Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11-2.46), p = 0.013), but not in influenza (1.74 (0.99-3.06), p = 0.052), or no viral infection groups (1.13 (0.68-1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality

a planned ancillary analysis of the coVAPid cohort

Funding: This study was supported in part by a grant from the French government through the «Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpreta tion, writing of the report, or decision to submit for publication.BACKGROUND: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. FINDINGS: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16-2.47), p = 0.006), and influenza groups (1.75 (1.03-3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64-1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. INTERPRETATION: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov, number NCT04359693.publishersversionpublishe

Simple scoring system to predict in-hospital mortality after surgery for infective endocarditis

BACKGROUND: Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. METHODS AND RESULTS: Outcomes of 361 consecutive patients (mean age, 59.1\ub115.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. CONCLUSIONS: A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Les polysaccharides et les ellagitanins du bois de chêne : influence sur la qualité sensorielle des vins

It is widely accepted that alcoholic beverages quality depends on their ageing in premium quality oak wood. Oak wood selection and maturation are essential steps in the course of barrel fabrication. Given the existence of many factors involved in the choice of raw material and in natural seasoning of oak wood, it is very difficult to determine the real impact of seasoning and selection factors on oak wood composition. A sampling was done to study the evolution of oak wood chemical composition during four seasoning steps: non matured, 12 months, 18 months and 24 months. For this sampling, three selection factors were taken into account: age, grain type and the Polyphenolic Index measured by Oakscan®. Besides extractables (~10%), three polymers constitute the main part of oak wood: cellulose, hemicelluloses and lignins. These compounds may undergo hydrolysis or chemical reactions during cooperage processes, especially during heat treatment, which release some aromatic compounds or aromatic precursors having a genuine sensorial interest on wine aged in barrel or in contact with oak products. To date, no studies revealed a link between the proportions of these compounds in oak wood and the chemical and sensorial impact in wines ageing with oak wood. Our study showed that the proportions of these compounds evolved significantly during oak wood seasoning and the results highlighted the impact of selection factors. Respectively, extractables, lignins, hemicelluloses and cellulose proportions were mostly for non-matured, 12 months, 18 months and 24 seasoning months. The development of a test plan with a Merlot wine from a second oak wood sampling, using similar modalities as the previous test plan allowed the evaluation of oak wood seasoning impact on the chemical composition of a wine ageing with oak wood pieces. Results showed a lowering of 8% in ellagitannins content of wine between 12 and 24 months modalities. An impact on volatile composition in wine has also been established: furanic aldehydes were positively correlated with a long maturation time (18 and 24 months), whereas phenolic aldehydes were positively correlated with a shorter seasoning time (12 months). Our results highlighted also the impact of selection factors on wine chemical composition. Sensorial analysis on this Merlot wine led to significant differences detected by the panel between 12 and 24 seasoning modalities, but not between 18 and 24 months modalities with triangular tests. Sensorial profiles were also established to attempt to associate the differences detected to one or more descriptors. For this test, results highlighted the difficulty for the panel to make a significant difference between 12 and 24 months modalities. However they contribute to explain the differences demonstrated with triangular tests for some seasoning modalities: toasted, bitterness, astringency, roundness and sweet perception.Il est généralement admis que la qualité des vins et des eaux de vie dépend de leur vieillissement au contact du bois de chêne. La sélection du bois de chêne et sa maturation constituent des étapes essentielles dans la fabrication de barriques. Compte tenu des nombreux facteurs impliqués dans le choix de la matière première et dans la phase de séchage naturel du bois de chêne, il est très complexe de déterminer l’impact de la durée de séchage et l’incidence des facteurs de sélection combinés. Nous avons pu mettre en œuvre un plan d’essai qui nous a permis d’étudier l’évolution de la composition chimique du bois de chêne pour quatre stades de séchage : bois frais, 12 mois, 18 mois et 24 mois. Pour ce plan d’essai, l’échantillonnage a été réalisé en prenant en compte trois facteurs de sélection d’intérêt en tonnellerie : l’âge du bois, le type de grain et la classe d’Indice Polyphénolique mesurée par Oakscan®. En plus de la partie extractible (~10%), trois polymères constituent la majeure partie (~90%) du bois de chêne : la cellulose, les hémicelluloses et les lignines. Ces composés sont susceptibles de subir des hydrolyses ou des réactions chimiques au cours des différents processus de tonnellerie et notamment lors de la chauffe, libérant ainsi des composés aromatiques ou certains précurseurs aromatiques ayant un véritable intérêt sensoriel pour le vin vieilli en fût ou en contact avec du bois de chêne. Aucune étude n’a, à ce jour, montré un lien entre les proportions de ces composés dans le bois de chêne et l’impact au niveau chimique et organoleptique dans des vins élevés au contact de bois de chêne. Nous avons pu montrer que leurs proportions évoluent de façon significative au cours du séchage du bois de chêne et nos résultats soulignent l’incidence des différents facteurs de sélection. Respectivement, les proportions en composés extractibles, lignines, hémicelluloses et cellulose apparaissent majoritaires aux stades bois frais, 12 mois, 18 mois et 24 mois de séchage. La mise en place d’un plan d’essai sur un vin de Merlot à partir d’un deuxième échantillonnage de bois de chêne, selon les mêmes modalités que le plan d’essai sur bois, nous a permis d’évaluer l’impact du temps de séchage du bois sur la composition chimique d’un vin élevé au contact de morceaux de bois de chêne. Les résultats ont montré entre autres une baisse de près de 8% de teneur en ellagitanins moléculaires du vin entre les modalités 12 et 24 mois de séchage mais aussi des impacts sur les concentrations en composés volatiles du vin : les aldéhydes furaniques sont corrélés positivement à des temps de séchage longs (18 et 24 mois), tandis que les aldéhydes phénoliques le sont avec un temps de maturation plus court (12 mois). Nos résultats soulignent aussi l’influence des facteurs de sélection sur la composition chimique du vin. Sur le même vin de Merlot, la réalisation d’analyses sensorielles a mis en évidence des différences significatives perçues par notre panel entre les modalités de séchage 12 et 24 mois, tandis que les modalités 18 et 24 mois n’ont pas été distinguées lors de tests triangulaires. Des profils sensoriels ont également été établis pour tenter d’associer les différences perçues à un ou plusieurs descripteurs. Pour cette épreuve, les résultats soulignent la difficulté pour notre panel de dégustateurs de s’accorder sur l’existence d’une différence globale et significative entre les modalités 12 et 24 mois. Cependant, ils contribuent à expliquer les différences mises en évidence lors des tests triangulaires pour certaines modalités de séchage pour les descripteurs grillé/fumé, amertume, astringence, rondeur en bouche et perception sucrée

Oak wood polysaccharides and ellagitannins : the impact on sensory quality of wines

Il est généralement admis que la qualité des vins et des eaux de vie dépend de leur vieillissement au contact du bois de chêne. La sélection du bois de chêne et sa maturation constituent des étapes essentielles dans la fabrication de barriques. Compte tenu des nombreux facteurs impliqués dans le choix de la matière première et dans la phase de séchage naturel du bois de chêne, il est très complexe de déterminer l’impact de la durée de séchage et l’incidence des facteurs de sélection combinés. Nous avons pu mettre en œuvre un plan d’essai qui nous a permis d’étudier l’évolution de la composition chimique du bois de chêne pour quatre stades de séchage : bois frais, 12 mois, 18 mois et 24 mois. Pour ce plan d’essai, l’échantillonnage a été réalisé en prenant en compte trois facteurs de sélection d’intérêt en tonnellerie : l’âge du bois, le type de grain et la classe d’Indice Polyphénolique mesurée par Oakscan®. En plus de la partie extractible (~10%), trois polymères constituent la majeure partie (~90%) du bois de chêne : la cellulose, les hémicelluloses et les lignines. Ces composés sont susceptibles de subir des hydrolyses ou des réactions chimiques au cours des différents processus de tonnellerie et notamment lors de la chauffe, libérant ainsi des composés aromatiques ou certains précurseurs aromatiques ayant un véritable intérêt sensoriel pour le vin vieilli en fût ou en contact avec du bois de chêne. Aucune étude n’a, à ce jour, montré un lien entre les proportions de ces composés dans le bois de chêne et l’impact au niveau chimique et organoleptique dans des vins élevés au contact de bois de chêne. Nous avons pu montrer que leurs proportions évoluent de façon significative au cours du séchage du bois de chêne et nos résultats soulignent l’incidence des différents facteurs de sélection. Respectivement, les proportions en composés extractibles, lignines, hémicelluloses et cellulose apparaissent majoritaires aux stades bois frais, 12 mois, 18 mois et 24 mois de séchage. La mise en place d’un plan d’essai sur un vin de Merlot à partir d’un deuxième échantillonnage de bois de chêne, selon les mêmes modalités que le plan d’essai sur bois, nous a permis d’évaluer l’impact du temps de séchage du bois sur la composition chimique d’un vin élevé au contact de morceaux de bois de chêne. Les résultats ont montré entre autres une baisse de près de 8% de teneur en ellagitanins moléculaires du vin entre les modalités 12 et 24 mois de séchage mais aussi des impacts sur les concentrations en composés volatiles du vin : les aldéhydes furaniques sont corrélés positivement à des temps de séchage longs (18 et 24 mois), tandis que les aldéhydes phénoliques le sont avec un temps de maturation plus court (12 mois). Nos résultats soulignent aussi l’influence des facteurs de sélection sur la composition chimique du vin. Sur le même vin de Merlot, la réalisation d’analyses sensorielles a mis en évidence des différences significatives perçues par notre panel entre les modalités de séchage 12 et 24 mois, tandis que les modalités 18 et 24 mois n’ont pas été distinguées lors de tests triangulaires. Des profils sensoriels ont également été établis pour tenter d’associer les différences perçues à un ou plusieurs descripteurs. Pour cette épreuve, les résultats soulignent la difficulté pour notre panel de dégustateurs de s’accorder sur l’existence d’une différence globale et significative entre les modalités 12 et 24 mois. Cependant, ils contribuent à expliquer les différences mises en évidence lors des tests triangulaires pour certaines modalités de séchage pour les descripteurs grillé/fumé, amertume, astringence, rondeur en bouche et perception sucrée.It is widely accepted that alcoholic beverages quality depends on their ageing in premium quality oak wood. Oak wood selection and maturation are essential steps in the course of barrel fabrication. Given the existence of many factors involved in the choice of raw material and in natural seasoning of oak wood, it is very difficult to determine the real impact of seasoning and selection factors on oak wood composition. A sampling was done to study the evolution of oak wood chemical composition during four seasoning steps: non matured, 12 months, 18 months and 24 months. For this sampling, three selection factors were taken into account: age, grain type and the Polyphenolic Index measured by Oakscan®. Besides extractables (~10%), three polymers constitute the main part of oak wood: cellulose, hemicelluloses and lignins. These compounds may undergo hydrolysis or chemical reactions during cooperage processes, especially during heat treatment, which release some aromatic compounds or aromatic precursors having a genuine sensorial interest on wine aged in barrel or in contact with oak products. To date, no studies revealed a link between the proportions of these compounds in oak wood and the chemical and sensorial impact in wines ageing with oak wood. Our study showed that the proportions of these compounds evolved significantly during oak wood seasoning and the results highlighted the impact of selection factors. Respectively, extractables, lignins, hemicelluloses and cellulose proportions were mostly for non-matured, 12 months, 18 months and 24 seasoning months. The development of a test plan with a Merlot wine from a second oak wood sampling, using similar modalities as the previous test plan allowed the evaluation of oak wood seasoning impact on the chemical composition of a wine ageing with oak wood pieces. Results showed a lowering of 8% in ellagitannins content of wine between 12 and 24 months modalities. An impact on volatile composition in wine has also been established: furanic aldehydes were positively correlated with a long maturation time (18 and 24 months), whereas phenolic aldehydes were positively correlated with a shorter seasoning time (12 months). Our results highlighted also the impact of selection factors on wine chemical composition. Sensorial analysis on this Merlot wine led to significant differences detected by the panel between 12 and 24 seasoning modalities, but not between 18 and 24 months modalities with triangular tests. Sensorial profiles were also established to attempt to associate the differences detected to one or more descriptors. For this test, results highlighted the difficulty for the panel to make a significant difference between 12 and 24 months modalities. However they contribute to explain the differences demonstrated with triangular tests for some seasoning modalities: toasted, bitterness, astringency, roundness and sweet perception

Variations in oxygen and ellagitannins, and organoleptic properties of red wine aged in French oak barrels classified by a near infrared system

International audienceDuring wine aging in barrels, antioxidant molecules from wood, such as ellagitannins, are solubilized and react with wine molecules and oxygen. However, their concentrations are highly variable. Oxygen is an important factor, as it plays a role in wine parameters and organoleptic perceptions. Five barrel modalities were used; three polyphenol indices (IP), classified using the NIRS procedure, and three grain qualities. Barrels were equipped with windows to measure the oxygen using luminescence technology. The ellagitannin concentrations in the wine and its organoleptic properties were monitored. Oxygen concentrations decreased quickly during the first 8 days of aging and this phenomenon was significantly more marked in barrels with a higher IP and medium grain. The ellagitannin concentrations were believed to be correlated with wood classification and oxygen consumption. Furthermore, the organoleptic properties were significantly impacted, as the wine with the lowest ellagitannin level was described as less astringent, bitter, woody, and smoky/toasty

Carbohydr Res

It is widely accepted that alcoholic beverage quality depends on their ageing in premium quality oak wood. From the choice of wood to beverage ageing, through the different steps in cask manufacturing, many factors should be considered. One of the biggest challenge in cooperages is to take into account all these factors. Most of the studies are interested in phenolic compounds, extracted during ageing and especially involved in wine oxidation, colour, and sensory properties such as astringency and bitterness. Oak aroma volatile compounds have also been the subject of numerous studies. These compounds of interest are part of low molecular weight compounds which represent 2%-10% of oak wood composition. However, three polymers constitute the main part of oak wood: cellulose, hemicellulose and lignin. As far as we are aware, few studies concerning the role of these major macromolecules in oak wood have been published previously. This article reviews oak wood polysaccharides and lignin, their potential interest and different assays used to determine their content

Compositional and Sensory Characterization of Grape Proanthocyanidins and Oak wood Ellagitannin

Aimed at increasing our knowledge on the astringency of sensory-active non-volatiles compounds migrating principally from grapes and from oak wood into the wine, grape extracts and an aqueous ethanolic extract from oak wood chips were used for their key taste compounds. Monomeric/oligomeric and polymeric proanthocyanidin fraction of seed and skin extracts were obtained from grapes. Ellagitannins were extracted and purified from oak wood. Compositional characterization, purity and sensory evaluation of grape extracts were performed by liquid chromatography/mass spectrometry and sensory analysis, respectively. Purification of ellagitannin extract at 93.4% was realized by successive fractionations on Toyopearl TSK HW-40 (F) and on C-18 column. At the same concentration, ellagitannin fraction was perceived rather mellow, seed and skin monomeric/oligomeric fraction was characterized slight astringent, polymeric seed fraction was identified as tannic whereas polymeric skin fraction was appreciated rather mellow