Le rapport E/Ea mesuré en échocardiographie n'est pas prédictif de la réponse au remplissage vasculaire chez le patient de la réanimation en ventilation mécanique

L'échocardiographie transthoracique (ETT) est utilisée quotidiennement en réanimation afin d'établir le statut hémodynamique des malades. Les indices combinés mitraux mesurés en ETT, tel que le rapport de la vitesse maximale de l'onde E à la vitesse maximale de l'onde Ea (E/Ea) est un indice permettant l'étude de la fonction diastolique chez le malade de cardiologie. En réanimation, E/Ea a principalement été étudié comme succédané de la pression artérielle pulmonaire d'occlusion, dont on connaît les limites pour l'étude de la réponse au remplissage vasculaire. Le but de cette étude est d'étudier la valeur prédictive du rapport E/Ea dans la réponse au remplissage chez le malade de réanimation ventilé mécaniquement. Matériel et méthodes: Nous avons conduit une étude prospective observationnelle chez des malades de réanimation ventilé mécaniquement et recevant une expansion volémique dans le cadre d'une défaillance circulatoire. Une analyse échocardiographique transthoracique complète, comprenant l'estimation du volume d'éjection systolique (VES), les mesures des flux doppler conventionnels et des dopplers tissulaires (vitesse des ondes E,A, Ea, Aa) a été conduite avant et après l'administration de 500 ml de sérum salé isotonique sur 15 minutes. Une réponse positive à été définie par une augmentation du VES >= 15%. Les caractéristiques générales, les paramètres mitraux ainsi que les indices combinés (E/Ea et E/A) ont été comparés entre répondeurs (R) et non répondeurs (NR), à l'aide de tests t de Student, de tests de Chi2, de courbes ROC et par la méthode des Likelihood ratios. Résultats: Quatre-vingt treize (n=93) patients ont été étudiés: 43 R et 50 NR, avec des caractéristiques basales similaires. La fraction d'éjection ventriculaire gauche était altérée (FEVG50%) n=69, sans différence pour le statut R ou NR. Avant remplissage, les valeurs de E/Ea n'étaient pas différentes entre R et NR et un chevauchement important était constaté (7,4 +- 2,4 vs 8,4 +- 3,1 respectivement; p=0,09). Les résultats étaient similaires lorsque n'étaient considérés que les patients ayant un E/Ea inférieur à la médiane c'est-à-dire 1,8 (LHR-=0,14; sens 97,7%, spé 16%). Conclusion: Le rapport E/Ea n'est pas différent entre répondeurs et non répondeurs en réanimation et aucun seuil n'a pu se révéler discriminant dans la prédiction de la réponse au remplissage. A contrario, E/A était significativement différent mais seules les valeurs extrêmes se sont avérées cliniquement pertinentes (1,8).TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area.

In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen

Associated risk factors of severe dengue in Reunion Island: A prospective cohort study.

BackgroundSince 2018, a dengue epidemic has been raging annually in Reunion Island, which poses the major problem of its morbidity and mortality. However, there is no consensus in the literature on factors associated with severity of illness. The objective of this study was to identify the factors associated with the occurrence of severe dengue (SD) according to the criteria adopted in 2009 by the World Health Organization (WHO), during the 2019 epidemic.Methodology/principal findingsA total of 163 patients with RT-PCR-confirmed dengue were included in a multicenter prospective cohort study in Reunion Island between January and June 2019. Of these, 37 (23%) were classified as SD, which involves presentation dominated by at least one organ failure, and 126 (77%) classified as non-SD (of which 90 (71%) had warning signs). Confusion, dehydration, and relative hypovolemia were significantly associated with SD in bivariate analysis (p Conclusions/significanceThis study confirms that SD is a frequent cause of hospitalization during dengue epidemics in Reunion Island. It suggests that cardiovascular disease, Western European origin, and delay in diagnosis and management are risk factors associated with SD fever, and that restoration of blood volume and correction of dehydration must be performed early to be effective.Trial registrationNCT01099852; clinicaltrials.gov

Effects of Mesenchymal Stem Cells Associated with Pharmacologically Active Microcarriers on Cartilage Healing in Horses

CERVOXY COLLInternational audienc

Harness risk stratification of diabetic patients with dengue in a cohort study

Background: Identifying predictors of severe dengue (SD) is key for triage and management of patients as well as for advising travellers to countries where dengue is endemic. In this, meta-analyses have raised diabetes mellitus as a risk factor for SD and a prognostic factor for dengue-related mortality. The purpose of this study was to assess whether diabetic patients (DPs) are at increased risk for SD in comparison to non-diabetic patients (NDPs) in a setting of high prevalence of type 2 diabetes mellitus and increasing endemicity for dengue. Methods: In a cohort study conducted during the 2019 dengue epidemic on Reunion Island, we estimated the risk ratios (RR) of DPs for SD (WHO 2009 definition), hospitalisation, intensive care unit (ICU) admission, critical care need or death in the ICU, and scales rating severity or multiple organ dysfunction syndrome (MODS), among confirmed cases of dengue (positive RT-PCR or NS1 antigen). Results: In a Poisson regression model adjusted for age, gender and comorbidity, DPs were more likely to develop SD (adjusted RR: 1.46, 95%CI 1.10–1.95), to be hospitalised, admitted to the ICU, and need critical care or die in the ICU. Subgroup analyses identified female DPs, non-elderly DPs (< 65 years) and DPs with low Charlson score (< 3) to be at higher risk for SD, the two first subgroups trough more severe presentation (higher Simplified Acute Physiology Score-2 values; higher MODS scores, respectively). Male gender, age less than 65 years and mixed comorbidity were identified as prognostic factors for critical care need or death in the ICU, male and non-elderly DPs being more likely to develop MODS than their non-diabetic counterparts. Conclusions: Together, these data highlight the role of diabetes mellitus in the progression from dengue to SD through higher severity per se or the event of MODS

Study flowchart and diagnostic methods.

*Retrospective analysis of medical and laboratory charts between 2018 and 2019, †Medical chart analysis of patients arriving at the hospital with febrile illness from 01/01/2019 to 06/30/2019.</p

Comparison of the main biological factors at initial hospital evaluation for leptospirosis and dengue fever cases on Reunion Island from 2018 to 2019 (bivariate analysis).

Comparison of the main biological factors at initial hospital evaluation for leptospirosis and dengue fever cases on Reunion Island from 2018 to 2019 (bivariate analysis).</p

Multivariate logistic regression analysis for the diagnosis of leptospirosis compared to dengue fever at initial hospital evaluation on Reunion Island from 2018 to 2019.

Multivariate logistic regression analysis for the diagnosis of leptospirosis compared to dengue fever at initial hospital evaluation on Reunion Island from 2018 to 2019.</p

Comparison of DF patients characteristics according to CRP threshold of 50mg/L on Reunion Island during 2018 and 2019.

Comparison of DF patients characteristics according to CRP threshold of 50mg/L on Reunion Island during 2018 and 2019.</p

Comparison of clinical and biological factors at initial hospital presentation of leptospirosis and dengue fever cases on Reunion Island between 2018 and 2019 (bivariate analysis).

*Regarding symptoms and other physical signs not reported, if a symptom/sign was not mentioned during the retrospective review of the medical charts then it was considered as absent. Therefore, there is no data considered as missing data for the symptom category. ALP: alkaline phosphatase; aPTT: activated partial thromboplastin time; AST: aspartate aminotransferase; ALT: alanine aminotransferase; BUN: blood urea nitrogen; CK: creatinine kinase; CRP: C-reactive protein; DBP: diastolic blood pressure; GGT: gamma-glutamyl transferase; RBC: red blood cell; SBP: systolic blood pressure. (DOCX)</p