1
|
Drummond D, Roy C, Cornet M, Bucher J, Boussaud V, Pimpec-Barthes FL, Pontailler M, Raisky O, Lopez V, Barbanti C, Guillemain R, Renolleau S, Grimaud M, Oualha M, de Saint Blanquat L, Sermet-Gaudelus I. Acute respiratory failure due to pulmonary exacerbation in children with cystic fibrosis admitted in a pediatric intensive care unit: outcomes and factors associated with mortality. Respir Res 2024; 25:190. [PMID: 38685088 PMCID: PMC11059703 DOI: 10.1186/s12931-024-02778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Children with advanced pulmonary disease due to cystic fibrosis (CF) are at risk of acute respiratory failure due to pulmonary exacerbations leading to their admission to pediatric intensive care units (PICU). The objectives of this study were to determine short and medium-term outcomes of children with CF admitted to PICU for acute respiratory failure due to pulmonary exacerbation and to identify prognosis factors. METHODS This retrospective monocentric study included patients less than 18 years old admitted to the PICU of a French university hospital between 2000 and 2020. Cox proportional hazard regression methods were used to determine prognosis factors of mortality or lung transplant. RESULTS Prior to PICU admission, the 29 patients included (median age 13.5 years) had a severe lung disease (median Forced Expiratory Volume in 1 s percentage predicted at 29%). Mortality rates were respectively 17%, 31%, 34%, 41% at discharge and at 3, 12 and 36 months post-discharge. Survival rates free of lung transplant were 34%, 32%, 24% and 17% respectively. Risk factors associated with mortality or lung transplant using the univariate analysis were female sex and higher pCO2 and chloride levels at PICU admission, and following pre admission characteristics: home respiratory and nutritional support, registration on lung transplant list and Stenotrophomonas Maltophilia bronchial colonization. CONCLUSION Children with CF admitted to PICU for acute respiratory failure secondary to pulmonary exacerbations are at high risk of death, both in the short and medium terms. Lung transplant is their main chance of survival and should be considered early.
Collapse
Affiliation(s)
- David Drummond
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Charlotte Roy
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Matthieu Cornet
- Institut Necker Enfants Malades, INSERM U1151, CNRS, Université de Paris, Paris, France
- CBIO-Centre de BioInformatique. Ecole des Mines, Paris, France
| | - Julie Bucher
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Véronique Boussaud
- Hôpital Européen George Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Margaux Pontailler
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de chirurgie thoracique et cardio-vasculaire pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Olivier Raisky
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de chirurgie thoracique et cardio-vasculaire pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Vanessa Lopez
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service d'anesthésie et réanimation pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Claudio Barbanti
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service d'anesthésie et réanimation pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Romain Guillemain
- Hôpital Européen George Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sylvain Renolleau
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marion Grimaud
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mehdi Oualha
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Laure de Saint Blanquat
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Isabelle Sermet-Gaudelus
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
- Institut Necker Enfants Malades, INSERM U1151, CNRS, Université de Paris, Paris, France.
| |
Collapse
|
2
|
Moreno-Pérez O, Andres M, Leon-Ramirez JM, Sánchez-Payá J, Rodríguez JC, Sánchez R, García-Sevila R, Boix V, Gil J, Merino E. Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study. J Autoimmun 2020; 114:102523. [PMID: 32690352 PMCID: PMC7365106 DOI: 10.1016/j.jaut.2020.102523] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To describe the clinical characteristics and predictors of major outcomes in patients treated with tocilizumab (TCZ) for severe COVID-19 pneumonia. PATIENTS AND METHODS Case series of all sequential patients with severe COVID-19 pneumonia treated with TCZ at an Academic Spanish hospital (March 12 - May 2, 2020). Clinical outcomes: death, length of hospital stay. An early clinical response to TCZ (48-72 h after the administration) was assessed by variations in respiratory function markers, Brescia COVID Respiratory Severity Scale (BCRSS), inflammatory parameters, and patients' and physicians' opinion. Associations were tested by multiple logistic regression. RESULTS From a cohort of 236 patients, 77 patients treated with TCZ were included (median age 62 years (IQR 53.0-72.0), 64.9% were males), 42.9% had Charlson index ≥3; hypertension (41.6%), obesity (34.7%), and diabetes (20.8%). Median follow-up was 83.0 days (78.0-86.5), no patient was readmitted. ICU admission was required for 42 (54.5%), invasive mechanical ventilation in 38 (49.4%) and 10 patients died (12.9% global, 23.8% at ICU admitted). After multivariate adjustment, TCZ response by BCRSS (OR 0.03 (0.01-0.68), p = 0.028), and Charlson index (OR 3.54 (1.20-10.44), p = 0.022) has been identified as independent factors associated with mortality. Median of hospital stay was 16.0 days (11.0-23.0); BCRSS, physician subjective and D-dimer response were associated with shorter hospitalization stay. CONCLUSIONS In a Mediterranean cohort, use of tocilizumab for severe COVID-19 show 12.9% of mortality. Early TCZ-response by BCRSS and low comorbidity were associated with increased survival. Early TCZ-response was related to shorter median hospital stay.
Collapse
MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antiviral Agents/administration & dosage
- Betacoronavirus/immunology
- Betacoronavirus/pathogenicity
- COVID-19
- Coronavirus Infections/diagnosis
- Coronavirus Infections/immunology
- Coronavirus Infections/mortality
- Coronavirus Infections/therapy
- Drug Therapy, Combination
- Female
- Fibrin Fibrinogen Degradation Products/analysis
- Follow-Up Studies
- Hospital Mortality
- Humans
- Infusions, Intravenous
- Interleukin-6/immunology
- Interleukin-6/metabolism
- Length of Stay/statistics & numerical data
- Male
- Middle Aged
- Pandemics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/immunology
- Pneumonia, Viral/mortality
- Pneumonia, Viral/therapy
- Prognosis
- Receptors, Interleukin-6/antagonists & inhibitors
- Receptors, Interleukin-6/metabolism
- Respiration, Artificial/statistics & numerical data
- Respiratory Function Tests/statistics & numerical data
- Retrospective Studies
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- Survival Analysis
- Time Factors
- Time-to-Treatment
- Treatment Outcome
Collapse
Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain.
| | - Mariano Andres
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Rheumatology Department, Alicante General University Hospital Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Jose-Manuel Leon-Ramirez
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - José Sánchez-Payá
- Preventive Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Juan Carlos Rodríguez
- Microbiology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Elche, Spain.
| | - Rosario Sánchez
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Raquel García-Sevila
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Vicente Boix
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Joan Gil
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| |
Collapse
|