Facteurs de risque de mortalité à 90 jours des patients admis en réanimation pour syndrome de détresse respiratoire aiguë (S.D.R.A) lié au COVID-19 à Marseille

Objectifs : décrire les caractéristiques cliniques et la prise en charge des patients admis en réanimation avec un diagnostic de COVID-19 confirmé par PCR, déterminer la mortalité à 90 jours et les facteurs de risque associés à cette mortalité.Matériels et méthodes : il s’agit d’une étude observationnelle rétrospective qui fut conduite dans six unités de réanimation au sein des trois hôpitaux universitaires de Marseille, France. Tous les patients majeurs admis dans ces services entre le 10 mars et le 10 mai 2020 avec un diagnostic PCR de COVID-19 et un tableau de détresse respiratoire aiguë ont été considérés pour l’inclusion. L’analyse statistique s’est concentrée sur la cohorte des patients ayant reçu de la ventilation mécanique invasive. Le critère de jugement principal est la mortalité à 90 jours après admission en réanimation.Résultats : 172 patients ont été inclus pour détresse respiratoire aiguë lié au COVID-19, parmi lesquels 117 (67%) ont reçu de la ventilation mécanique invasive. L’âge médian de ces patients ventilés est de 63 (56-72) ans et 88 (75.2%) d’entre eux sont des hommes. Leur mortalité à 28 jours et 90 jours après admission sont respectivement de 18.8% et 27.4%. La durée médiane de ventilation invasive est de 20 (9-33) jours et la durée médiane de séjour pour les patients intubés est de 29 (17-46) jours. Après analyse multivariée, les facteurs de risque associés à la mortalité à 90 jours sont l’âge, un index de comorbidités de Charlson élevé, une prise chronique de statines et la survenue au cours du séjour d’une thrombose artérielle. Conclusion : la mortalité des patients ayant reçu de la ventilation invasive pour un syndrome de détresse respiratoire aiguë lié au COVID-19 est plutôt inférieure dans cette cohorte à celle observée dans les autres publications similaires. Conformément à ce qui fut rapporté ailleurs l’âge et le nombre de comorbidités restent les principaux facteurs de risque de décès. Ces données pourraient également supporter l’hypothèse de l’importance sur le pronostic final des patients des facteurs liés aux capacités de réorganisation des services de réanimation durant l’épidémie

Contrasting gene decay in subterranean vertebrates: insights from cavefishes and fossorial mammals

International audienceEvolution sometimes proceeds by loss, especially when structures and genes become dispensable after an environmental shift relaxes functional constraints. Subterranean vertebrates are outstanding models to analyze this process, and gene decay can serve as a readout. We sought to understand some general principles on the extent and tempo of the decay of genes involved in vision, circadian clock and pigmentation in cavefishes. The analysis of the genomes of two Cuban species belonging to the genus Lucifuga provided evidence for the largest loss of eye-specific genes and non-visual opsin genes reported so far in cavefishes. Comparisons with a recently evolved cave population of Astyanax mexicanus and three species belonging to the Chinese tetraploid genus Sinocyclocheilus revealed the combined effects of the level of eye regression, time and genome ploidy on eye-specific gene pseudogenization. The limited extent of gene decay in all these cavefishes and the very small number of loss of function (LoF) mutations per pseudogene suggest that their eye degeneration may not be very ancient, ranging from early to late Pleistocene. This is in sharp contrast with the identification of several vision genes carrying many LoF mutations in ancient fossorial mammals, further suggesting that blind fishes cannot thrive more than a few million years in cave ecosystems

Impact of Dexamethasone and Inhaled Nitric Oxide on Severe Acute Kidney Injury in Critically Ill Patients with COVID-19

International audienceBackground: Acute kidney injury (AKI) is the second most frequent condition after acute respiratory distress syndrome (ARDS) in critically ill patients with severe COVID-19 and is strongly associated with mortality. The aim of this multicentric study was to assess the impact of the specific treatments of COVID-19 and ARDS on the risk of severe AKI in critically ill COVID-19 patients. Methods: In this cohort study, data from consecutive patients older than 18 years admitted to 6 ICUs for COVID-19-related ARDS requiring invasive mechanical ventilation were included. The incidence and severity of AKI, defined according to the 2012 KDIGO definition, were monitored during the entire ICU stay until day 90. Patients older than 18 years admitted to the ICU for COVID-19-related ARDS requiring invasive mechanical ventilation were included. Results: 164 patients were included in the final analysis; 97 (59.1%) displayed AKI, of which 39 (23.8%) had severe stage 3 AKI, and 21 (12.8%) required renal replacement therapy (RRT). In univariate analysis, severe AKI was associated with angiotensin-converting enzyme inhibitors (ACEI) exposure (p = 0.016), arterial hypertension (p = 0.029), APACHE-II score (p = 0.004) and mortality at D28 (p = 0.008), D60 (p < 0.001) and D90 (p < 0.001). In multivariate analysis, the factors associated with the onset of stage 3 AKI were: exposure to ACEI (OR: 4.238 (1.307–13.736), p = 0.016), APACHE II score (without age) (OR: 1.138 (1.044–1.241), p = 0.003) and iNO (OR: 5.694 (1.953–16.606), p = 0.001). Prone positioning (OR: 0.234 (0.057–0.967), p = 0.045) and dexamethasone (OR: 0.194 (0.053–0.713), p = 0.014) were associated with a decreased risk of severe AKI. Conclusions: Dexamethasone was associated with the prevention of the risk of severe AKI and RRT, and iNO was associated with severe AKI and RRT in critically ill patients with COVID-19. iNO should be used with caution in COVID-19-related ARDS

Factors Associated with 90-Day Mortality in Invasively Ventilated Patients with COVID-19 in Marseille, France

International audienceOBJECTIVES: To describe clinical characteristics and management of intensive care units (ICU) patients with laboratory-confirmed COVID-19 and to determine 90-day mortality after ICU admission and associated risk factors. METHODS: This observational retrospective study was conducted in six intensive care units (ICUs) in three university hospitals in Marseille, France. Between 10 March and 10 May 2020, all adult patients admitted in ICU with laboratory-confirmed SARS-CoV-2 and respiratory failure were eligible for inclusion. The statistical analysis was focused on the mechanically ventilated patients. The primary outcome was the 90-day mortality after ICU admission. RESULTS: Included in the study were 172 patients with COVID-19 related respiratory failure, 117 of whom (67%) received invasive mechanical ventilation. 90-day mortality of the invasively ventilated patients was 27.4%. Median duration of ventilation and median length of stay in ICU for these patients were 20 (9-33) days and 29 (17-46) days. Mortality increased with the severity of ARDS at ICU admission. After multivariable analysis was carried out, risk factors associated with 90-day mortality were age, elevated Charlson comorbidity index, chronic statins intake and occurrence of an arterial thrombosis. CONCLUSION: In this cohort, age and number of comorbidities were the main predictors of mortality in invasively ventilated patients. The only modifiable factor associated with mortality in multivariate analysis was arterial thrombosis