Reply to The perceived efficacy of hydroxychloroquine in observational studies: the results of the confounding effects of goals of care

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Reply to the letter to the editor “Low‐dose hydroxychloroquine therapy and lower mortality in hospitalized patients with COVID‐19: association does not mean causality.”

info:eu-repo/semantics/publishe

L’ouverture du Système national d’information inter-régimes de l’assurance maladie (SNIIRAM) : des opportunités et des difficultés. L’expérience des cohortes Gazel et Constances

International audienceBACKGROUND - In France, the national health database (SNIIRAM) is an administrative health database that collects data on hospitalizations and healthcare consumption for more than 60 million people. Although it does not record behavioral and environmental data, these data have a major interest for epidemiology, surveillance and public health. One of the most interesting uses of SNIIRAM is its linkage with surveys collecting data directly from persons. Access to the SNIIRAM data is currently relatively limited, but in the near future changes in regulations will largely facilitate open access. However, it is a huge and complex database and there are some important methodological and technical difficulties for using it due to its volume and architecture. METHODS - We are developing tools for facilitating the linkage of the Gazel and Constances cohorts to the SNIIRAM: interactive documentation on the SNIIRAM database, software for the verification of the completeness and validity of the data received from the SNIIRAM, methods for constructing indicators from the raw data in order to flag the presence of certain events (specific diagnosis, procedure, drug…), standard queries for producing a set of variables on a specific area (drugs, diagnoses during a hospital stay…). Moreover, the REDSIAM network recently set up aims to develop, evaluate and make available algorithms to identify pathologies in SNIIRAM. CONCLUSION - In order to fully benefit from the exceptional potential of the SNIIRAM database, it is essential to develop tools to facilitate its use.POSITION DU PROBLEME – Le Système national d’information inter-régimes de l’assurance maladie (SNIIRAM) comporte des données d’hospitalisation et de consommation de soins concernant plus de 60 millions de personnes. Bien qu’elles n’informent pas sur de nombreuses données personnelles et environnementales, les données du SNIIRAM ont un intérêt majeur pour l’épidémiologie, la surveillance et la santé publique. Une de ses utilisations particulièrement intéressante est l’appariement avec des données d’enquêtes recueillant des informations directement auprès des personnes. D’accès encore relativement restreint, son ouverture va être largement facilitée par les prochaines évolutions législatives, réglementaires et organisationnelles. Son utilisation nécessite cependant un important travail technique et méthodologique, de contrôle et de validation, du fait qu’il s’agit d’une base de données gigantesque et d’une très grande complexité, qui concerne trois aspects principaux : la volumétrie, l’architecture des données et l’interprétation de celles-ci. METHODES – Des outils sont en cours de développement afin d’utiliser le SNIIRAM pour enrichir les données des cohortes Gazel et Constances : documentation interactive regroupant les informations sur le SNIIRAM, logiciel d’aide au recettage des données du SNIIRAM, méthodes de calcul à partir des données brutes de variables indicatrices permettant de noter la présence d’un évènement (acte, consommation, diagnostic, etc.) pour chaque participant des cohortes, et de variables synthétiques permettant de produire un ensemble de variables sur un domaine spécifique (médicaments en soins de ville, actes, diagnostics au cours d’un séjour hospitalier...). Par ailleurs, le réseau REDSIAM mis en place récemment a pour objectif de développer, évaluer et mettre à disposition des algorithmes pour identifier des pathologies dans le SNIIRAM. CONCLUSION – Si l’on veut que le potentiel de la base de données exceptionnelle que constitue le SNIIRAM soit utilisé´ à sa juste valeur, il est indispensable de développer les outils permettant de faciliter son utilisation

Typology of Patients with Behavioral Addictions or Eating Disorders during a One-Year Period of Care: Exploring Similarities of Trajectory Using Growth Mixture Modeling Coupled with Latent Class Analysis

International audienceOBJECTIVES: Addictions are not restricted to substance-use disorders, and it is now widely recognized that they also include behavioral addictions. Certain individuals with eating disorders also experiment their disorder as an addiction. The objective was to identify typologies of patients presenting with various behavioral addictions or eating disorders according to their evolution within the framework of care, and to specify the factors associated with the differential clinical trajectories. METHODS: We included 302 patients presenting with problem gambling, sexual addiction, compulsive buying, excessive videogame use or eating disorders. The patients completed a multiaxial assessment through a face-to-face structured interview and self-administered questionnaires, including sociodemographic and addiction-related characteristics, psychiatric and addictive comorbidities and several psychological characteristics. The assessment was performed at inclusion and then repeated after 6 and 12 months. The statistical analysis included a combination of growth mixture models and latent class analysis. RESULTS: We identified five classes of patients with different profiles related to their trajectories during a one-year period of specialized care: "complex patients", "patients with impulsive psychological functioning", "patients with cooperative psychological functioning", "patients with immature psychological functioning," and "patients with resilient psychological functioning". CONCLUSIONS: The typology obtained brings interesting findings to propose patient-centered care strategies adapted to these disorders. Because the typology was independent from the type of disorder, it supports the general concept of behavioral addictions, and the similarities between eating disorders and behavioral addictions. The relevance of this model should be further examined in future studies

The role of organizational characteristics on the outcome of COVID-19 patients admitted to the ICU in Belgium

BACKGROUND : Several studies have investigated the predictors of in-hospital mortality for COVID-19 patients who need to be admitted to the Intensive Care Unit (ICU). However, no data on the role of organizational issues on patients’ outcome are available in this setting. The aim of this study was therefore to assess the role of surge capacity organisation on the outcome of critically ill COVID-19 patients admitted to ICUs in Belgium. METHODS : We conducted a retrospective analysis of in-hospital mortality in Belgian ICU COVID-19 patients via the national surveillance database. Non-survivors at hospital discharge were compared to survivors using multivariable mixed effects logistic regression analysis. Specific analyses including only patients with invasive ventilation were performed. To assess surge capacity, data were merged with administrative information on the type of hospital, the baseline number of recognized ICU beds, the number of supplementary beds specifically created for COVID-19 ICU care and the “ICU overflow” (i.e. a time-varying ratio between the number of occupied ICU beds by confirmed and suspected COVID-19 patients divided by the number of recognized ICU beds reserved for COVID-19 patients; ICU overflow present when this ratio is ≥ 1.0). FINDINGS : Over a total of 13,612 hospitalised COVID-19 patients with admission and discharge forms registered in the surveillance period (March, 1 to August, 9 2020), 1903 (14.0%) required ICU admission, of whom 1747 had available outcome data. Non-survivors (n=632, 36.1%) were older and had more frequently various comorbid diseases than survivors. In the multivariable analysis, ICU overflow, together with older age, presence of comorbidities, shorter delay between symptom onset and hospital admission, absence of hydroxychloroquine therapy and use of invasive mechanical ventilation and of ECMO, was independently associated with an increased in-hospital mortality. Similar results were found among the subgroup of invasively ventilated patients. In addition, the proportion of supplementary beds specifically created for COVID-19 ICU care to the previously existing total number of ICU beds was associated with increased an in-hospital mortality among invasively ventilated patients. The model also indicated a significant between-hospital difference in in-hospital mortality, not explained by the available patients and hospital characteristics. INTERPRETATION : Surge capacity organisation as reflected by ICU overflow or the creation of COVID-19 specific supplementary ICU beds were found to negatively impact ICU patient outcomes. FUNDING : No funding source was available for this study

Screening of subjects at risk of severe vitamin D deficiendy: a clustering approach

International audienceIntroduction: Avoiding vitamin D deficiency is essential regarding several health outcomes. Systematic blood testing may represent an important economic burden and systematic supplementation could lead, in some subjects, to a very high status, with unknown long-term consequences. Therefore, it is crucial to implement easy-to-apply strategies for screening at-risk patients. Objectives: Our objective was thus to characterize individuals at high risk of severe vitamin D deficiency (25OHD<10ng/ml). Method / Design: A combination of hierarchical and nonhierarchical cluster analysis was performed on 1528 French Caucasian adults (45-60y) from the SU.VI.MAX cohort. The following baseline variables (collected through self-administered questionnaires and anthropometric measurements) were included in the clustering procedure: severe vitamin D deficiency (yes/no, Roche Cobas® electrochemoluminescent assay on baseline plasma samples), gender, age, BMI, physical activity, educational level, dietary intake of vitamin D, latitude, sun exposure, Fitzpatrick phototype, and month of blood draw. Results: Two clusters were identified. Cluster 1 consisted of all participants with severe vitamin D deficiency and was characterized by the overrepresentation of: very low sun exposure, obesity, female gender, blood draw at the end of winter or early spring, Northern latitudes, irregular or low physical activity and the fairest skin phototypes. Cluster 2 consisted of all participants without severe vitamin D deficiency. Conclusions: This study presented for the first time a clustering analysis to identify high-risk individuals for severe vitamin D deficiency. This approach, based on easy-to-assess phenotypic, sociodemographic and lifestyle characteristics, can help to improve clinical practice by better targeting patients at need for vitamin D supplementation and/or blood testing

Interpretation of Plasma PTH Concentrations According to 25OHD Status, Gender, Age, Weight Status, and Calcium Intake: Importance of the Reference Values

International audienceContext: Reference values for plasma PTH assessment were generally established on small samples of apparently healthy subjects, without considering their 25-hydroxyvitamin D (25OHD) status or other potential modifiers of PTH concentration. Objective: Our objective was to assess ranges of plasma PTH concentration in a large sample of adults, stratifying by 25OHD status, age, gender, weight status, and calcium intake. Design, Setting, and Participants: This cross-sectional survey is based on 1824 middle-aged Caucasian adults from the Supplementation en Vitamines et Mineraux Antioxydants study (1994). Main Outcome Measures: Plasma PTH and 25OHD concentrations were measured by an electro-chemoluminescent immunoassay. Extreme percentiles of plasma PTH concentrations were assessed specifically in subjects who had plasmatic values of 25OHD of 20 ng/mL or greater and 30 ng/mL or greater. Results: Among subjects with 25OHD status of 20ng/mL or greater, the 97.5th percentile of plasma PTH concentration was 45.5 ng/L. By using this value as a reference, 5% of the subjects with plasma 25OHD less than 20 nmol/L had a high plasma PTH level, reflecting secondary hyperparathyroidism. Among vitamin D-replete subjects (25OHD status of 20 ng/mL or greater), the 97.5th percentile of plasma PTH was higher in overweight/obese subjects (51.9 vs 43.5 ng/L among normal weight subjects). Conclusions: The reference value for plasma PTH defined in this vitamin D-replete population was far below the value currently provided by the manufacturer (65 ng/L) and varied according to overweight status. These results may contribute to improve the diagnosis of primary and secondary hyperparathyroidism and subsequent therapeutic indication

Importance des valeurs de référence dans l’interprétation des concentrations plasmatiques en PTH : influence du statut en vitamine D, du sexe, de l’âge, du statut pondéral et des apports en calcium

International audienc

Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants.

Hydroxychloroquine (HCQ) has been largely used and investigated as therapy for COVID-19 across various settings at a total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (total 2400 mg over 5 days) was recommended for hospitalised patients with COVID-19. We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ monotherapy and supportive care (HCQ group) were compared with patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. Of 8075 patients with complete discharge data on 24 May 2020 and diagnosed before 1 May 2020, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, mortality was lower in the HCQ group compared with the no-HCQ group [adjusted hazard ratio (aHR) = 0.684, 95% confidence interval (CI) 0.617-0.758]. Compared with the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤5 days (n = 3975) and >5 days (n = 3487) after symptom onset [aHR = 0.701 (95% CI 0.617-0.796) and aHR = 0.647 (95% CI 0.525-0.797), respectively]. Compared with supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalised patients with COVID-19 diagnosed and treated early or later after symptom onset.info:eu-repo/semantics/publishe

Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants.

Hydroxychloroquine (HCQ) has been largely used and investigated as therapy for COVID-19 across various settings at a total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (total 2400 mg over 5 days) was recommended for hospitalised patients with COVID-19. We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ monotherapy and supportive care (HCQ group) were compared with patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. Of 8075 patients with complete discharge data on 24 May 2020 and diagnosed before 1 May 2020, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, mortality was lower in the HCQ group compared with the no-HCQ group [adjusted hazard ratio (aHR) = 0.684, 95% confidence interval (CI) 0.617-0.758]. Compared with the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤5 days (n = 3975) and >5 days (n = 3487) after symptom onset [aHR = 0.701 (95% CI 0.617-0.796) and aHR = 0.647 (95% CI 0.525-0.797), respectively]. Compared with supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalised patients with COVID-19 diagnosed and treated early or later after symptom onset