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Background A large-scale industrial fire occurred in Rouen, France, in 2019. This study assessed the health-related quality of life of people exposed to its consequences 1 year later. Methods The study population comprised inhabitants of the exposed area and a non-exposed area. A representative sample was randomly selected using a stratified design. Data were collected using a standardized questionnaire to describe fire exposure and to calculate three health-related quality of life scores according to the SF12-v2 scale. After adjustment, descriptive and multivariate analyses were conducted. Results The sample comprised 4773 participants (response rate 47.7%). In the exposed area, the average mental, physical and overall health scores were 47.5, 52.0 and 73.8 out of 100, respectively. Mean mental and overall health scores were higher in the non-exposed area (49.0 and 76.0, respectively). After adjustment, a lower mental health score was associated with a higher number of perceived types of exposure, reaching −3.72 points [−5.41; −2.04] for five or more different types of perceived exposure. A lower mental health score was associated with soot deposits (−1.04 [−1.70; −0.39]), perceiving odours [(−2.04 [−3.22; −0.86]) up to the day of data collection], and having seen, heard or been awakened by the fire (−1.21 [−1.90; −0.52]). A slightly lower physical health score was associated with soot deposits (−0.57 [−1.07; −0.08]). Conclusion This study highlighted associations between exposure to the consequences of the industrial fire in Rouen and a deterioration of perceived health-related quality of life 1 year later, particularly the mental health dimension. [ABSTRACT FROM AUTHOR]

Objective The optimal induction therapy for severe glomerulonephritis of ANCA-associated vasculitis (AAV) is debated. We compared the efficacy of glucocorticoid and rituximab (RTX) or CYC induction therapy for severe AAV-related glomerulonephritis and evaluated the potential benefit of plasma exchange (PE) as adjunct therapy to CYC. Methods This retrospective, multicentre study included AAV patients with severe renal active disease (serum creatinine level ≥350 µmol/l and/or estimated glomerular filtration ratio ≤15 ml/min/1.73 m2). Propensity-score analysis was used to adjust for potential confounders. Results Between 2005 and 2017, 153 patients with AAV-related glomerulonephritis were studied (96 [60%] men; mean [ s. d.] age 63 [13.1] years): 19 (12%) were treated with RTX and 134 (88%) with CYC. Remission rates did not differ between RTX- and CYC-treated groups. Although more patients with RTX than CYC were dialysis-free at month (M) 12 (79% vs 68%), the difference was not significant after adjustment. Among 134 patients with CYC-treated glomerulonephritis, 76 (57%) also had PE. M3 and M6 remission rates were comparable for weighted CYC groups with or without PE. For weighted groups, the dialysis-free survival rate with CYC was higher with than without PE at M6 (72% vs 64%; odds ratio 2.58) and M12 (74% vs 60%; odds ratio 2.78) reaching statistical significance at M12. Conclusion We could not find any difference between RTX and CYC as induction therapy for patients with severe AAV-related glomerulonephritis. In patients receiving CYC induction regimen, the addition of PE conferred short-term benefits with higher dialysis-free rate at M12. [ABSTRACT FROM AUTHOR]

Résumé: La réalisation d'une étude de santé perçue fait partie du dispositif de réponse épidémiologique à l'incendie industriel survenu à Rouen en septembre 2019. Cette enquête transversale en population, intitulée « Une étude à l'écoute de votre santé », a pour objectif d'évaluer l'impact sanitaire à court et à moyen termes de l'accident, dans sa dimension physique et mentale. Le présent article décrit la méthode d'enquête. La zone exposée à l'accident, qui couvre 122 communes et regroupe environ 350 000 habitants, a été divisée en quatre strates. Le Havre et sa périphérie nord ont été définis comme zone témoin. Un sondage stratifié aléatoire simple a été réalisé pour constituer un échantillon représentatif de la population des deux zones. Les données ont été collectées par un questionnaire structuré. Sa première partie est principalement destinée à décrire les expositions et les symptômes ressentis lors de l'incendie et dans ses suites. La seconde partie porte sur la période au moment de la collecte des données, un an après l'accident. Elle intègre un instrument normalisé de mesure de la santé globale, le MOS SF-12 (Medical Outcomes Study Short Form Health Survey). Un questionnaire additionnel a été administré dans un deuxième temps d'enquête pour évaluer l'impact de l'événement sur l'anxiété, la dépression et les symptômes de stress post-traumatique. L'analyse des données permettra de décrire les expositions à l'accident, les symptômes rapportés par la population et les recours aux soins qu'ils ont motivés, et d'estimer leur prévalence en population. Des modèles de régression multivariés seront développés pour quantifier, si elle existe, la relation entre les expositions environnementales perçues et, d'une part, les symptômes post-accidentels, et, d'autre part, la santé physique et mentale un an après l'accident. A perceived health study is part of the epidemiologic response to the industrial fire that occurred in Rouen (France) in September 2019. This cross-sectional population survey, entitled "A study that listens to your health", aims to assess the short and medium-term impact of the accident on both physical and mental health. The exposed area, encompassing 122 municipalities with a total of 350,000 inhabitants, was divided into four strata. Le Havre and its northern periphery were designated a control zone. A simple stratified random drawing was carried out to constitute a representative sample from the population of the two zones. Data collection used a structured questionnaire whose first section was mainly intended to describe the exposures and symptoms experienced during the fire and its aftermath. The second section covered the data collection period, one year after the event. It incorporated a standardized instrument for measuring global health: the MOS SF-12 (Medical Outcomes Study Short Form Health Survey). An additional questionnaire was administered at a later stage of investigation to assess the impact of the industrial fire on anxiety, depression, and post-traumatic stress. Data analysis will make it possible to describe the exposure to the accident, the symptoms reported by the population and any medical treatment sought, and thus to estimate their prevalence in the population. Multivariate regression models will be developed to quantify any relation between perceived environmental exposures and, on the one hand, post-accident symptoms, and on the other, perceived health one year after the accident. [ABSTRACT FROM AUTHOR]

Background Information regarding coronavirus disease 2019 (COVID-19) in haemodialysis (HD) patients is limited and early studies suggest a poor outcome. We aimed to identify clinical and biological markers associated with severe forms of COVID-19 in HD patients. Methods We conducted a prospective, observational and multicentric study. Sixty-two consecutive adult HD patients with confirmed COVID-19 from four dialysis facilities in Paris, France, from 19 March to 19 May 2020 were included. Blood tests were performed before diagnosis and at Days 7 and 14 after diagnosis. Severe forms of COVID-19 were defined as requiring oxygen therapy, admission in an intensive care unit or death. Cox regression models were used to compute adjusted hazard ratios (aHRs). Kaplan–Meier curves and log-rank tests were used for survival analysis. Results Twenty-eight patients (45%) displayed severe forms of COVID-19. Compared with non-severe forms, these patients had more fever (93% versus 56%, P < 0.01), cough (71% versus 38%, P = 0.02) and dyspnoea (43% versus 6%, P < 0.01) at diagnosis. At Day 7 post-diagnosis, neutrophil counts, neutrophil:lymphocyte (N:L) ratio, C-reactive protein, ferritin, fibrinogen and lactate dehydrogenase levels were significantly higher in severe COVID-19 patients. Multivariate analysis revealed an N:L ratio >3.7 was the major marker associated with severe forms, with an aHR of 4.28 (95% confidence interval 1.52–12.0; P = 0.006). After a median follow-up time of 48 days (range 27–61), six patients with severe forms died (10%). Conclusions HD patients are at increased risk of severe forms of COVID-19. An elevated N:L ratio at Day 7 was highly associated with the severe forms. Assessing the N:L ratio could inform clinicians for early treatment decisions. [ABSTRACT FROM AUTHOR]

Background: Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX., Methods: We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12)., Results: No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%., Conclusions: PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making., (Copyright © 2022 by the American Society of Nephrology.)