-Mondor, Creteil F-94010, France
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18
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Urbina T, Canoui-Poitrine F, Hua C, Layese R, Alves A, Ouedraogo R, Bosc R, Sbidian E, Chosidow O, Dessap AM, de Prost N. Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort study. Ann Intensive Care 2021; 11:102. [PMID: 34213694 PMCID: PMC8253876 DOI: 10.1186/s13613-021-00891-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background Compared to other life-threatening infection survivors, long-term health-related quality of life (QOL) of patients surviving necrotizing soft-tissue infections (NSTI) and its determinants are little known. In this monocentric prospective cohort including NSTI survivors admitted between 2014 and 2017, QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression (HAD), the activity of daily living (ADL), instrumental ADL (IADL) scales and the Impact of Event Scale-Revised (IES-R). The primary outcome measure was the SF-36 physical component summary (PCS). NSTI patients were compared according to intensive care unit (ICU) admission status. ICU survivors were matched on SAPS II with non-NSTI related septic shock survivors. Results Forty-nine NSTI survivors were phone-interviewed and included in the study. Median PCS was decreased compared to the reference population [− 0.97 (− 2.27; − 0.08) SD]. Previous cardiac disease was the only variable associated with PCS alteration [multivariate regression coefficient: − 8.86 (− 17.64; − 0.07), p = 0.048]. Of NSTI survivors, 15.2% had a HAD-D score ≥ 5 and 61.2% an IES-R score ≥ 33. ICU admission was not associated with lower PCS [35.21 (25.49–46.54) versus (vs) 41.82 (24.12–51.01), p = 0.516], but with higher IES-R score [14 (7.5–34) vs 7 (3–18), p = 0.035] and a higher proportion of HAD-D score ≥ 5 (28.6 vs 4.0%, p = 0.036). Compared to non-NSTI septic shock-matched controls, NSTI patients had similar PCS [33.81 (24.58; − 44.39) vs 44.87 (26.71; − 56.01), p = 0.706] but higher HAD-D [3.5 (1–7) vs 3 (1.5–6), p = 0.048] and IES-R scores [18 (8–35) vs 8 (3–19), p = 0.049]. Conclusions Long-term QOL in NSTI survivors is severely impaired, similarly to that of non-NSTI septic shock patients for physical compartments, but with more frequent depressive and/or post-traumatic stress disorders. Only ICU admission and previous cardiac disease were predictive of QOL impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00891-9.
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Affiliation(s)
- Tomas Urbina
- Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-Et-Marie Curie, Paris 6, France.,Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Florence Canoui-Poitrine
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Camille Hua
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Richard Layese
- Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Aline Alves
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Rachida Ouedraogo
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Romain Bosc
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.,Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.,Biology of the NeuroMuscular System, INSERM Team U955-E10, Paris East University, 94000, Créteil, France
| | - Emilie Sbidian
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France.,Centre D'Investigation Clinique 1430, Inserm, 94010, Créteil, France
| | - Olivier Chosidow
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France. .,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France. .,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.
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Xu E, Kachenoura N, Della Valle V, Dubern B, Karsenty A, Tounian P, Dacher JN, Layese R, Lamy J, Ducou le Pointe H, Redheuil A, Blondiaux E. Multichamber Dysfunction in Children and Adolescents With Severe Obesity: A Cardiac Magnetic Resonance Imaging Myocardial Strain Study. J Magn Reson Imaging 2021; 54:1393-1403. [PMID: 34155711 DOI: 10.1002/jmri.27796] [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: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In severe obesity, left ventricular (LV) and right ventricular (RV) remodeling and contractile dysfunction have been documented, but less is known regarding left atrial (LA) dysfunction and its association with LV/RV remodeling, especially in children. PURPOSE To assess the effects of severe childhood obesity on cardiac function by using multichamber strain analysis with MRI. STUDY TYPE Prospective. SUBJECTS Forty-five children aged 7-18 years (including 20 with severe obesity, defined as a body mass index values above the 99th percentile). FIELD STRENGTH 5 T. SEQUENCE Steady-state-free-precession (SSFP) images in short-axis views and longitudinal two- and four-chamber views. ASSESSMENT Cardiac strain measurements were derived from standard SSFP cine images by using a dedicated MR imaging feature tracking software. Inter- and intra-rater reliability were evaluated. STATISTICAL TESTS Independent sample t test, Spearman's correlation coefficient, principal component analysis, Bland-Altman analysis, and intra-class correlation coefficients (ICC). A P value <0.05 was considered statistically significant. RESULTS As compared to children without obesity, those with obesity showed significantly reduced LA reservoir function (22.2% ± 6.4% vs. 33.8% ± 9.0%) and contractile function (5.4% ± 3.2% vs. 13.3% ± 8.0%) as well as significantly decreased absolute values for LA longitudinal strain in reservoir and contraction phases and LA radial motion fraction in reservoir and contraction phases. Children with severe obesity showed significantly reduced absolute RV radial motion fraction (-10.6% ± 2.9% vs. -18.2% ± 2.9%) and circumferential strain (-10.6% ± 2.9% vs. -16% ± 2.5%) as well as higher LV mass index (28.7% ± 5.1% vs. 21.7 ± 4.6 g/m2 ) along with significantly reduced LV ejection fraction (56.4% ± 3.9% vs. 60% ± 4.1%), LV radial strain (56% ± 6% vs. 61.8% ± 11.3%), and longitudinal strain (-17.8% ± 1.8% vs. -20.3% ± 3.2%). Reliability was good to excellent, with ICC ranging from 79.1% to 97.7%. DATA CONCLUSION MR feature-tracking strain analysis revealed multichamber dysfunction in severely obese children with impaired LA reservoir and atrial contraction phases, which suggest an early loss in the compensatory ability of atrial contraction with severe obesity. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Eric Xu
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France
| | - Valeria Della Valle
- Department of Radiology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Béatrice Dubern
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Alexandra Karsenty
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Patrick Tounian
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | | | - Richard Layese
- Unité de Recherche Clinique, Henri Mondor Hospital, AP-HP and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), Unit EA4393, UPEC, Créteil, France
| | - Jérôme Lamy
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France
| | | | - Alban Redheuil
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France.,Cardiovascular and Thoracic Imaging Unit (ICT), Institute of Cardiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Eléonore Blondiaux
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Department of Radiology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
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20
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Ganne-Carrié N, Nahon P, Chaffaut C, N’Kontchou G, Layese R, Audureau E, Chevret S. Impact of cirrhosis aetiology on incidence and prognosis of hepatocellular carcinoma diagnosed during surveillance. JHEP Rep 2021; 3:100285. [PMID: 34522876 PMCID: PMC8424277 DOI: 10.1016/j.jhepr.2021.100285] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS In this study we aimed to analyse the impact of the aetiology of cirrhosis on the incidence, characteristics and prognosis of hepatocellular carcinoma (HCC) diagnosed during a surveillance program. METHODS Individual data from a randomized trial and 2 prospective cohorts of patients with compensated histologically proven cirrhosis recruited between 2000 and 2016 were pooled. The influence of cirrhosis aetiology on survival after HCC detection was assessed using multivariable regression models. RESULTS Among 3,533 patients (1,926 virus [VIR], 1,167 alcohol [ALC], 440 combined [MIX]), 431 were diagnosed with HCC after a median follow-up of 57.1 months. The 5-year HCC incidence was lowest in ALC (VIR 12.6%, ALC 9.1%, MIX 14.3%, p = 0.04). At the time of diagnosis, tumour burden and Child-Pugh score were comparable across aetiology groups, but early BCLC stages (0/A) were significantly less frequent in ALC (VIR 80%, ALC 37%, MIX 72%) as a result of worse ECOG performance status. However, similar access to first-line curative HCC treatment was reported across aetiology groups (p = 0.68). Median survival after HCC diagnosis was significantly reduced in ALC (VIR 39, ALC 21, MIX 34 months, p = 0.02). However, when adjusting for tumour size, ECOG and Child-Pugh score, the aetiology of the underlying cirrhosis no longer had a significant impact. CONCLUSION Compared to patients with virus-related cirrhosis, patients with alcohol-related compensated cirrhosis enrolled in a surveillance program have: i) the lowest 5-year HCC incidence; ii) worse overall prognosis, mostly driven by a poor general condition, despite similar access to first-line curative treatment. LAY SUMMARY It has been suggested that early detection of hepatocellular carcinoma (HCC) may be futile in patients with alcohol-related cirrhosis. By comparing outcomes in more than 3,000 patients with compensated cirrhosis included in surveillance programs, this study suggests that HCC surveillance enables early diagnosis in most patients with alcohol-related cirrhosis despite a higher competing risk of death in these patients. We also report similar access to first-line curative HCC treatment in these patients compared to those with viral cirrhosis, despite higher rates of comorbidities and impaired liver function. Following HCC detection, the later parameters were major drivers of death irrespective of the cause of cirrhosis. REGISTRATION CHC2000 (NCT00190385) and CIRRAL (NCT01213927) cohorts were registered at ClinicalTrials.gov and the full protocols are available at the following links (https://clinicaltrials.gov/ct2/show/NCT00190385) and https://clinicaltrials.gov/ct2/show/NCT01213927, respectively). The full CirVir protocol is available via the ANRS Web site (http://anrs.fr).
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Affiliation(s)
- Nathalie Ganne-Carrié
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, APHP, Liver Unit, Bobigny, France
- Université Sorbonne Paris Nord, F-93000 Bobigny, France
- Inserm, UMR–1138 «Functional Genomics of solid tumors», Centre de recherche des Cordeliers, Université de Paris, France
| | - Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, APHP, Liver Unit, Bobigny, France
- Université Sorbonne Paris Nord, F-93000 Bobigny, France
- Inserm, UMR–1138 «Functional Genomics of solid tumors», Centre de recherche des Cordeliers, Université de Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Gisèle N’Kontchou
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, APHP, Liver Unit, Bobigny, France
| | - Richard Layese
- Santé publique, APHP, hôpital Henri Mondor; Clinical Epidemiology and Ageing EA7376 UPEC, Créteil, France
| | - Etienne Audureau
- Santé publique, APHP, hôpital Henri Mondor; Clinical Epidemiology and Ageing EA7376 UPEC, Créteil, France
| | - Sylvie Chevret
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRA Team, Paris, France
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21
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Kempf E, Lamé G, Layese R, Priou S, Chatellier G, Chaieb H, Benderra MA, Bellamine A, Bey R, Bréant S, Galula G, Taright N, Tannier X, Guyet T, Salamanca E, Audureau E, Daniel C, Tournigand C. New cancer cases at the time of SARS-Cov2 pandemic and related public health policies: A persistent and concerning decrease long after the end of the national lockdown. Eur J Cancer 2021; 150:260-267. [PMID: 33940350 PMCID: PMC7904473 DOI: 10.1016/j.ejca.2021.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The dissemination of SARS-Cov2 may have delayed the diagnosis of new cancers. This study aimed at assessing the number of new cancers during and after the lockdown. METHODS We prospectively collected the clinical data of the 11.4 million patients referred to the Assistance Publique Hôpitaux de Paris Teaching Hospital. We identified new cancer cases between 1st January 2018 and 31st September 2020 and compared indicators for 2018 and 2019 to 2020 with a focus on the French lockdown (17th March to 11th May 2020) across cancer types and patient age classes. RESULTS Between January and September, 28,348, 27,272 and 23,734 new cancer cases were identified in 2018, 2019 and 2020, respectively. The monthly median number of new cases reached 3168 (interquartile range, IQR, 3027; 3282), 3054 (IQR 2945; 3127) and 2723 (IQR 2085; 2,863) in 2018, 2019 and 2020, respectively. From March 1st to May 31st, new cancer decreased by 30% in 2020 compared to the 2018-19 average; then by 9% from 1st June to 31st September. This evolution was consistent across all tumour types: -30% and -9% for colon, -27% and -6% for lung, -29% and -14% for breast, -33% and -12% for prostate cancers, respectively. For patients aged <70 years, the decrease of colorectal and breast new cancers in April between 2018 and 2019 average and 2020 reached 41% and 39%, respectively. CONCLUSION The SARS-Cov2 pandemic led to a substantial decrease in new cancer cases. Delays in cancer diagnoses may affect clinical outcomes in the coming years.
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Affiliation(s)
- Emmanuelle Kempf
- Assistance Publique - Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France.
| | - Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Richard Layese
- Université Paris Est Créteil, INSERM, IMRB, CEpiA Team, Assistance Publique - Hôpitaux de Paris, Clinical Research Unit, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Sonia Priou
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Gilles Chatellier
- Université de Paris, Department of Medical Informatics, Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Paris, F-75015, France
| | - Hedi Chaieb
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Marc-Antoine Benderra
- Assistance Publique - Hôpitaux de Paris, Department of Medical Oncology, Tenon Teaching Hospital, Paris, France
| | - Ali Bellamine
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Romain Bey
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Stéphane Bréant
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Gilles Galula
- Assistance Publique - Hôpitaux de Paris, Head Office, Department of Chronic Diseases and Cancer, Paris, France
| | - Namik Taright
- Assistance Publique - Hôpitaux de Paris, Head Office, Department of Medical Information, Paris, France
| | - Xavier Tannier
- Sorbonne Université, Laboratoire D'informatique Médicale et D'ingénierie des Connaissances en e-Santé, Paris, France
| | - Thomas Guyet
- Agrocampus-Ouest / IRISA - Inria, Rennes, France
| | - Elisa Salamanca
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Etienne Audureau
- Université Paris Est Créteil, INSERM, IMRB, CEpiA Team, Assistance Publique - Hôpitaux de Paris, Clinical Research Unit, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Christel Daniel
- Assistance Publique - Hôpitaux de Paris, IT System Department, Paris, France
| | - Christophe Tournigand
- Université Paris Est Créteil, INSERM, IMRB, Assistance Publique - Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
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22
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Nahon P, Layese R, Cagnot C, Asselah T, Guyader D, Pol S, Pageaux GP, De Lédinghen V, Ouzan D, Zoulim F, Audureau E. HCV Eradication in Primary or Secondary Prevention Optimizes Hepatocellular Carcinoma Curative Management. Cancer Prev Res (Phila) 2021; 14:581-592. [PMID: 33608313 DOI: 10.1158/1940-6207.capr-20-0465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 01/13/2023]
Abstract
To assess the impact of HCV eradication on the outcomes of cirrhotic patients treated curatively for incidental hepatocellular carcinoma (HCC) detected during surveillance program. Data were collected on 1,323 French patients with compensated biopsy-proven HCV cirrhosis recruited in 35 centers (ANRS CO12 CirVir cohort). Sustained virologic responses (SVR) and the occurrence of HCC were recorded prospectively. During a median follow-up of 68.3 months, 218 patients developed HCC, 126 of whom underwent a curative procedure as first-line therapy (ablation = 95, resection = 31). The HCC BCLC stage was 0/A in 97.5% of patients; 74 (58.7%) never achieved SVR. During a median follow-up of 26.0 months after HCC treatment, 59 (46.8%) experienced HCC recurrence. SVR was not associated with a recurrence, whether considering final SVR status [HR = 0.77; 95% confidence interval (95% CI), 0.43-1.39; P = 0.39] or its time to achievement (prior to/after HCC occurrence; global P = 0.28). During the same timeframe, 46 patients with HCC (36.5%) died (liver failure: 41.9%, HCC progression: 37.2%, extrahepatic causes: 20.9%). Under multivariate analysis, SVR was associated with improved survival [HR = 0.21; 95% CI, 0.08-0.52; P = 0.001]. Survival benefit was explained by a lower incidence of liver decompensation and higher rates of sequential HCC re-treatment. Direct antiviral intake was not associated with a higher risk of HCC recurrence, but with improved survival (HR = 0.23; 95% CI, 0.06-0.83; P = 0.024). HCV eradication in primary or secondary prevention optimizes HCC management through preservation of liver function and improves survival, whatever the regimen. PREVENTION RELEVANCE: Liver failure is a competing risk of death in patients with HCC eligible for curative procedures. HCV eradication does not decrease risk of HCC recurrence in the first two years, but enables sequential curative HCC treatments through preservation of liver function. Direct-acting antiviral agent intake is not associated with HCC recurrence and improves survival.
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Affiliation(s)
- Pierre Nahon
- Service d'Hépatologie, Hôpital Avicenne, AP-HP, Bobigny, France. .,Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis, France.,Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | - Richard Layese
- Département de Santé Publique, Hôpital Henri Mondor, AP-HP and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France REcherche Nord et sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Tarik Asselah
- Service d'Hépatologie, Hôpital Beaujon, AP-HP and University Paris Diderot, Sorbonne Paris Cité, CRI, UMR 1149, Paris, France
| | | | - Stanislas Pol
- Département d'Hépatologie, Hôpital Cochin, AP-HP, Paris, France.,Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Service d'Hépatologie, Institut Arnaud Tzanck, St Laurent du Var, Nice, France
| | - Fabien Zoulim
- Service d'Hépatologie et Université de Lyon, Hospices Civils de Lyon, Lyon, France
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23
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Bataille P, Layese R, Amiot A, Claudepierre P, Sbidian E. Incidence des réactions paradoxales chez les patients débutant un biomédicament : étude de cohorte de 9303 patients. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.047] [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: 11/30/2022]
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24
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Audureau E, Carrat F, Layese R, Cagnot C, Asselah T, Guyader D, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Chazouillères O, Mallat A, Grangé JD, Attali P, d'Alteroche L, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Pol S, Nahon P. Personalized surveillance for hepatocellular carcinoma in cirrhosis - using machine learning adapted to HCV status. J Hepatol 2020; 73:1434-1445. [PMID: 32615276 DOI: 10.1016/j.jhep.2020.05.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 11/17/2019] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Refining hepatocellular carcinoma (HCC) surveillance programs requires improved individual risk prediction. Thus, we aimed to develop algorithms based on machine learning approaches to predict the risk of HCC more accurately in patients with HCV-related cirrhosis, according to their virological status. METHODS Patients with compensated biopsy-proven HCV-related cirrhosis from the French ANRS CO12 CirVir cohort were included in a semi-annual HCC surveillance program. Three prognostic models for HCC occurrence were built, using (i) Fine-Gray regression as a benchmark, (ii) single decision tree (DT), and (iii) random survival forest for competing risks survival (RSF). Model performance was evaluated from C-indexes validated externally in the ANRS CO22 Hepather cohort (n = 668 enrolled between 08/2012-01/2014). RESULTS Out of 836 patients analyzed, 156 (19%) developed HCC and 434 (52%) achieved sustained virological response (SVR) (median follow-up 63 months). Fine-Gray regression models identified 6 independent predictors of HCC occurrence in patients before SVR (past excessive alcohol intake, genotype 1, elevated AFP and GGT, low platelet count and albuminemia) and 3 in patients after SVR (elevated AST, low platelet count and shorter prothrombin time). DT analysis confirmed these associations but revealed more complex interactions, yielding 8 patient groups with varying cancer risks and predictors depending on SVR achievement. On RSF analysis, the most important predictors of HCC varied by SVR status (non-SVR: platelet count, GGT, AFP and albuminemia; SVR: prothrombin time, ALT, age and platelet count). Externally validated C-indexes before/after SVR were 0.64/0.64 [Fine-Gray], 0.60/62 [DT] and 0.71/0.70 [RSF]. CONCLUSIONS Risk factors for hepatocarcinogenesis differ according to SVR status. Machine learning algorithms can refine HCC risk assessment by revealing complex interactions between cancer predictors. Such approaches could be used to develop more cost-effective tailored surveillance programs. LAY SUMMARY Patients with HCV-related cirrhosis must be included in liver cancer surveillance programs, which rely on ultrasound examination every 6 months. Hepatocellular carcinoma (HCC) screening is hampered by sensitivity issues, leading to late cancer diagnoses in a substantial number of patients. Refining surveillance periodicity and modality using more sophisticated imaging techniques such as MRI may only be cost-effective in patients with the highest HCC incidence. Herein, we demonstrate how machine learning algorithms (i.e. data-driven mathematical models to make predictions or decisions), can refine individualized risk prediction.
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Affiliation(s)
- Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Fabrice Carrat
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH)
| | - Tarik Asselah
- AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy
| | | | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie; INSERM U1052 - CRCL; Université de Lyon, Lyon
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice
| | | | | | | | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse
| | | | | | - Jean-Frédéric Blanc
- Hôpital St André, Service d'Hépatologie, Bordeaux et Hôpital Haut-Lévêque, CHU Bordeaux, 33604 Pessac
| | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | - Olivier Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, and Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, Paris
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | | | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206 Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000, Paris, France.
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Roulot D, Brichler S, Layese R, BenAbdesselam Z, Zoulim F, Thibault V, Scholtes C, Roche B, Castelnau C, Poynard T, Chazouillères O, Ganne N, Fontaine H, Gournay J, Guyader D, Le Gal F, Nahon P, Roudot-Thoraval F, Gordien E, Landman R, Hezode C, Riachi G, Lascoux-Combe C, Loustaud-Ratti V, Rosa I, Mathurin P, Nguyen-Khac E, Causse X, Naveau S, Habersetzer F, Metivier S, Labadie H, Sellier P, Bottero J, de Ledinghen V, Alric L, Calès P, Goujard C, Cadranel JF, Salmon D, Hillaire S. Origin, HDV genotype and persistent viremia determine outcome and treatment response in patients with chronic hepatitis delta. J Hepatol 2020; 73:1046-1062. [PMID: 32634548 DOI: 10.1016/j.jhep.2020.06.038] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [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: 08/29/2019] [Revised: 06/04/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS HDV infection causes severe chronic liver disease in individuals infected with HBV. However, the factors associated with poor prognosis are largely unknown. Thus, we aimed to identify prognostic factors in patients with HDV infection. METHODS The French National Reference Centre for HDV performed a nationwide retrospective study on 1,112 HDV-infected patients, collecting epidemiological, clinical, virological and histological data from the initial referral to the last recorded follow-up. RESULTS The median age of our cohort was 36.5 (29.9-43.2) years and 68.6% of our cohort were male. Most patients whose birthplace was known were immigrants from sub-Saharan Africa (52.5%), southern and eastern Europe (21.3%), northern Africa and the Middle East (6.2%), Asia (5.9%) and South America (0.3%). Only 150 patients (13.8%) were French native. HDV load was positive in 659 of 748 tested patients (88.1%). HDV-1 was predominant (75.9%), followed by sub-Saharan genotypes: HDV-5 (17.6%), HDV-7 (2.9%), HDV-6 (1.8%) and HDV-8 (1.6%). At referral, 312 patients (28.2%) had cirrhosis, half having experienced at least 1 episode of hepatic decompensation. Cirrhosis was significantly less frequent in African than in European patients regardless of HDV genotype. At the end of follow-up (median 3.0 [0.8-7.2] years), 48.8% of the patients had developed cirrhosis, 24.2% had ≥1 episode(s) of decompensation and 9.2% had hepatocellular carcinoma. European HDV-1 and African HDV-5 patients were more at risk of developing cirrhosis. Persistent replicative HDV infection was associated with decompensation, hepatocellular carcinoma and death. African patients displayed better response to interferon therapy than non-African patients (46.4% vs. 29.1%, p <0.001). HDV viral load at baseline was significantly lower in responders than in non-responders. CONCLUSION Place of birth, HDV genotype and persistent viremia constitute the main determinants of liver involvement and response to treatment in chronic HDV-infected patients. LAY SUMMARY Chronic liver infection by hepatitis delta virus (HDV) is the most severe form of chronic viral hepatitis. Despite the fact that at least 15-20 million people are chronically infected by HDV worldwide, factors determining the severity of liver involvement are largely unknown. By investigating a large cohort of 1,112 HDV-infected patients followed-up in France, but coming from different areas of the world, we were able to determine that HDV genotype, place of birth (reflecting both viral and host-related factors) and persistent viremia constitute the main determinants of liver involvement and response to treatment.
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Affiliation(s)
- Dominique Roulot
- AP-HP, Hôpital Avicenne, Unité d'hépatologie, Université Paris 13, Bobigny; Inserm U955, équipe 18, Université Paris-Est, Créteil.
| | - Ségolène Brichler
- AP-HP, Hôpital Avicenne, Laboratoire de microbiologie clinique, Université Paris 13, Centre national de référence des hépatites B, C et Delta, Bobigny, Inserm U955, équipe 18, Université Paris-Est, Créteil
| | - Richard Layese
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil
| | - Zahia BenAbdesselam
- AP-HP, Hôpital Avicenne, Unité d'hépatologie et Centre de Recherche Clinique, Bobigny
| | - Fabien Zoulim
- Hospices civils de Lyon, Hôpital Croix Rousse, Service d'hépatologie; Inserm U1052; Université de Lyon
| | | | - Caroline Scholtes
- Hospices civils de Lyon, Hôpital Croix Rousse, Département de virologie, Université de Lyon
| | - Bruno Roche
- AP-HP, Hopital Paul Brousse, Service d'hépatologie, Villejuif
| | | | - Thierry Poynard
- AP-HP, Groupe hospitalier Pitié-Salpêtriere, Service d'hépatologie, Sorbonne Université, Paris
| | - Olivier Chazouillères
- AP-HP, Hopital Saint-Antoine, Service d'hépatologie et Centre de Recherche, Inserm, Sorbonne Université, Paris
| | - Nathalie Ganne
- AP-HP, Hôpital Jean-Verdier, Service d'hépatologie, Bondy, Université Paris 13, Bobigny; Inserm U1162, Université Paris 5, Paris
| | | | - Jerome Gournay
- CHU de Nantes, Hopital Hôtel Dieu, Département d'hépatogastroentérologie, Nantes
| | | | - Frédéric Le Gal
- AP-HP, Hôpital Avicenne, Laboratoire de microbiologie clinique, Université Paris 13, Centre national de référence des hépatites B, C et Delta, Bobigny, Inserm U955, équipe 18, Université Paris-Est, Créteil
| | - Pierre Nahon
- AP-HP, Hôpital Jean-Verdier, Service d'hépatologie, Bondy, Université Paris 13, Bobigny; Inserm U1162, Université Paris 5, Paris
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Créteil; AP-HP, Hôpital Henri-Mondor, Service d'hépatologie, Créteil
| | - Emmanuel Gordien
- AP-HP, Hôpital Avicenne, Laboratoire de microbiologie clinique, Université Paris 13, Centre national de référence des hépatites B, C et Delta, Bobigny, Inserm U955, équipe 18, Université Paris-Est, Créteil
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Zarski JP, David-Tchouda S, Trocme C, Margier J, Vilotitch A, Hilleret MN, Cagnot C, Boursier V, Ziol M, Sutton A, Layese R, Audureau E, Roudot-Thoraval F, Nahon P. Non-invasive fibrosis tests to predict complications in compensated post-hepatitis C cirrhosis. Clin Res Hepatol Gastroenterol 2020; 44:524-531. [PMID: 31839535 DOI: 10.1016/j.clinre.2019.11.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Markers predicting complications of post-hepatitis C cirrhosis are needed. We asked whether changes in noninvasive markers of fibrosis can predict liver-related complications. METHODS This was a case-controlled study using a prospective national cohort (ANRS-CO12-CIRVIR) of 1323 HCV-infected patients with compensated cirrhosis: 97 patients who developed liver-related complications such as hepatocellular carcinoma or hepatic decompensation (cases) matched in age, sex and follow-up duration were compared with 257 patients without complications (controls). Actitest/Fibrotest™, Inflameter/Fibrometer™, ELF™ and Fibroscan™ were performed at baseline and yearly. Samples based on Propensity score matching were built and mixed linear models performed. Outcomes in a sustained virological response (SVR) negative population and a SVR-positive population were also described. RESULTS At baseline, all characteristics of patients were similar between the groups. All fibrosis tests were statistically higher for cases compared to controls, Fibroscan™ excepted: Fibrotest™: 0.83±0.13 vs. 0.77±0.16; Fibrometer™: 0.93±0.07 vs. 0.90±0.11; ELF™: 11.4±1.0 vs. 11.0±1.2 (P<0.02). The mean follow-up was 5.7±1.9 years. Over a 3-year period, the significant difference in fibrosis marker values between cases and controls remained constant; with a trend toward a decrease in inflammation markers in controls, independent of SVR status. CONCLUSIONS Baseline noninvasive serum fibrosis and inflammation markers were significantly higher in patients developing a complication than in controls. During the follow-up only inflammatory markers decreased in controls, but not in cases, and thus could potentially be used to predict the occurrence of complications in cirrhotic patients.
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Affiliation(s)
- Jean-Pierre Zarski
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France.
| | - Sandra David-Tchouda
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Candice Trocme
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Jennifer Margier
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Antoine Vilotitch
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | | | - Carole Cagnot
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Valerie Boursier
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Marianne Ziol
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Angela Sutton
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Richard Layese
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Etienne Audureau
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | | | - Pierre Nahon
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
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Contou D, Canoui-Poitrine F, Coudroy R, Préau S, Cour M, Barbier F, Terzi N, Schnell G, Galbois A, Zafrani L, Zuber B, Ehrmann S, Gelisse E, Colling D, Schmidt M, Jaber S, Conia A, Sonneville R, Colin G, Guérin L, Roux D, Jochmans S, Kentish-Barnes N, Audureau E, Layese R, Alves A, Ouedraogo R, Brun-Buisson C, Mekontso Dessap A, de Prost N, Barbier F, Bazire A, Béduneau G, Bellec F, Beuret P, Blanc P, Bruel C, Brun-Buisson C, Colin G, Colling D, Conia A, Coudroy R, Cour M, Contou D, Daviaud F, Das V, Dellamonica J, Demars N, Ehrmann S, Galbois A, Gelisse E, Grouille J, Guérin L, Guérot E, Jaber S, Jannière C, Jochmans S, Jozwiak M, Kalfon P, Kimmoun A, Lautrette A, Layese R, Lemarié J, Le Moal C, Lenclud C, Lerolle N, Leroy O, Marchalot A, Mégarbane B, Mekontso Dessap A, de Montmollin E, Pène F, Pichereau C, Plantefève G, Préau S, Preda G, de Prost N, Quenot JP, Ricome S, Roux D, Sauneuf B, Schmidt M, Schnell G, Sonneville R, Tadié JM, Tandjaoui Y, Tchir M, Terzi N, Valette X, Zafrani L, Zuber B. Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study. Clin Infect Dis 2020; 69:332-340. [PMID: 30335142 DOI: 10.1093/cid/ciy901] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/11/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated. METHODS This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale-Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire. RESULTS Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35-83) months and 44 (IQR, 35-72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36-53] vs 54 [IQR, 36-57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24-38] vs 52 [IQR, 42-56]; P = .001) and IADL scores (7 [IQR, 4-8] vs 8 [IQR, 7-8]; P = .021) compared with nonamputated patients. CONCLUSIONS Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health. CLINICAL TRIALS REGISTRATION NCT03216577.
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Affiliation(s)
- Damien Contou
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.,Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil.,Groupe de Recherche Clinique Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis (CARMAS), Université Paris Est-Créteil
| | - Florence Canoui-Poitrine
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP.,Université Paris-Est, Clinical Epidemiology and Aging Unit, Créteil
| | - Rémi Coudroy
- Service de réanimation médicale, Centre Hospitalier Universitaire de Poitiers, Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d'Investigation Clinique 1402, Acute Lung Injury and Ventilation Group, Université de Poitiers
| | - Sébastien Préau
- Service de réanimation médicale, Centre hospitalier régional universitaire de Lille
| | - Martin Cour
- Réanimation Médicale, Hospices Civils de Lyon-Groupement Hospitalier Edouard Herriot
| | - François Barbier
- Service de réanimation médicale, Centre Hospitalier Régional d'Orléans
| | - Nicolas Terzi
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche
| | - Guillaume Schnell
- Service de réanimation médico-chirurgicale, Groupe Hospitalier Le Havre
| | - Arnaud Galbois
- Service de réanimation médico-chirurgicale, Hôpital Claude Galien, Quincy-sous-Sénart
| | - Lara Zafrani
- Service de réanimation médicale, Hôpital Saint-Louis, AP-HP, Paris
| | - Benjamin Zuber
- Service de réanimation médico-chirurgicale, Centre Hospitalier André Mignot, Le Chesnay
| | - Stephan Ehrmann
- Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire, Tours
| | - Elodie Gelisse
- Service de réanimation médico-chirurgicale, Centre Hospitalier Universitaire de Reims
| | - Delphine Colling
- Service de réanimation médico-chirurgicale, Centre hospitalier de Roubaix
| | - Matthieu Schmidt
- Service de Réanimation médicale, Centre Hospitalier Universitaire Pitié-Salpétrière, AP-HP, Paris
| | - Samir Jaber
- Service de Réanimation médico-chirurgicale, Centre Hospitalier Universitaire de Montpellier
| | - Alexandre Conia
- Service de Réanimation médico-chirurgicale, Centre Hospitalier de Chartres
| | - Romain Sonneville
- Service de Réanimation Médicale, Hôpital Bichat Claude Bernard, AP-HP, Paris
| | - Gwenhaël Colin
- Service de réanimation médico-chirurgicale, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon
| | - Laurent Guérin
- Service de réanimation médico-chirurgicale, Hôpital Ambroise Paré, Boulogne-Billancourt
| | - Damien Roux
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Louis Mourier, AP-HP, Colombes
| | | | | | - Etienne Audureau
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP.,Université Paris-Est, Clinical Epidemiology and Aging Unit, Créteil
| | - Richard Layese
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP.,Université Paris-Est, Clinical Epidemiology and Aging Unit, Créteil
| | - Aline Alves
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil
| | - Rachida Ouedraogo
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil
| | - Christian Brun-Buisson
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil
| | - Armand Mekontso Dessap
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.,Groupe de Recherche Clinique Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis (CARMAS), Université Paris Est-Créteil
| | - Nicolas de Prost
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.,Groupe de Recherche Clinique Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis (CARMAS), Université Paris Est-Créteil
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Salmon Ceron D, Bartier S, Hautefort C, Nguyen Y, Nevoux J, Hamel AL, Camhi Y, Canouï-Poitrine F, Verillaud B, Slama D, Haim-Boukobza S, Sourdeau E, Cantin D, Corré A, Bryn A, Etienne N, Rozenberg F, Layese R, Papon JF, Bequignon E. Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study. J Infect 2020; 81:614-620. [PMID: 32650110 PMCID: PMC7338860 DOI: 10.1016/j.jinf.2020.07.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 05/14/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/23/2022]
Abstract
Isolated loss of smell without nasal obstruction is an early red-flag of COVID-19. These patients should adopt all the preventive measures and a lockdown. Olfactory/gustative dysfunction had high predictive value to identify COVID-19. Olfactory/gustative dysfunction had high specificity to identify COVID-19. Self-reported loss of smell, among other symptoms, could help to screen COVID-19.
Objectives To determine the frequency of SARS-CoV-2 positive samples in a subset of patients consulting for primarily isolated acute (<7 days) loss of smell and to assess the diagnostic accuracy of olfactory/gustatory dysfunction for COVID-19 diagnosis in the overall population tested for COVID-19 in the same period. Methods Prospective multicentric cohort study in four olfactory ENT units and a screening center for COVID-19. Results i) Among a subset of 55 patients consulting for primarily recent loss of smell, we found that 51 (92.7%) had a COVID-19 positive test (median viral load of 28.8 cycle threshold). Loss of smell was mostly total (anosmia), rarely associated with nasal obstruction but associated with a taste disorder in 80%. Olfactory dysfunction occurred suddenly, either as first complaint or preceded by mild symptoms occurring a median of 3 days. The majority of patients (72.9%) partially recovered the sense of smell within 15 days. ii) In a population of 1824 patients tested for COVID-19, the positive predictive value and the specificity of loss of smell and/or taste were 78.5% and 90.3% respectively (sensitivity (40.8%), negative predictive value (63.6%)). Conclusions Self-reported loss of smell had a high predictive positive value to identify COVID-19. Making this sign well known publicly could help to adopt isolation measures and inform potential contacts.
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Affiliation(s)
- Dominique Salmon Ceron
- Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France; University of Paris, School of Medicine, Paris 75005, France.
| | - Sophie Bartier
- Department of Oto-rhino-laryngology, Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil 94000, France; University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Department of Oto-rhino-laryngology, Henri Mondor Hospital of Créteil, Paris Public Hospitals, Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France
| | - Charlotte Hautefort
- Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Lariboisière Hospital (APHP), Paris 75010, France; University Paris Diderot, School of Medicine, Paris 75010, France
| | - Yann Nguyen
- Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France; Sorbonne University, Paris 75013, France
| | - Jérôme Nevoux
- Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France
| | - Anne-Laure Hamel
- Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Lariboisière Hospital (APHP), Paris 75010, France; University Paris Diderot, School of Medicine, Paris 75010, France
| | - Yohan Camhi
- Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France
| | - Florence Canouï-Poitrine
- University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Clinical Research Unit: (URC-Mondor), Department of Public Health, Henri Mondor Hospital Paris Public Hospitals (AP-HP), Créteil 94000, France
| | - Benjamin Verillaud
- Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Lariboisière Hospital (APHP), Paris 75010, France; University Paris Diderot, School of Medicine, Paris 75010, France
| | - Dorsaf Slama
- Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France
| | | | - Elise Sourdeau
- Emergency Department, Hotel Dieu Hospital, Paris Public Hospitals (APHP), Paris 75004, France
| | - Delphine Cantin
- Emergency Department, Hotel Dieu Hospital, Paris Public Hospitals (APHP), Paris 75004, France
| | - Alain Corré
- Department of Oto-rhino-laryngology Head and Neck Surgery, Hopital Rothschild Foundation, Paris, France
| | - Agnes Bryn
- University of Paris, School of Medicine, Paris 75005, France; General Medical Practioner, Paris, France
| | - Nicolas Etienne
- Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France
| | - Flore Rozenberg
- University of Paris, School of Medicine, Paris 75005, France; Virology Department, Cochin Hospital, Paris Public Hospitals (APHP), Paris 75004, France
| | - Richard Layese
- University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Clinical Research Unit: (URC-Mondor), Department of Public Health, Henri Mondor Hospital Paris Public Hospitals (AP-HP), Créteil 94000, France
| | - Jean-François Papon
- INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France; Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France
| | - Emilie Bequignon
- Department of Oto-rhino-laryngology, Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil 94000, France; University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Department of Oto-rhino-laryngology, Henri Mondor Hospital of Créteil, Paris Public Hospitals, Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France
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Ingen‐Housz‐Oro S, Alves A, Colin A, Ouedraogo R, Layese R, Canoui‐Poitrine F, Chosidow O, Mekontso‐Dessap A, Wolkenstein P, Prost N. 表皮坏死松解症幸存者的健康相关生活质量和长期相关疾病:一项针对 57 例患者的研究. Br J Dermatol 2020. [DOI: 10.1111/bjd.18931] [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: 11/30/2022]
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Ingen‐Housz‐Oro S, Alves A, Colin A, Ouedraogo R, Layese R, Canoui‐Poitrine F, Chosidow O, Mekontso‐Dessap A, Wolkenstein P, Prost N. Health‐related quality of life and long‐term related conditions in survivors of epidermal necrolysis: a study of 57 patients. Br J Dermatol 2020. [DOI: 10.1111/bjd.18912] [Citation(s) in RCA: 1] [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] [Indexed: 11/30/2022]
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Oro S, Alvès A, Colin A, Ouedraogo R, Layese R, Canoui-Poitrine F, Chosidow O, Mekontso-Dessap A, Wolkenstein P, de Prost N. Qualité de vie et séquelles après syndromes de Stevens-Johnson et de Lyell: étude observationnelle chez 57 patients. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.042] [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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Deshayes S, Khellaf M, Zarour A, Layese R, Fain O, Terriou L, Viallard J, Cheze S, Graveleau J, Slama B, Audia S, Cliquennois M, Ebbo M, Le Guenno G, Salles G, Bonmati C, Teillet F, Galicier L, Lambotte O, Hot A, Lefrère F, Mahévas M, Canoui‐Poitrine F, Michel M, Godeau B. Long-term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP-ritux. Am J Hematol 2019; 94:1314-1324. [PMID: 31489694 DOI: 10.1002/ajh.25632] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 01/19/2023]
Abstract
Rituximab is a second-line option in adults with immune thrombocytopenia (ITP), but the estimated 5-year response rate, only based on pooled retrospective data, is about 20%, and no studies have focused on long-term safety. We conducted a prospective multicenter registry of 248 adults with ITP treated with rituximab with 5 years of follow-up to assess its long-term safety and efficacy. The median follow-up was 68.4 [53.7-78.5] months. The incidence of severe infections was only 2/100 patient-years. Profound hypogammaglobulinemia (<5 g/L) developed in five patients at 15 to 31 months after the last rituximab infusion. In total, 25 patients died at a median age of 80 [69.5-83.9] years, corresponding to a mortality rate of 2.3/100 patient-years. Only three deaths related to infection that occurred 12 to 14 months after rituximab infusions could be due in part to rituximab. At 60 months of follow-up, 73 (29.4%) patients had a sustained response. On univariate and multivariate analysis, the only factor significantly associated with sustained response was a previous transient response to corticosteroids (P = .022). Overall, 24 patients with an initial response and then relapse received retreatment with rituximab, which gave a response in 92%, with a higher duration of response in 54%. As a result of its safety profile and its sustained response rate, rituximab remains an important option in the current therapeutic armamentarium for adult ITP. Retreatment could be an effective and safe option.
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Affiliation(s)
- Samuel Deshayes
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'Adulte, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
- Service de Médecine Interne Normandie Univ, UNICAEN, CHU de Caen Normandie Caen France
| | - Mehdi Khellaf
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'Adulte, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Anissa Zarour
- Unité de Recherche Clinique, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Richard Layese
- Unité de Recherche Clinique, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
- Service de Santé Publique CHU Henri‐Mondor, EA 7376 CEpiA, UPEC Créteil France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint‐Antoine, Assistance Publique‐Hôpitaux de Paris Sorbonne Université Paris France
| | - Louis Terriou
- Service de Médecine Interne Centre Hospitalier Régional Universitaire de Lille Lille France
| | - Jean‐François Viallard
- Département de Médecine Interne et Maladies Infectieuses Centre Hospitalier Universitaire Haut Lévêque, Université de Bordeaux Pessac France
| | - Stéphane Cheze
- Service d'Hématologie Clinique Normandie Univ, UNICAEN, CHU de Caen Normandie Caen France
| | - Julie Graveleau
- Service de Médecine Interne Centre Hospitalier Universitaire de Nantes Nantes France
| | - Borhane Slama
- Service d'Hématologie Centre Hospitalier d'Avignon Avignon France
| | | | - Manuel Cliquennois
- Département d'Hématologie Groupe Hospitalier de l'Institut Catholique de Lille Lille France
| | - Mikael Ebbo
- Service de Médecine Interne Hôpital de la Timone, Assistance Publique‐Hôpitaux de Marseille, Université Aix‐Marseille Marseille France
| | - Guillaume Le Guenno
- Service de Médecine Interne Centre Hospitalier Universitaire Estaing Clermont Ferrand France
| | - Gilles Salles
- Service d'Hématologie Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre‐Bénite, University Claude Bernard Lyon 1 Lyon France
| | - Caroline Bonmati
- Service d'Hématologie Centre Hospitalier Universitaire de Nancy Nancy France
| | - France Teillet
- Département d'Immuno‐Hématologie Centre Hospitalier Universitaire Louis Mourier, Assistance Publique‐Hôpitaux de Paris Colombes France
| | - Lionel Galicier
- Service d'Immuno‐Pathologie Centre Hospitalier Universitaire Saint‐Louis, Assistance Publique‐Hôpitaux de Paris Paris France
| | - Olivier Lambotte
- Service de Médecine Interne Centre Hospitalier Universitaire Bicêtre, Assistance Publique‐Hôpitaux de Paris Paris France
| | - Arnaud Hot
- Service de Médecine Interne Groupement Hospitalier Edouard Herriot Lyon France
| | - François Lefrère
- Service d'Hématologie Centre Hospitalier Universitaire Necker, Assistance Publique‐ Hôpitaux de Paris Paris France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'Adulte, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Florence Canoui‐Poitrine
- Unité de Recherche Clinique, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
- Service de Santé Publique CHU Henri‐Mondor, EA 7376 CEpiA, UPEC Créteil France
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'Adulte, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto‐Immunes de l'Adulte, Centre Hospitalier Universitaire Henri‐Mondor, Assistance Publique‐Hôpitaux de Paris Université Paris Est Créteil Créteil France
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Sobhani I, Itti E, Luciani A, Baumgaertner I, Layese R, André T, Ducreux M, Gornet JM, Goujon G, Aparicio T, Taieb J, Bachet JB, Hemery F, Retbi A, Mons M, Flicoteaux R, Rhein B, Baron S, Cherrak I, Rufat P, Le Corvoisier P, de'Angelis N, Natella PA, Maoulida H, Tournigand C, Durand Zaleski I, Bastuji-Garin S. Colorectal cancer (CRC) monitoring by 6-monthly 18FDG-PET/CT: an open-label multicentre randomised trial. Ann Oncol 2019; 29:931-937. [PMID: 29365058 PMCID: PMC5913635 DOI: 10.1093/annonc/mdy031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18FDG-PET/CT) has high sensitivity for detecting recurrences of colorectal cancer (CRC). Our objective was to determine whether adding routine 6-monthly 18FDG-PET/CT to our usual monitoring strategy improved patient outcomes and to assess the effect on costs. Patients and methods In this open-label multicentre trial, patients in remission of CRC (stage II perforated, stage III, or stage IV) after curative surgery were randomly assigned (1 : 1) to usual monitoring alone (3-monthly physical and tumour marker assays, 6-monthly liver ultrasound and chest radiograph, and 6-monthly whole-body computed tomography) or with 6-monthly 18FDG-PET/CT, for 3 years. A multidisciplinary committee reviewed each patient’s data every 3 months and classified the recurrence status as yes/no/doubtful. Recurrences were treated with curative surgery alone if feasible and with chemotherapy otherwise. The primary end point was treatment failure defined as unresectable recurrence or death. Relative risks were estimated, and survival was analysed using the Kaplan–Meier method, log-rank test, and Cox models. Direct costs were compared. Results Of the 239 enrolled patients, 120 were in the intervention arm and 119 in the control arm. The failure rate was 29.2% (31 unresectable recurrences and 4 deaths) in the intervention group and 23.7% (27 unresectable recurrences and 1 death) in the control group (relative risk = 1.23; 95% confidence interval, 0.80–1.88; P = 0.34). The multivariate analysis also showed no significant difference (hazards ratio, 1.33; 95% confidence interval, 0.8–2.19; P = 0.27). Median time to diagnosis of unresectable recurrence (months) was significantly shorter in the intervention group [7 (3–20) versus 14.3 (7.3–27), P = 0.016]. Mean cost/patient was higher in the intervention group (18 192 ± 27 679 € versus 11 131 ± 13 €, P < 0.033). Conclusion 18FDG-PET/CT, when added every 6 months, increased costs without decreasing treatment failure rates in patients in remission of CRC. The control group had very close follow-up, and any additional improvement (if present) would be small and hard to detect. ClinicalTrials.gov identifier NCT00624260
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Affiliation(s)
- I Sobhani
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France; Department of Gastroenterology, APHP-Hôpital Henri Mondor, Créteil, France.
| | - E Itti
- Department of Nuclear Medicine, APHP-Hôpital Henri Mondor, Créteil, France
| | - A Luciani
- Department of Medical Imaging, APHP-Hôpital Henri Mondor, Créteil, France
| | - I Baumgaertner
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | - R Layese
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France; CEpiA Clinical Epidemiology and Ageing Un, EA7376, Université Paris-Est (UPEC), A-TVB DHU, IMRB, Créteil, France
| | - T André
- Sorbonnes University and Department of Medical Oncology, APHP-Hôpital St Antoine, Paris, France
| | - M Ducreux
- Department of Gastrointestinal Oncology, Institut Gustave Roussy, Villejuif, France
| | - J-M Gornet
- Department of Gastroenterology, APHP-Hôpital St Louis, Paris, France
| | - G Goujon
- Department of Gastroenterology, APHP-Hôpital Bichat, Paris, France
| | - T Aparicio
- Department of Gastroenterology, APHP-Hôpital Avicenne, Paris, France
| | - J Taieb
- Department of Gastrointestinal Oncology, APHP-Hôpital Européen Georges Pompidou, Paris, France
| | - J-B Bachet
- Department of Gastroenterology and Medical Informatics, APHP-Hôpital Pitié-Salpêtrière, Paris, France
| | - F Hemery
- Department of Medical Informatics, APHP-Hôpital Henri Mondor, Créteil, France
| | - A Retbi
- Sorbonnes University and Department of Medical Oncology, APHP-Hôpital St Antoine, Paris, France
| | - M Mons
- Department of Gastrointestinal Oncology, Institut Gustave Roussy, Villejuif, France
| | - R Flicoteaux
- Department of Gastroenterology, APHP-Hôpital St Louis, Paris, France
| | - B Rhein
- Department of Medical Informatics, Centre Hospitalier d'Intercommunal de Créteil, Créteil, France
| | - S Baron
- Department of Gastroenterology, APHP-Hôpital Avicenne, Paris, France
| | - I Cherrak
- Department of Gastrointestinal Oncology, APHP-Hôpital Européen Georges Pompidou, Paris, France
| | - P Rufat
- Department of Gastroenterology and Medical Informatics, APHP-Hôpital Pitié-Salpêtrière, Paris, France
| | - P Le Corvoisier
- Clinical Investigations Centre, APHP-Hôpital Henri Mondor, Créteil, France
| | - N de'Angelis
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | - P-A Natella
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France
| | - H Maoulida
- Healthcare Economics Research Unit, APHP, Paris, France, France
| | - C Tournigand
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | | | - S Bastuji-Garin
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France; CEpiA Clinical Epidemiology and Ageing Un, EA7376, Université Paris-Est (UPEC), A-TVB DHU, IMRB, Créteil, France
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Ingen-Housz-Oro S, Alves A, Colin A, Ouedraogo R, Layese R, Canoui-Poitrine F, Chosidow O, Mekontso-Dessap A, Wolkenstein P, de Prost N. Health-related quality of life and long-term sequelae in survivors of epidermal necrolysis: an observational study of 57 patients. Br J Dermatol 2019; 182:916-926. [PMID: 31385287 DOI: 10.1111/bjd.18387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Few studies have investigated the global burden of sequelae and health-related quality of life (HRQoL) for survivors of epidermal necrolysis (EN). OBJECTIVES To investigate the long-term HRQoL for survivors of EN using validated instruments. METHODS We conducted a single-centre study that enrolled patients who were admitted for EN between 2010 and 2017. HRQoL was assessed via phone interview using the Short Form (SF)-36 questionnaire, Hospital Anxiety and Depression (HAD) scale, Impact of Event Scale-Revised, and general quality-of-life outcomes, including EN-specific sequelae. The primary outcome measure was the physical component summary (PCS) score of the SF-36. RESULTS In total, 57 survivors of EN [19 (33%) with intensive care unit (ICU) admission] were interviewed via telephone at a median of 3·6 years (1·9-6·1) after hospital discharge. The median PCS score was 0·44 SDs below that of the age- and sex-matched reference population and was significantly lower for survivors of EN who were admitted to the ICU vs. those who were not [43·7 (28·7-49·3) vs. 51·2 (39·4-56·5), P = 0·042]. The proportion of patients with EN who had HAD-anxiety score ≥ 8 or HAD-depression score ≥ 5 was 54% and 21%, respectively. Physical and mental outcomes did not differ between patients with EN who were admitted to the ICU and survivors of septic shock. Reported EN-specific sequelae were cutaneous (77%), ocular (70%), psychological (60%), dental/oral (49%), genital (30%) and respiratory (18%), with median intensity on a visual analogue scale. CONCLUSIONS Our study confirms the major burden and long-term impact of EN on quality of life for survivors and emphasizes the need for prolonged close follow-up after the acute phase. What's already known about this topic? Long-term sequelae have been reported in 90% of survivors of epidermal necrolysis (EN). Few studies have investigated the global burden of sequelae and health-related quality of life (HRQoL) in survivors of EN. What does this study add? Survivors of EN, particularly those admitted to the intensive care unit, had poorer physical HRQoL than the French reference population but had comparable HRQoL to survivors of septic shock. Survivors of EN exhibited symptoms of anxiety, depression and post-traumatic stress syndrome. The most frequent sequelae were cutaneous, ocular and psychological, with visual analogue scale scores of 5/10 and 6/10. These results confirm the burden of EN on quality of life.
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Affiliation(s)
- S Ingen-Housz-Oro
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France.,EA7379 EpidermE, UPEC, Créteil, France
| | - A Alves
- Service de Réanimation Médicale, Créteil, France
| | - A Colin
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - R Ouedraogo
- Service de Réanimation Médicale, Créteil, France
| | - R Layese
- Service de Santé Publique, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Clinical Epidemiology And Ageing Unit, DHU A-TVB, IMRB-EA 7376 CEpiA, Université Paris-Est UPEC, Créteil, France
| | - F Canoui-Poitrine
- Service de Santé Publique, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Clinical Epidemiology And Ageing Unit, DHU A-TVB, IMRB-EA 7376 CEpiA, Université Paris-Est UPEC, Créteil, France
| | - O Chosidow
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - A Mekontso-Dessap
- Service de Réanimation Médicale, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France
| | - P Wolkenstein
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - N de Prost
- Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France.,Service de Réanimation Médicale, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France
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Salmon-Ceron D, Nahon P, Layese R, Bourcier V, Sogni P, Bani-Sadr F, Audureau E, Merchadou L, Dabis F, Wittkop L, Roudot-Thoraval F. Human Immunodeficiency Virus/Hepatitis C Virus (HCV) Co-infected Patients With Cirrhosis Are No Longer at Higher Risk for Hepatocellular Carcinoma or End-Stage Liver Disease as Compared to HCV Mono-infected Patients. Hepatology 2019; 70:939-954. [PMID: 30569448 DOI: 10.1002/hep.30400] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Received: 03/09/2018] [Accepted: 10/24/2018] [Indexed: 12/12/2022]
Abstract
It is widely accepted that human immunodeficiency virus (HIV) infection is a risk factor for increased severity of hepatitis C virus (HCV) liver disease. However, owing to better efficacy and safety of combination antiretroviral therapy (cART), and increased access to HCV therapy, whether this condition remains true is still unknown. Overall, 1,253 HCV mono-infected patients and 175 HIV/HCV co-infected patients with cirrhosis, included in two prospective French national cohorts (ANRS CO12 CirVir and CO13 HEPAVIH), were studied. Cirrhosis was compensated (Child-Pugh A), without past history of complication, and assessed on liver biopsy. Incidences of liver decompensation (LD), hepatocellular carcinoma (HCC), and death according to HIV status were calculated by a Fine-Gray model adjusted for age. Propensity score matching was also performed to minimize confounding by baseline characteristics. At baseline, HIV/HCV patients were younger (47.5 vs. 56.0 years; P < 0.001), more frequently males (77.1% vs. 62.3%; P < 0.001), and had at baseline and at end of follow-up similar rates of HCV eradication than HCV mono-infected patients. A total of 80.4% of HIV/HCV patients had an undetectable HIV viral load. After adjustment for age, 5-year cumulative incidences of HCC and decompensation were similar in HIV/HCV and HCV patients (8.5% vs. 13.2%, P = 0.12 and 12.8% vs. 15.6%, P = 0.40, respectively). Overall mortality adjusted for age was higher in HIV/HCV co-infected patients (subhazard ratio [SHR] = 1.88; 95% confidence interval [CI], 1.15-3.06; P = 0.011). Factors associated with LD and HCC were age, absence of sustained virological response, and severity of cirrhosis, but not HIV status. Using a propensity score matching 95 patients of each group according to baseline features, similar results were observed. Conclusion: In HCV-infected patients with cirrhosis, HIV co-infection was no longer associated with higher risks of HCC and hepatic decompensation. Increased mortality, however, persisted, attributed to extrahepatic conditions.
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Affiliation(s)
- Dominique Salmon-Ceron
- APHP, Hôpitaux Universitaires Paris Centre, Infectious Diseases Federation, Paris, France.,Paris Descartes University, Paris, France
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Hepatology Department, Bondy, France.,Paris 13 University, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, and Inserm UMR 1162, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri-Mondor, Public Health Department, 94000, Créteil, France.,AP-HP, Hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), 94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, 94000, Créteil, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Hepatology Department, Bondy, France
| | - Philippe Sogni
- Paris Descartes University, Paris, France.,INSERM U-1223, Institut Pasteur and APHP, Hôpitaux Universitaires Paris Centre, Hepatology Department, Paris, France
| | - Firouze Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Internal Medicine Department, Infectious Diseases and Clinical Immunology Unit, Reims, France.,Reims University, Champagne-Ardenne, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri-Mondor, Public Health Department, 94000, Créteil, France.,AP-HP, Hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), 94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, 94000, Créteil, France
| | - Laurence Merchadou
- Bordeaux University, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000, Bordeaux, France
| | - François Dabis
- Bordeaux University, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000, Bordeaux, France.,CHU de Bordeaux, Public Health and Medical Information Department, F-33000, Bordeaux, France
| | - Linda Wittkop
- Bordeaux University, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000, Bordeaux, France.,CHU de Bordeaux, Public Health and Medical Information Department, F-33000, Bordeaux, France
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri-Mondor, Public Health Department, 94000, Créteil, France.,AP-HP, Hôpital Henri-Mondor, Clinical Research Unit (URC-Mondor), 94000, Créteil, France.,Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, 94000, Créteil, France
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Brichler S, Nahon P, Zoulim F, Layese R, Bourcier V, Audureau E, Sutton A, Letouze E, Cagnot C, Marcellin P, Guyader D, Roulot D, Pol S, de Ledinghen V, Zarski JP, Calès P, Tran A, Peron JM, Mallat A, Riachi G, Grange JD, Blanc JF, Bacq Y, Ouzan D, Bronowicki JP, Mathurin P, Larrey D, Alric L, Attali P, Serfaty L, Pilette C, Bourlière M, Thabut D, Silvain C, Wartelle C, Zucman D, Christidis C, Roudot-Thoraval F, Ganne-Carrie N. Non-virological factors are drivers of hepatocellular carcinoma in virosuppressed hepatitis B cirrhosis: Results of ANRS CO12 CirVir cohort. J Viral Hepat 2019; 26:384-396. [PMID: 30380181 DOI: 10.1111/jvh.13029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/25/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022]
Abstract
Worldwide, hepatocellular carcinoma (HCC) occurs mainly in Asian patients with hepatitis B virus (HBV) infection. This study aimed to decipher the environmental and virological factors associated with HCC occurrence and validate risk scoring systems in a French multicentre prospective cohort of HBV cirrhotic patients. Patients with biopsy-proven Child-Pugh A viral cirrhosis included in the ANRS CO12 CirVir cohort who were HBsAg(+) without hepatitis C coinfection were selected for: (a) interview through a standardized questionnaire reporting coffee consumption and HCC familial history; (b) HBsAg quantification using baseline and sequential 2-year frozen sera; (c) baseline HBV genotype determination; and (d) assessment of risk factors and applicability of HCC risk scores (Kaplan-Meier analysis, Cox models). Among 317 patients studied (261 men, median age 53 years, past or ongoing antiviral treatment 93.3% and baseline detectable HBV DNA in 88 patients), the baseline and 2-year median HBsAg levels were 810 and 463 IU/mL, respectively. After a median follow-up of 65.2 months, 27 HCC cases were diagnosed (annual incidence: 1.6%). Three factors were independently associated with HCC occurrence: age > 50 years, platelets ≤ 150 × 103 /mm3 and body mass index ≥ 30 kg/m2 . Two out of five risk scores were validated, and the most accurate was PAGE-B at 1 year. Moreover, HCC in patients without maintained virological suppression seems more aggressive and less accessible to curative treatment. In conclusion, in French patients with HBV cirrhosis mostly virally suppressed, independent HCC risk factors were host-related (age, obesity) or linked to the severity of cirrhosis (thrombopenia), and the European PAGE-B score was the most accurate risk score.
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Affiliation(s)
- Segolene Brichler
- AP-HP, Hôpital Avicenne, Microbiologie Clinique, Bobigny, France.,Université Paris 13, Bobigny, France.,INSERM U955, Université Paris-Est, Créteil, France
| | - Pierre Nahon
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Hépatologie, Lyon, France.,INSERM U1052, Université de Lyon, Lyon, France
| | - Richard Layese
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Valerie Bourcier
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Angela Sutton
- APHP, Hôpital Jean-Verdier, Biochimie, Bondy, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | | | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Hépatologie, INSERM UMS20 and U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | | | - Albert Tran
- CHU, Hépatologie, INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri-Mondor, Hépatologie, Créteil, France
| | | | | | | | | | - Denis Ouzan
- Institut Arnaud-Tzanck, Hépatologie, St-Laurent-du-Var, France
| | | | | | | | - Laurent Alric
- CHU, Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Pierre Attali
- AP-HP, Hôpital Paul-Brousse, Hépatologie, Villejuif, France
| | | | | | | | | | | | | | | | | | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France.,AP-HP, Hôpital Henri-Mondor, Hépatologie, Créteil, France
| | - Nathalie Ganne-Carrie
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
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Thabut D, Bureau C, Layese R, Bourcier V, Hammouche M, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle-Bladou C, Dao T, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Sutton A, Audureau E, Roudot-Thoraval F, Nahon P. Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy. Gastroenterology 2019; 156:997-1009.e5. [PMID: 30768988 DOI: 10.1053/j.gastro.2018.11.053] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [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: 03/30/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy. METHODS We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT. RESULTS A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival. CONCLUSIONS In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.
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Affiliation(s)
- Dominique Thabut
- Paris Sorbonne Université, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Service d'hépato-gastroentérologie, Paris, France.
| | - Christophe Bureau
- Service d'hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, 31059 Toulouse Cedex; Université Paul Sabatier Toulouse III, Toulouse
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris
| | - Maryam Hammouche
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris
| | - Carole Cagnot
- ANRS (France Recherche Nord & sud Sida-HIV Hépatites), Paris
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | | | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice
| | | | | | - Odile Goria
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours
| | | | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | | | | | | | | | | | | | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris
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Costentin CE, Layese R, Roudot-Thoraval F, Audureau E, Nahon P. Reply. Gastroenterology 2019; 156:289-290. [PMID: 30472229 DOI: 10.1053/j.gastro.2018.11.046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Charlotte E Costentin
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France and INSERM U1042, Hypoxie Physiopathologies cardiovasculaires et respiratoires, Faculté de Médecine-Pharmacie, Université Grenoble Alpes, Grenoble, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor) and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France
| | | | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Public Health Department and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France and Inserm UMR-1162, "Functional Genomics of Solid Tumors", Université Paris Descartes, Université Paris Diderot, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
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- AP-HP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France and Inserm UMR-1162, "Functional Genomics of Solid Tumors", Université Paris Descartes, Université Paris Diderot, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
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39
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Allaire M, Rekik S, Layese R, Mumana A, Guyot E, Nkontchou G, Bourcier V, Grando V, Ziol M, Nahon P, Ganne-Carrié N, Sutter O, Audureau E, Seror O, Nault JC. Virologic control and severity of liver disease determine survival after radiofrequency ablation of hepatocellular carcinoma on cirrhosis. Dig Liver Dis 2019; 51:86-94. [PMID: 30126822 DOI: 10.1016/j.dld.2018.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/13/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to identify the main determinants of long-term overall survival (OS), including virologic control, and recurrence after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) on cirrhosis. METHODS Cirrhotic patients treated by RFA for HCC within Milan criteria were included. Associations between patient features and events were estimated by the Kaplan-Meier method with the log rank test and using uni/multivariate Cox models. RESULTS 389 cirrhotic patients (Child-Pugh A 86.6%, 473 tumors) were included. OS was 79.8%, 42.4% and 16%, and overall tumor recurrence 45%, 78% and 88% at 2, 5 and 10 years, respectively. In multivariate analysis, age, Child-Pugh, GGT, HCC near major vessels, esophageal varices, alkaline phosphatase and HBV predicted OS. Gender, ALT, AFP and alcohol intake were associated with tumor recurrence. Multinodular HCC (19.5%) was associated with risk of tumor recurrence outside Milan criteria. HBV patients had longer OS than other patients (P = 0.0059); negative HBV PCR at RFA was associated with decreased tumor recurrence (P = 0.0157). Using time-dependent analysis in HCV patients, a sustained virologic response was associated with increased OS (124.5 months) compared to other patients (49.2 months, P < 0.001). CONCLUSION Virologic response and severity of underlying liver disease were the main determinants of long-term OS after RFA for HCC developing on cirrhosis.
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Affiliation(s)
- Manon Allaire
- Department of hepatogastroenterology, CHU côte de Nacre, Caen, France
| | | | - Richard Layese
- Center of clinical research, Paris-Est university, A-TVB DHU, CEpiA (clinical epidemiology and ageing) unit EAA393, UPEC, Créteil, France
| | | | - Erwan Guyot
- Department of biochemistry, CHU Jean Verdier, Bondy, France
| | | | | | | | - Marianne Ziol
- Department of pathology, CHU Jean Verdier, Bondy, France
| | - Pierre Nahon
- Liver unit, CHU Jean verdier, Bondy, France; Inserm UMR1162, Paris, France
| | | | - Olivier Sutter
- Department of radiology, CHU Jean Verdier, Bondy, France
| | - Etienne Audureau
- Center of clinical research, Paris-Est university, A-TVB DHU, CEpiA (clinical epidemiology and ageing) unit EAA393, UPEC, Créteil, France
| | - Olivier Seror
- Inserm UMR1162, Paris, France; Department of radiology, CHU Jean Verdier, Bondy, France
| | - Jean-Charles Nault
- Liver unit, CHU Jean verdier, Bondy, France; Inserm UMR1162, Paris, France.
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40
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Gelu-Simeon M, Lewin M, Ostos M, Bayan T, Beso Delgado M, Teicher E, Layese R, Roudot-Thoraval F, Fontaine H, Sobesky R, Salmon-Céron D, Samuel D, Seror O, Nahon P, Meyer L, Duclos-Vallée JC. Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort. Liver Int 2019; 39:136-146. [PMID: 29947467 DOI: 10.1111/liv.13921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 06/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS HIV/HCV co-infected patients with hepatocellular carcinoma (HCC) have poorer survival than HCV mono-infected patients. We aimed to evaluate the prognostic factors for survival. METHODS From 2006 to 2013, 55 incident HCCs among HIV+/HCV+ patients, from three ANRS cohorts, were compared with 181 HCCs in HIV-/HCV+ patients from the ANRS Cirvir cohort. RESULTS HIV+/HCV+ patients were younger (50 years [IQR: 47-53] vs 62 [54-70], P < 0.001), male (89% vs 63%, P < 0.001) than HIV-/HCV+ patients. At HCC diagnosis, both groups had a majority of non-responders to anti-HCV-therapy, and HIV+/HCV+ patients had more frequently known a previous cirrhosis decompensation (31% vs 14%, P = 0.005). At diagnostic imaging, there were more infiltrative forms of HCC in HIV+/HCV+ group (24% vs 14%, P < 0.001), associated with tumour portal thrombosis in 29%. During a median follow-up period of 11.96 [5.51-27] months since HCC diagnosis, a majority of palliative treatments were decided in HIV+/HCV+ patients (51% vs 19%, P < 0.001). The 1 and 2-year crude survival rates were 61% versus 78% and 47% versus 63%, P = 0.003 respectively. In a Cox model multivariate analysis adjusted for the cohort, age and sex, the most important prognostic factor for survival was the infiltrative form of the tumour (aRR: 8.10 [4.17-15.75], P < 0.001). CONCLUSIONS The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High α-foetoprotein level and decompensated cirrhosis are other ones. This justifies a particular attention to the detection and the management of small nodules in this high-risk population.
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Affiliation(s)
- Moana Gelu-Simeon
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,CHU de Guadeloupe, Service d'Hépato-Gastro-Entérologie, Faculté de Médecine Hyacinthe Bastaraud, Université Antilles-Guyane, Guadeloupe, France.,Inserm-UMR-S1085/IRSET, Rennes, France
| | - Maïté Lewin
- DHU Hepatinov, Villejuif, France.,Service de Radiologie, AP-HP Hôpital Paul-Brousse, Villejuif, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Maria Ostos
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Tatiana Bayan
- Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Maria Beso Delgado
- Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Elina Teicher
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Service de Médecine Interne, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Richard Layese
- AP-HP Hôpital Henri Mondor, URC-CEpiA-EA7376, Université Paris Est, Créteil, France
| | | | - Hélène Fontaine
- Unité d'Hépatologie, AP-HP Hôpital Cochin, USM20, Institut Pasteur, Université Paris-Descartes, Paris, France
| | - Rodolphe Sobesky
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
| | - Dominique Salmon-Céron
- Service des Maladies Infectieuses et Tropicales, AP-HP Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
| | - Olivier Seror
- Service de Radiologie, AP-HP Hôpital Jean Verdier, Université Paris13, Bondy, France
| | - Pierre Nahon
- Service d'Hépato-Gastro-Entérologie, AP-HP Hôpital Jean Verdier, Bondy, France.,Bobigny, Inserm-UMR1162, Université Paris13, Paris, France
| | - Laurence Meyer
- Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Service de Santé Publique, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Charles Duclos-Vallée
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Inserm-UMR1193, Université Paris-Saclay, Villejuif, France
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Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Roudot-Thoraval F, Audureau E. Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs. Gastroenterology 2018; 155:1436-1450.e6. [PMID: 30031138 DOI: 10.1053/j.gastro.2018.07.015] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [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: 04/07/2018] [Revised: 06/30/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Retrospective studies have found an unexpectedly high incidence of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV)-associated cirrhosis who received direct-acting antiviral (DAA) agents. We analyzed data from the ANRS CO12 CirVir cohort to compare the incidence of HCC in patients with cirrhosis who received DAA therapy vs patients treated with interferon (IFN). METHODS Data were collected from 1270 patients with compensated biopsy-proven HCV-associated cirrhosis recruited from 2006 through 2012 at 35 centers in France. For descriptive purpose, patients were classified as follows: patients who received DAA treatment (DAA group, n = 336), patients who achieved a sustained virologic response (SVR) following an IFN-based regimen (SVR-IFN group, n = 495), or patients who never received DAA treatment and never had an SVR following IFN therapy (non-SVR group, n = 439). The patients were included in HCC surveillance programs based on ultrasound examination every 6 months, and clinical and biological data were recorded. To account for confounding by indication due to differences in patient characteristics at treatment initiation, we constructed a time-dependent Cox regression model weighted by the inverse probability of treatment and censoring (IPTCW) to assess the treatment effects of DAA on time until HCC. RESULTS Compared with patients in the SVR-IFN group, patients in the DAA group were older, higher proportions had diabetes or portal hypertension, and liver function was more severely impaired. The crude 3-year cumulative incidences of HCC were 5.9% in the DAA group, 3.1% in the SVR-IFN group, and 12.7% in the non-SVR group (overall P < .001; unadjusted hazard ratio [HR] for HCC 2.03; 95% confidence interval [CI] 1.07-3.84; P = .030 for the DAA group vs the SVR-IFN group). HCC characteristics were similar among groups. Among patients with HCC, the DAA group received less-frequent HCC screening than the other 2 groups (P = .002). After Cox analyses weighted by the IPTCW, we found no statistically significant increase in risk of HCC associated with DAA use (HR 0.89; 95% CI 0.46-1.73; P = .73). CONCLUSIONS Analysis of data from the ANRS CO12 CirVir cohort reveals that the apparent increase in HCC incidence observed in patients with cirrhosis treated with DAAs compared with patients who achieved SVR following an IFN therapy can be explained by patient characteristics (age, diabetes, reduced liver function) and lower screening intensity.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer," F-93206 Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides," F-75000, Paris, France.
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord and sud Sida-HIV Hépatites-FRENSH), France
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie, France; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie et Université de Lyon, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice, France; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers, France
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027, Paris, France; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Inserm U1148, Université Paris 13, Bobigny, France
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
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42
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Allaire M, Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, DI Martino V, Sutton A, Letouzé E, Audureau E, Roudot-Thoraval F. Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication. Hepatology 2018; 68:1245-1259. [PMID: 29663511 DOI: 10.1002/hep.30034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Received: 03/08/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Data on extrahepatic cancers (EHCs) in compensated viral cirrhosis are limited. The objective of the prospective multicenter Agence Nationale de Recherche sur le SIDA et les Hépatites virales CO12 CirVir cohort was to assess the occurrence of all clinical events in patients with compensated viral cirrhosis, including all types of cancer. Patients with the following inclusion criteria were enrolled in 35 French centers: (1) biopsy-proven hepatitis B virus (HBV) or hepatitis C virus (HCV) cirrhosis, (2) Child-Pugh A, or (3) absence of previous liver complications including primary liver cancer (PLC). Patients were followed up prospectively every 6 months. The standardized mortality ratio (SMR) was calculated according to age and gender using 5-year periods. The impact of sustained viral response (SVR) in HCV patients and maintained viral suppression in HBV patients were assessed using time-dependent analysis. A total of 1,671 patients were enrolled between 2006 and 2012 (median age, 54.9 years; men, 67.3%; HCV, 1,323; HBV, 317; HCV-HBV, 31). Metabolic features and excessive alcohol and tobacco consumption were recorded in 15.2%, 36.4%, and 56.4% of cases, respectively. After a median follow-up of 59.7 months, 227 PLCs were diagnosed (5-year cumulative incidence [CumI] 13.4%) and 93 patients developed EHC (14 patients with lymphoid or related tissue cancer and 79 with solid tissue cancer; 5-year EHC CumI, 5.9%). Compared to the general French population, patients were younger at cancer diagnosis, with significantly higher risk of EHC in HCV patients (SMR, 1.31; 95 confidence interval [CI], 1.04-1.64; P = 0.017) and after SVR (SMR = 1.57; 95% CI, 1.08-2.22; P = 0.013). EHC was the fourth leading cause of death in the whole cohort and the first in patients with viral control/eradication. CONCLUSION Compared to the general French population, HCV cirrhosis is associated with a higher risk of EHC and the first cause of death in patients with viral cirrhosis who achieve virological control/eradication. (Hepatology 2018).
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Affiliation(s)
- Manon Allaire
- Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France.,Inserm UMR 1149, Centre de recherche sur l'inflammation, Paris, France
| | - Pierre Nahon
- Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France.,Equipe Labellisée Ligue contre le cancer, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.,Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France
| | - Richard Layese
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
| | - Valérie Bourcier
- Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France
| | - Carole Cagnot
- ANRS (France Recherche Nord & sud Sida-hiv Hépatites), Paris, France
| | | | - Dominique Guyader
- Service d'Hépatologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Stanislas Pol
- Service d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.,Inserm MS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Dominique Larrey
- Service d'Hépatologie, Centre Hospitalo-Universitaire Saint Eloi, Montpellier, France.,Liver and Gastroenterology, Department-IRB-INSERM-1183, Bordeaux, France
| | | | - Denis Ouzan
- Service d'Hépatologie, Institut Arnaud Tzanck, Saint Laurent du Var, France
| | - Fabien Zoulim
- Service d'Hépatologie, Hospices Civils de Lyon, Lyon, France
| | | | - Albert Tran
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Nice, Nice, France.,Hepatic Complications in Obesity, Inserm U1065, C3M, Team 8, Nice, France
| | - Jean-Pierre Bronowicki
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - Jean-Pierre Zarski
- Service d'Hépatologie, Centre Hospitalo-Universitaire Michallon, Grenoble, France
| | - Ghassan Riachi
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire Charles-Nicolle, Rouen, France
| | - Paul Calès
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire d'Angers, Angers, France.,Laboratoire HIFIH, UPRES 3859, SFR ICAT 4208, UFR Santé, Université d'Angers, UBL, Angers, France
| | - Jean-Marie Péron
- Service d'Hépatologie, Centre Hospitalo-Universitaire Purpan, Toulouse, France
| | - Laurent Alric
- Service de Médecine Interne, Centre Hospitalo-Universitaire Purpan, Toulouse, France
| | - Marc Bourlière
- Service d'Hépatologie, Hôpital Saint Joseph, Marseille, France
| | - Philippe Mathurin
- Service d'Hépatologie, Centre Hospitalo-Universitaire Claude Huriez, Lille, France
| | - Jean-Frédéric Blanc
- Service d'Hépatologie, Centre Hospitalo-Universitaire Saint André, Bordeaux, France
| | - Armand Abergel
- Service d'Hépatologie, Centre Hospitalo-Universitaire Hôtel Dieu, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Service d'Hépatologie, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Ariane Mallat
- Service d'Hépatologie, AP-HP, Hôpital Henri Mondor, University Paris-Est, Créteil, France.,Inserm, U955, Créteil, France
| | | | - Pierre Attali
- Service d'Hépatologie, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Yannick Bacq
- Service d'Hépatologie, Centre Hospitalo-Universitaire Trousseau, Tours, France
| | - Claire Wartelle
- Service d'Hépatologie, Hôpital d'Aix-en-Provence, Aix-En-Provence, France
| | - Thông Dao
- Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France
| | - Dominique Thabut
- Service d'Hépatologie, AP-HP, Hôpital La Pitié Salpêtrière, Paris, France
| | | | - Christine Silvain
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | | | - Eric Nguyen-Khac
- Service d'Hépatologie, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | | | - David Zucman
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Vincent DI Martino
- Service d'Hépatologie, Centre Hospitalo-Universitaire Jean Minjoz, Besançon, France
| | - Angela Sutton
- Centre de Ressources Biologiques, Groupe Hospitalier Paris, Seine-Saint-Denis, France.,Service de Biochimie, AP-HP, Hôpital Jean Verdier, Bondy, France.,Inserm U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France
| | - Etienne Audureau
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
| | - Françoise Roudot-Thoraval
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
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Wendum D, Layese R, Ganne-Carrié N, Bourcier V, Merabtene F, Cagnot C, Sauce E, Barget N, Bedossa P, Terris B, Selves J, Bioulac-Sage P, Sturm N, Sattonnet C, Nahon P, Roudot-Thoraval F, Ziol M. Influence of Progenitor-Derived Regeneration Markers on Hepatitis C Virus-Related Cirrhosis Outcome (ANRS CO12 CirVir Cohort). Hepatology 2018; 68:1534-1548. [PMID: 29637581 DOI: 10.1002/hep.29927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
Abstract
UNLABELLED Progenitor-derived regeneration gives rise to the aberrant expression of biliary markers such as cytokeratin 7 (K7) and epithelial cell adhesion molecule (EpCAM) in hepatocytes. We aimed to describe the expression of these molecules in patients with compensated hepatitis C virus (HCV)-related cirrhosis and to investigate its potential influence on cirrhosis complications. Among patients with Child-Pugh A uncomplicated HCV-related cirrhosis enrolled in the prospective ANRS CO12 CirVir cohort, we selected individuals with a liver biopsy collected within 2 years before inclusion in the study. K7 and EpCAM immunostaining identified intermediate hepatobiliary cells. The influence of biliary marker expres-sion in hepatocytes on decompensation events and the occurrence of hepatocellular carcinoma (HCC) was studied using a multivariate Cox proportional hazards regression model. Among the 337 patients eligible for the study (men, 67%; median age, 52 years), 198 (58.8%) had biopsies with K7-positive hepatocytes including extensive staining in 40 (11.9%) and 203 had EpCAM-positive hepatocytes (60.6%). During follow-up (median, 54.2 months), 47 patients (14%) experienced a decompensation event, and HCC was diagnosed in 37 patients (11%). Extensive K7 staining was independently associated with the occurrence of a decompensation event (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.30-6.89; P = 0.010). EpCAM expression was independently associated with HCC occurrence (HR, 2.37; 95% CI, 1.07-5.23; P =0.033) along with age and a low prothrombin ratio. CONCLUSION Progenitor-derived regeneration depicted by K7 and EpCAM immunostaining of hepatocytes in liver biopsies of patients with compensated HCV-related cirrhosis marks a cirrhosis stage more prone to develop complications. (HEPATOLOGY 2018; 68:1534-1548).
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Affiliation(s)
- Dominique Wendum
- APHP, Hôpital St. Antoine, Anatomie Pathologiques.,Sorbonne Universités, UPMC Université Paris 06, INSERM UMRS_938 Centre de Recherche St. Antoine (CRSA), Paris, France
| | - Richard Layese
- APHP, Hôpital Henri Mondor, Unité de recherche clinique (URC-Mondor), Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, Créteil, France.,Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Nathalie Ganne-Carrié
- APHP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,INSERM UMR 1162, Génomique fonctionnelle des tumeurs solides, Université Paris Descartes, Université Paris Diderot, France
| | - Valérie Bourcier
- APHP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France
| | - Fatiha Merabtene
- Sorbonne Universités, UPMC Université Paris 06, INSERM UMRS_938 Centre de Recherche St. Antoine (CRSA), Paris, France.,Sorbonne Universités, UMS 30 LUMIC plateforme d'histomorphologie St. Antoine
| | | | - Emmanuel Sauce
- APHP, Hôpital Jean Verdier, Anatomie Pathologique et CRB BB-0033-00027, Bondy, France
| | - Nathalie Barget
- APHP, Hôpital Jean Verdier, Anatomie Pathologique et CRB BB-0033-00027, Bondy, France
| | - Pierre Bedossa
- APHP, Hôpital Beaujon, Département de Pathologie, Clichy, France
| | - Benoit Terris
- APHP, Hôpital Cochin, Anatomie Pathologique, Paris, France
| | - Janick Selves
- IUCT-Oncopole Toulouse, Departement d'Anatomie Pathologique, Toulouse, France
| | - Paulette Bioulac-Sage
- Pathology Department, Pellegrin Hospital, CHU Bordeaux.,Inserm, UMR1053 Bordeaux Research in Translational Oncology BaRITOn.,Université Bordeaux, UMR1053 Bordeaux Research in Translational Oncology BaRITOn, Bordeaux, France
| | - Nathalie Sturm
- CHU Grenoble, Département de Pathologie, Grenoble, France
| | | | - Pierre Nahon
- APHP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,INSERM UMR 1162, Génomique fonctionnelle des tumeurs solides, Université Paris Descartes, Université Paris Diderot, France
| | - Françoise Roudot-Thoraval
- APHP, Hôpital Henri Mondor, Unité de recherche clinique (URC-Mondor), Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, Créteil, France.,Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Marianne Ziol
- Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,INSERM UMR 1162, Génomique fonctionnelle des tumeurs solides, Université Paris Descartes, Université Paris Diderot, France.,APHP, Hôpital Jean Verdier, Anatomie Pathologique et CRB BB-0033-00027, Bondy, France
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Contou D, Sonneville R, Canoui-Poitrine F, Colin G, Coudroy R, Pène F, Tadié JM, Cour M, Béduneau G, Marchalot A, Guérin L, Jochmans S, Ehrmann S, Terzi N, Préau S, Barbier F, Schnell G, Roux D, Leroy O, Pichereau C, Gélisse E, Zafrani L, Layese R, Brun-Buisson C, Mekontso Dessap A, de Prost N. Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study. Intensive Care Med 2018; 44:1502-1511. [PMID: 30128591 DOI: 10.1007/s00134-018-5341-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality. METHODS A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up). RESULTS Among the 306 included patients, 126 (41.2%; 95% CI 35.6-46.9) died and 180 (58.8%; 95% CI 53.3-64.3) survived during the follow-up period [13 (3-24) days], including 51/180 patients (28.3%, 95% CI 21.9-35.5) who eventually required limb amputations, with a median number of 3 (1-4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR) = 1.03 (1.02-1.04); p < 0.001], lower leucocytes [HR 0.83 (0.69-0.99); p = 0.034] and platelet counts [HR 0.77 (0.60-0.91); p = 0.007], and arterial blood lactate levels [HR 2.71 (1.68-4.38); p < 0.001] were independently associated with hospital death, while a neck stiffness [HR 0.51 (0.28-0.92); p = 0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06-3.38); p = 0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis. CONCLUSION Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation. TRIALS REGISTRATION NCT03216577.
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Affiliation(s)
- Damien Contou
- Service de Réanimation Médicale, Groupe de Recherche CARMAS, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. .,Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France.
| | - Romain Sonneville
- Service de Réanimation Médicale, Hôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
| | - Florence Canoui-Poitrine
- Service de Santé Publique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51,Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,Clinical Epidemiology and Ageing Unit, Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA7376 CEpiA, Créteil, France
| | - Gwenhaël Colin
- Service de Réanimation Médico-chirurgicale, Centre Hospitalier Départemental de Vendée, Boulevard Stéphane Moreau, 85925, La Roche-sur-Yon, France
| | - Rémi Coudroy
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France.,INSERM CIC1402, ALIVE Group, Université de Poitiers, Poitiers, France
| | - Frédéric Pène
- Service de Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Jean-Marc Tadié
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033, Rennes, France
| | - Martin Cour
- Réanimation Médicale, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, 3 Quai des Célestins, 69002, Lyon, France
| | - Gaëtan Béduneau
- Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, 1 Rue de Germont, 76000, Rouen, France
| | - Antoine Marchalot
- Service de Réanimation Polyvalente, Centre Hospitalier de Melun, 98 Rue Freteau de Peny, 77000, Melun, France
| | - Laurent Guérin
- CHRU de Tours, Médecin Intensive Réanimation, CIC 1415, CRICS-TriggerSEP, Centre d'étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Sébastien Jochmans
- Service de Réanimation Polyvalente, Centre Hospitalier de Melun, 98 Avenue du Général Patton, 77000, Melun, France
| | - Stephan Ehrmann
- Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Sébastien Préau
- Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, 59000, Lille, France
| | - François Barbier
- Service de Réanimation Médicale, Centre Hospitalier Régional d'Orléans, 1 Rue Porte Madeleine, 45000, Orléans, France
| | - Guillaume Schnell
- Service de Réanimation Médico-Chirurgicale, GH Le Havre, 76600, Le Havre, France
| | - Damien Roux
- Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 Rue des Renouillers, 92700, Colombes, France
| | - Olivier Leroy
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Tourcoing, 55 Rue du Président Coty, 59200, Tourcoing, France
| | - Claire Pichereau
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300, Poissy, France
| | - Elodie Gélisse
- Service de Réanimation Médico-Chirurgicale, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, 51092, Reims, France
| | - Lara Zafrani
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Richard Layese
- Service de Santé Publique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51,Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Christian Brun-Buisson
- Service de Réanimation Médicale, Groupe de Recherche CARMAS, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Armand Mekontso Dessap
- Service de Réanimation Médicale, Groupe de Recherche CARMAS, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nicolas de Prost
- Service de Réanimation Médicale, Groupe de Recherche CARMAS, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
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Costentin CE, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Letouzé E, Imbeaud S, Zucman-Rossi J, Audureau E, Roudot-Thoraval F, Nahon P. Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study. Gastroenterology 2018; 155:431-442.e10. [PMID: 29729258 DOI: 10.1053/j.gastro.2018.04.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [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: 12/12/2016] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Semi-annual surveillance for hepatocellular carcinoma (HCC) is recommended for patients with cirrhosis. We aimed to determine how compliance with HCC surveillance guidelines affects survival times of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis who developed HCC. METHODS We collected data from the prospective ANRS CO12 CirVir study, from March 2006 through June 2012, on 1671 patients with biopsy-proven viral cirrhosis and no previous liver complications who were undergoing surveillance for HCC at 35 centers in France. Only 216 patients who developed HCC during the follow-up period were included in the analysis. Patients were considered to be compliant with surveillance guidelines if the time between their last surveillance image evaluation and diagnosis of HCC were fewer than 7 months and noncompliant if this time was 7 months or longer. RESULTS HCC was detected in 216 patients, at a median follow-up time of 59.7 months. Of these patients, 140 (80.5%) were Barcelona Clinic Liver Cancer stage 0/A, 135 (69.9%) received first-line curative treatment (15 underwent transplantation, 29 underwent resection, 89 received percutaneous ablation, and 2 received resection and percutaneous ablation), and 129 (60.0%) were compliant with surveillance guidelines. Seventy-nine of the patients with HCC died; 49 deaths were associated with tumor progression. After lead-time adjustment, overall survival (OS) time was longer in patients compliant with surveillance guidelines (median OS time, 53.2 months) than noncompliant patients (median OS time, 25.4 months) (P = .0107); this difference remained significant even when we changed lead time assumptions. In multivariate analysis adjusted for a propensity score, compliance with HCC surveillance guidelines was associated with low tumor burden, allocation of curative treatment, and increased OS time compared with noncompliance (hazard ratio for OS, 2.19; 95% confidence interval, 1.16-4.14; P = .0150). CONCLUSIONS In an analysis of data from the ANRS CO12 CirVir cohort, we associated compliance with HCC surveillance guidelines (fewer than 7 months between image evaluations) with early diagnosis, allocation of curative treatment, and longer adjusted OS of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis and a diagnosis of HCC.
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Affiliation(s)
- Charlotte E Costentin
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France.
| | - Richard Layese
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Valérie Bourcier
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord & sud Sida-HIV Hépatites, Paris, France
| | - Patrick Marcellin
- Assistance Publique-Hopitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
| | - Dominique Guyader
- Centre Hospitalier Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France
| | - Stanislas Pol
- Assistance Publique-Hopitaux de Paris, Hôpital Cochin, Département d'Hépatologie et Institut National de la Santé et de la Recherche Médicale, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Département d'Hépatologie, Lyon, France
| | - Dominique Roulot
- Assistance Publique-Hopitaux de Paris, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France
| | - Albert Tran
- Centre Hospitalier Universitaire de Nice, Service d'Hépatologie, et Institut National de la Santé et de la Recherche Médicale, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastroentérologie, Rouen, France
| | - Paul Calès
- Centre Hospitalier Universitaire d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- Centre Hospitalier Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Centre Hospitalier Universitaire Estaing, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Assistance Publique-Hopitaux de Paris, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; L'Université Paris-Est Créteil et Institut National de la Santé et de la Recherche Médicale, Créteil, France
| | - Jean-Didier Grangé
- Assistance Publique-Hopitaux de Paris, Hôpital Tenon, Service d'Hépatologie, Paris, France
| | - Pierre Attali
- Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, Centres Hospitaliers Régionaux et Universitaires de Tours, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- Assistance Publique-Hopitaux de Paris, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Christophe Pilette
- Centre Hospitalier Universitaire Le Mans, Service d'Hépatologie, Le Mans, France
| | - Christine Silvain
- Centre Hospitalier Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France
| | | | | | | | - David Zucman
- Hôpital Foch, Service d'Hépatologie, Suresnes, France
| | | | - Angela Sutton
- Liver Disease Biobank, Groupe Hospitalier Paris Seine-Saint-Denis, France; Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Institut National de la Santé et de la Recherche Médicale U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Sandrine Imbeaud
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Jessica Zucman-Rossi
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France; Assistance Publique-Hopitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Oncologie, Paris, France
| | - Etienne Audureau
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Françoise Roudot-Thoraval
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Pierre Nahon
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
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Cacoub P, Nahon P, Layese R, Blaise L, Desbois AC, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Zucman D, Di Martino V, Bagnis CI, Ziol M, Sutton A, Letouze E, Roudot-Thoraval F, Audureau E. Prognostic value of viral eradication for major adverse cardiovascular events in hepatitis C cirrhotic patients. Am Heart J 2018; 198:4-17. [PMID: 29653647 DOI: 10.1016/j.ahj.2017.10.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 08/01/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective was to examine the role of a sustained virological response (SVR) on major adverse cardiovascular events (MACEs) in patients with compensated hepatitis C virus (HCV) cirrhosis. METHODS Patients with the following criteria were enrolled in 35 French centers: (1) biopsy-proven HCV cirrhosis; (2) Child-Pugh A; (3) positive viremia; and (4) no prior liver complication, and then prospectively followed. All patients received HCV treatment after inclusion. MACEs included stroke, myocardial infarction, ischemic heart disease, heart failure, peripheral arterial disease, cardiac arrest, and cardiovascular death. SVR, defined as negative viremia 12 weeks posttreatment, was considered as a time-dependent covariate, and its effect on MACE occurrence was assessed. The median follow up was 57.5 months, ending in December 2015. RESULTS Sixty-two of 878 (7.1%) patients presented a total of 79 MACEs. The main predictive baseline factors of MACEs were Asian ethnic origin, history of MACEs, arterial hypertension, diabetes mellitus, current smoking, low serum albumin level, high total bilirubin level, and low platelet count. In multivariate analysis, SVR was associated with a decreased risk of MACEs (hazard ratio=0.35, 95% CI 0.09-0.97, P=.044), whereas Asian ethnic origin, arterial hypertension, smoking, and low serum albumin level remained predictive of MACE occurrence. The 5-year survival rate was 60.1% versus 87.5% in patients who did versus those who did not present a MACE (P<.001). CONCLUSIONS In patients with compensated HCV-related cirrhosis, Asian ethnic origin, arterial hypertension, smoking, and low serum albumin are independent predictive factors of cardiovascular events, whereas an SVR is associated with a decreased rate of cardiovascular events.
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Affiliation(s)
- Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
| | | | - Anne Claire Desbois
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENCH)
| | | | | | - Stanislas Pol
- Université Paris Descartes, APHP, Unité d'Hépatologie, Hôpital Cochin, INSERM U-1223 et USM20, Institut Pasteur, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | | | | | - Albert Tran
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France and University Hospital of Nice, Digestive Centre, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastro-entérologie, Rouen
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers
| | | | - Laurent Alric
- Service de Médecine Interne-Pôle Digestif CHU Toulouse, UMR 152, IRD, Toulouse 3 University
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | | | | | - Corinne Isnard Bagnis
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Nephrology, Paris, France
| | - Marianne Ziol
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris; AP-HP, Hôpital Jean Verdier, Service d'Anatomopathologie, Bondy; CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027
| | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy
| | - Eric Letouze
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
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Sobhani I, Baumgaertner I, Itti E, Luciani A, Layese R, Natella PA, Gornet JM, Andre T, Goujon G, Aparicio T, Taieb J, Bachet JB, Ducreux M, Tournigand C, Hemery F, Durand-Zaleski I, Bastuji Garin S. Colorectal cancer (CRC) patients surveyed by 18FDGPET-CT (PET-CT): An open-label multicenter randomized trial (NCT 00624260). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3520 Background: Curative surgery is the best therapy of CRC and recurrences. We assessed whether adding semi-annual PET-CT to the usual surveillance would be cost-effective in high risk recurrent CRC patients. Methods: CRC patients (stage II tumor perforated, stages III and IV) in remission after curative surgery were randomly assigned (1:1) to trimester usual surveillance (control) or usual surveillance + semi-annual course PET-CT (intervention) for a 3-yr follow up period. Every 3 months, multidisciplinary committee decided about recurrence by yes/no/doubtful. If yes, curative surgery alone (when relevant), or chemotherapy alone (unresecable recurrence) were conducted; additional exams could be performed if doubtful. Primary composite endpoint (failure) comprised unresectable recurrence & death. The economic assessments according to standards (CHEERS) were performed and costs were compared between groups. Statistical tests for calculation of the relative risk (RR) were used and survival was analyzed using Kaplan-Meier method, Log-Rang test and Cox models. Results: Baseline characteristics of 239 patients (120/119) enrolled in 12 centers were balanced. The failure rate was 29.2% (31 unresectable recurrences & 4 deaths) and 23.5% (27 & 1) in Interventional vs Control, respectively with no significant difference (RR = 1.24, 95% CI: 0.81-1.90; P = .32). Similar results were observed in multivariate analysis (Cox models) adjusted for stage and tumor differentiation (HR = 1.33, 95% CI: 0.8-2.19, P = .27). Period until the unresectable recurrence was significantly shorter in Interventional (median = 7; IQR: 3-20 months) than in Control group (14.3; 7.3-27; P= 0.016). This was consistent with lower elevation (median; IQR) of tumour marker in interventional (3.8; 2.8-19) than in control group (10; 5.2-28.6) at the first recurrence time as compared to the baseline (p = 0.007). Overall (mean; SD) cost (euros)/patient was higher in the PET-Scan (9385; 11658) than in the control group (7027; 7656). Conclusions: Although recurrences were detected earlier in PET-CT group, the strategy was less effective, more expensive. This exam should not be advised routinely. Clinical trial information: NCT 00624260.
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Affiliation(s)
- Iradj Sobhani
- Departement of Gastroenterology and Oncology Hopital Henri Mondor, Creteil, France
| | | | - Emmanuel Itti
- Centre Hospitalier Universitaire Henri Mondor, Creteil, France
| | | | | | | | | | - Thierry Andre
- Medical Oncology Department, Saint-Antoine Hospital, Paris, France
| | | | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | - Julien Taieb
- Georges Pompidou European Hospital, Paris, France
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48
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Cadier B, Bulsei J, Nahon P, Seror O, Laurent A, Rosa I, Layese R, Costentin C, Cagnot C, Durand-Zaleski I, Chevreul K. Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States. Hepatology 2017; 65:1237-1248. [PMID: 28176349 DOI: 10.1002/hep.28961] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [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] [Received: 08/02/2016] [Revised: 10/20/2016] [Accepted: 11/17/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Patients outside clinical trials seldom benefit from evidence-based monitoring. The objective of this study was to estimate the cost-effectiveness of complying with HCC screening guidelines. The economic evaluation compared surveillance of patients with cirrhosis as recommended by the guidelines ("gold-standard monitoring") to "real-life monitoring" from the health care system perspective. A Markov model described the history of the disease and treatment course including current first-line curative treatment: liver resection, radiofrequency ablation (RFA), and liver transplantation. Transition probabilities were derived mainly from two French cohorts, CIRVIR and CHANGH. Costs were computed using French and U.S. tariffs. Effectiveness was measured in life years gained (LYG). An incremental cost-effectiveness ratio (ICER) was calculated for a 10-year horizon and tested with one-way and probabilistic sensitivity analyses. The cost difference between the two groups was $648 ($87,476 in the gold-standard monitoring group vs. $86,829 in the real-life monitoring group) in France and $11,965 ($93,795 vs. $81,829) in the United States. Survival increased by 0.37 years (7.18 vs. 6.81 years). The ICER was $1,754 per LYG in France and $32,415 per LYG in the United States. The health gain resulted from earlier diagnosis and access to first-line curative treatments, among which RFA provided the best value for money. CONCLUSION Our results indicate that gold-standard monitoring for patients with cirrhosis is cost-effective, attributed to a higher probability of benefiting from a curative treatment and so a higher survival probability. (Hepatology 2017;65:1237-1248).
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Affiliation(s)
- Benjamin Cadier
- AP-HP, Health economics research unit, Paris, France.,ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France
| | - Julie Bulsei
- AP-HP, Health economics research unit, Paris, France
| | - Pierre Nahon
- AP-HP, Department of Hepatology, Jean Verdier hospital, Bondy, France.,French League Against Cancer; Education and Research in Health Medicine and Human Biology, University Paris 13, Sorbonne Paris Cité, Paris, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France
| | - Olivier Seror
- Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.,AP-HP, Department of Radiology, Jean Verdier hospital, Bondy, France
| | - Alexis Laurent
- AP-HP, Department of Hepatobiliary and Digestive Surgery, Henri Mondor hospital, Creteil l, France.,University Paris-Est, Creteil, France.,Inserm U955-Creteil, France
| | - Isabelle Rosa
- CHANGH study Group, Hepatology and Gastroenterology Department, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Richard Layese
- AP-HP, Department of Public Health, Henri Mondor hospital, Creteil, France.,University Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, University Paris-Est, Creteil, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP, Health economics research unit, Paris, France.,ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.,AP-HP, Department of Public Health, Henri Mondor hospital, Creteil, France
| | - Karine Chevreul
- AP-HP, Health economics research unit, Paris, France.,ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.,University Paris Diderot, Sorbonne Paris Cite, Paris, France
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49
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Notarpaolo A, Layese R, Magistri P, Gambato M, Colledan M, Magini G, Miglioresi L, Vitale A, Vennarecci G, Ambrosio CD, Burra P, Di Benedetto F, Fagiuoli S, Colasanti M, Maria Ettorre G, Andreoli A, Cillo U, Laurent A, Katsahian S, Audureau E, Roudot-Thoraval F, Duvoux C. Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC. J Hepatol 2017; 66:552-559. [PMID: 27899297 DOI: 10.1016/j.jhep.2016.10.038] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [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: 12/30/2015] [Revised: 09/16/2016] [Accepted: 10/31/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The AFP model was shown to be superior to the Milan criteria for predicting hepatocellular carcinoma (HCC) recurrence after liver transplantation in a French population. Our aim was to test the AFP model in a non-French, post-hepatitic cirrhosis-based population of HCC candidates. METHODS 574 patients transplanted for HCC in four Italian centers were studied. AFP score was assessed at the last evaluation before liver transplantation (LT). Probabilities of recurrence and survival were estimated by the log-rank test or competing risk analysis and compared according to the AFP model. RESULTS 24.7% patients were beyond Milan criteria. HCC complicated hepatitis C virus (HCV) and hepatitis B virus (HBV) cirrhosis in 58.7% and 24% of the cases, respectively. Five-year probabilities of recurrence differed according to AFP score ⩽2 vs. >2 in the whole population (13.2±1.8% vs. 49.8±8.7%, p<0.001, HR=4.98), in patients within Milan criteria (12.8±2.0% vs. 32.4±12.1%, p=0.009, HR=3.51), beyond Milan criteria (14.9±4.2% vs. 58.9±11.5%, p<0.001, HR=4.26), HCV patients (14.9±2.5% vs. 67.6±14.7%, p<0.001, HR=6.56) and HBV patients (11.6±3.4% vs. 34.3±12.5%, p=0.012, HR=3.49). By net reclassification improvement analysis AFP score significantly improved prediction of non-recurrence compared to Milan criteria. Overall five-year survival rates according to AFP score ⩽2 or >2 were 71.7±2.2% vs. 42.2±8.3% (p<0.001, HR=2.14). CONCLUSIONS The AFP model identifies HCC candidates at low risk of recurrence, otherwise excluded by Milan criteria in a population with a predominance of post-hepatitic-related HCC. The AFP score can be proposed for selection of HCC candidates in programs with a high proportion of viral/HCV-related cirrhosis. LAY SUMMARY Selection criteria for liver transplantation of patients affected with hepatocellular carcinoma (HCC) are based on the Milan criteria, which have been shown to be too restrictive, precluding access to liver transplantation for some patients who might be cured by this operation. Recently, a French group of researchers developed a new selection model called the AFP model, or AFP score, allowing some patients with HCC not meeting Milan criteria to be transplanted with excellent results. In the present work, the AFP score was tested in a population of non-French patients transplanted for HCC occurring mainly on post-hepatitic (HCV or HBV) cirrhosis. The results confirm that in this specific population, as in the original French population of patients, the AFP model better selects patients with HCC eligible for transplantation, compared to Milan criteria. We conclude that the AFP score, which has been officially adopted by the French organization for Organ Sharing for HCC patients, can also be implemented in countries with an important burden of HCC occurring on post-hepatitic cirrhosis.
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Affiliation(s)
- Andrea Notarpaolo
- Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Liver Transplant Unit- Department of Hepatology, Henri Mondor Hospital-APHP, University of Paris-Est, Creteil, France
| | - Richard Layese
- Department of Public Health & Biostatistics, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of General Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Gambato
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Michele Colledan
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Magini
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Alessandro Vitale
- Hepatobiliary Surgery and Liver Transplant Unit, Padova University Hospital, Padova, Italy
| | - Giovanni Vennarecci
- Multiorgan Transplantation Program-General Surgery and Transplantation Unit, Ospedale San Camillo di Roma, Roma, Italy
| | | | - Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of General Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Colasanti
- Multiorgan Transplantation Program-General Surgery and Transplantation Unit, Ospedale San Camillo di Roma, Roma, Italy
| | - Giuseppe Maria Ettorre
- Multiorgan Transplantation Program-General Surgery and Transplantation Unit, Ospedale San Camillo di Roma, Roma, Italy
| | | | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplant Unit, Padova University Hospital, Padova, Italy
| | - Alexis Laurent
- Liver Transplant Unit- Department of Hepatology, Henri Mondor Hospital-APHP, University of Paris-Est, Creteil, France
| | - Sandrine Katsahian
- Department of Public Health & Biostatistics, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - Etienne Audureau
- Department of Public Health & Biostatistics, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - Françoise Roudot-Thoraval
- Department of Public Health & Biostatistics, Henri Mondor Hospital, University of Paris-Est, Créteil, France
| | - Christophe Duvoux
- Liver Transplant Unit- Department of Hepatology, Henri Mondor Hospital-APHP, University of Paris-Est, Creteil, France.
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50
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Nahon P, Lescat M, Layese R, Bourcier V, Talmat N, Allam S, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Trinchet JC, Moreau R, Roudot-Thoraval F. Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort). Gut 2017; 66:330-341. [PMID: 26511797 DOI: 10.1136/gutjnl-2015-310275] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 07/01/2015] [Revised: 09/27/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis. DESIGN This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework. RESULTS 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control. CONCLUSION BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Mathilde Lescat
- AP-HP, Hôpital Jean Verdier, Service de Microbiologie, Bondy, Université Paris 13, Bobigny, et INSERM UMR 1139, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, Créteil, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Nabila Talmat
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Setty Allam
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Odile Goria
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Yves Benhamou
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | | | | | | | | | | | | | | | - Jean-Claude Trinchet
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
| | - Richard Moreau
- AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
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