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1. Prevalence of cardiovascular risk factors, the use of statins and of aspirin in Takayasu Arteritis

Author

Charlotte Laurent, Sergio Prieto-González, Pierre Belnou, Fabrice Carrat, Olivier Fain, Azeddine Dellal, Maria C. Cid, José Hernández-Rodríguez, and Arsène Mekinian

Subjects
Medicine, Science
Abstract

Abstract The aim of this study was to assess the prevalence of cardiovascular risk factors in TAK, to describe the use of aspirin and statins and the risk factors associated with vascular ischemic complications and relapses. We conducted a retrospective study on TAK patients diagnosed between 2010 and 2018. Demographic, clinical, laboratory data and treatments were evaluated at diagnosis and during the follow-up. We included fifty-two TAK patients with median age 37.5 years [range 16–53] and 43 (83%) women. At diagnosis, cardiovascular risk factors were present in 32 (62%) patients: hypertension (n = 20, 38%), hyperlipidemia (n = 8, 15%), tobacco use (n = 16, 31%). During the median 4-year follow-up [range 0.1–17 years], 17 (33%) patients had at least one ischemic event and 15 (29%) patients needed endovascular procedure. Whereas TAK patients with cardiovascular risk factors were more frequently on statins and anti-hypertensive drugs, they have higher rates of cumulative ischemic complications (5 (24%) versus 21 (67%); p = 0.004), but similar rates of aspirin-treated patients. Patients who have developed vascular ischemic events were more frequently smokers (53% versus 20%; p = 0.03). The vascular complication-free survival was not significantly different in TAK patients with or without statins or aspirin at diagnosis. During the follow-up, 27 (52%) patients had at least one relapse, and the relapse-free survival was not significantly different in patients treated with statins or aspirin. Cardiovascular risk factors in TAK have to be strictly controlled since these risk factors could be associated with increased risk of ischemic complications.

Published
2021
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2. Acute and Chronic Sarcoid Arthropathies: Characteristics and Treatments From a Retrospective Nationwide French Study

Author

Carlotta Cacciatore, Pierre Belnou, Sara Thietart, Carole Desthieux, Mathilde Versini, Noemie Abisror, Sébastien Ottaviani, Gregoire Cormier, Alban Deroux, Azeddine Dellal, Nicolas Belhomme, Nathalie Saidenberg Kermanac'H, Philippe Khafagy, Martin Michaud, Sylvain Lanot, Fabrice Carrat, Olivier Fain, and Arsène Mékinian

Subjects
sarcoid arthropathy, outcome, methotrexate, infliximab, sarcoidosis, Medicine (General), R5-920
Abstract

Introduction: We aimed to analyze patients with acute and chronic joint involvements in sarcoidosis.Methods: This is a retrospective multicenter analysis of patients with proven sarcoidosis, as defined by clinical, radiological, and histological criteria, with at least one clinical and/or ultrasonographic synovitis.Results: Thirty-nine patients with sarcoid arthropathy were included, and among them 19 had acute sarcoidosis (Lofgren's syndrome). Joint involvement and DAS44-CRP were not significantly different in acute and chronic sarcoid arthropathies. Acute forms were more frequent than chronic sarcoid arthropathy in Caucasians, without any difference of sex or age between these 2 forms. Joint involvement was frequently more symmetrical in acute than chronic forms (100 vs. 70%; p < 0.05), with a more frequent involvement in wrists and ankles in acute forms, whereas the tender and swollen joint counts and the DAS44-CRP were similar between the 2 groups. Skin lesions were significantly more frequent in patients with acute forms [17 (89%) vs. 5 (25%); p < 0.05] and were erythema nodosum in all patients with Löfgren's syndrome and sarcoid skin lesions in those with chronic sarcoidosis. Among 20 patients with chronic sarcoidosis, treatment was used in 17 (85%) cases, and consisted in NSAIDs alone (n = 5; 25%), steroids alone (n = 5; 25%), hydroxychloroquine (n = 2; 20%), methotrexate (n = 3; 15%), and TNF inhibitors (n = 2; 10%). A complete/partial joint response was noted in 14 (70%) cases with a DAS44-CRP reduction of 2.07 [1.85–2.44] (from 3.13 [2.76–3.42] to 1.06 [0.9–1.17]; p < 0.05).Conclusion: Sarcoid arthropathies have different clinical phenotypes in acute and chronic forms and various treatment regimens such as hydroxychloroquine and methotrexate could be used in chronic forms.

Published
2020
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3. Prevalence of cardiovascular risk factors, the use of statins and of aspirin in Takayasu Arteritis

Author

Maria C. Cid, Pierre Belnou, Arsène Mekinian, José Hernández-Rodríguez, Olivier Fain, Sergio Prieto-González, Charlotte Laurent, Fabrice Carrat, Azeddine Dellal, Gestionnaire, HAL Sorbonne Université 5, Service de médecine interne [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Service de santé publique [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, and Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, medicine.medical_specialty, Tobacco use, Adolescent, Science, Cardiovascular risk factors, Takayasu arteritis, Diseases, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Medical research, Internal medicine, Hyperlipidemia, Prevalence, Medicine, Humans, In patient, 030203 arthritis & rheumatology, Aspirin, Multidisciplinary, business.industry, Retrospective cohort study, medicine.disease, Takayasu Arteritis, 3. Good health, Increased risk, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, medicine.drug
Abstract

The aim of this study was to assess the prevalence of cardiovascular risk factors in TAK, to describe the use of aspirin and statins and the risk factors associated with vascular ischemic complications and relapses. We conducted a retrospective study on TAK patients diagnosed between 2010 and 2018. Demographic, clinical, laboratory data and treatments were evaluated at diagnosis and during the follow-up. We included fifty-two TAK patients with median age 37.5 years [range 16–53] and 43 (83%) women. At diagnosis, cardiovascular risk factors were present in 32 (62%) patients: hypertension (n = 20, 38%), hyperlipidemia (n = 8, 15%), tobacco use (n = 16, 31%). During the median 4-year follow-up [range 0.1–17 years], 17 (33%) patients had at least one ischemic event and 15 (29%) patients needed endovascular procedure. Whereas TAK patients with cardiovascular risk factors were more frequently on statins and anti-hypertensive drugs, they have higher rates of cumulative ischemic complications (5 (24%) versus 21 (67%); p = 0.004), but similar rates of aspirin-treated patients. Patients who have developed vascular ischemic events were more frequently smokers (53% versus 20%; p = 0.03). The vascular complication-free survival was not significantly different in TAK patients with or without statins or aspirin at diagnosis. During the follow-up, 27 (52%) patients had at least one relapse, and the relapse-free survival was not significantly different in patients treated with statins or aspirin. Cardiovascular risk factors in TAK have to be strictly controlled since these risk factors could be associated with increased risk of ischemic complications.

Published
2021
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4. Long-term impact of preventive UDCA therapy after transplantation for primary biliary cholangitis

Author

Gideon M. Hirschfield, Maryam Ebadi, Xavier Verhelst, Federica Malinverno, Nora Cazzagon, Pierre Belnou, Christophe Corpechot, Falk Rauchfuss, Olivier Boillot, Raoul Poupon, Jérôme Dumortier, Palak J. Trivedi, Maria Francesca Donato, Sascha Chopra, Dennis Eurich, Francesco Paolo Russo, Martina Sterneck, Aldo J. Montano-Loza, Maren H. Harms, Fabrice Carrat, Philipp A. Reuken, Christoph Schramm, Alexie Bosch, Albert Parés, Patrick McDowell, Davide Roccarina, Andrew Mason, Jorn C Goet, Bettina E. Hansen, Emiliano Giostra, Anna Reig, Annarosa Floreani, Dietmar Jacob, Douglas Thorburn, Olivier Chazouillères, Tony Bruns, Alessio Gerussi, Henk R. van Buuren, Filomena Conti, Frederik Nevens, Corpechot, C, Chazouilleres, O, Belnou, P, Montano-Loza, A, Mason, A, Ebadi, M, Eurich, D, Chopra, S, Jacob, D, Schramm, C, Sterneck, M, Bruns, T, Reuken, P, Rauchfuss, F, Roccarina, D, Thorburn, D, Gerussi, A, Trivedi, P, Hirschfield, G, Mcdowell, P, Nevens, F, Boillot, O, Bosch, A, Giostra, E, Conti, F, Poupon, R, Pares, A, Reig, A, Donato, M, Malinverno, F, Floreani, A, Russo, F, Cazzagon, N, Verhelst, X, Goet, J, Harms, M, van Buuren, H, Hansen, B, Carrat, F, Dumortier, J, Gastroenterology & Hepatology, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Graft Rejection, Male, 0301 basic medicine, Cholagogues and Choleretics, Cirrhosis, Survival, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Placebo-controlled study, Liver transplantation, PBC, Gastroenterology, UDCA, 0302 clinical medicine, MED/12 - GASTROENTEROLOGIA, Recurrence, Liver Cirrhosis, Biliary, Ursodeoxycholic Acid, Hazard ratio, Middle Aged, Ursodeoxycholic acid, 3. Good health, Survival Rate, Treatment Outcome, Tacrolimu, Cyclosporine, Tacrolimus, Transplantation, Drug Therapy, Combination, Female, 030211 gastroenterology & hepatology, Immunosuppressive Agents, medicine.drug, Risk, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, Humans, Aged, Retrospective Studies, Hepatology, business.industry, Retrospective cohort study, medicine.disease, digestive system diseases, Liver Transplantation, Regimen, 030104 developmental biology, MED/09 - MEDICINA INTERNA, business, Follow-Up Studies
Abstract

Background & Aims: Recurrence of primary biliary cholangitis (PBC) after liver transplantation (LT) is frequent and can impair graft and patient survival. Ursodeoxycholic acid (UDCA) is the current standard therapy for PBC. We investigated the effect of preventive exposure to UDCA on the incidence and long-term consequences of PBC recurrence after LT. Methods: We performed a retrospective cohort study in 780 patients transplanted for PBC, between 1983–2017 in 16 centers (9 countries), and followed-up for a median of 11 years. Among them, 190 received preventive UDCA (10–15 mg/kg/day). The primary outcome was histological evidence of PBC recurrence. The secondary outcomes were graft loss, liver-related death, and all-cause death. The association between preventive UDCA and outcomes was quantified using multivariable-adjusted Cox and restricted mean survival time (RMST) models. Results: While recurrence of PBC significantly shortened graft and patient survival, preventive exposure to UDCA was associated with reduced risk of PBC recurrence (adjusted hazard ratio [aHR] 0.41; 95% CI 0.28–0.61; p

Published
2020
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5. Prognostic performance of GRACE and TIMI risk scores in critically ill patients with sepsis and a concomitant myocardial infarction

Author

Cyrielle Desnos, Stéphane Ederhy, Pierre Belnou, Nathanaël Lapidus, Guillaume Lefevre, Guillaume Voiriot, Ariel Cohen, Muriel Fartoukh, Vincent Labbé, Gestionnaire, Hal Sorbonne Université, Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Département Médico-Universitaire APPROCHES, Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Groupe de REcherche en Cardio Oncologie [CHU Saint-Antoine] (GRC 27 GRECO), Service de santé publique [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de biochimie et hormonologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Adult, Male, Aspirin, [SDV]Life Sciences [q-bio], Critical Illness, Myocardial Infarction, General Medicine, Prognosis, Risk Assessment, Brain Ischemia, [SDV] Life Sciences [q-bio], Stroke, Risk Factors, Sepsis, Humans, Female, Registries, Cardiology and Cardiovascular Medicine, Aged, Retrospective Studies
Abstract

Identifying which patients with acute myocardial infarction (AMI) during sepsis are at risk of poor outcome is a clinical challenge.To evaluate Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores to predict in-hospital mortality and severe ischaemic events in this setting.In this single-centre retrospective study conducted from 2012 to 2016, all consecutive adults hospitalized in the intensive care unit for sepsis who had a concomitant AMI (within 72hours of admission) were enrolled. AMI was defined by an elevated cardiac troponin I value associated with at least one sign (clinical, electrocardiographic or echocardiographic) suggestive of myocardial ischaemia. The primary outcome was in-hospital mortality from any cause. Secondary outcomes were in-hospital occurrence of severe ischaemic events (cardiac arrest with resuscitation, ischaemic stroke and myocardial reinfarction) and major bleeding events.Among 856 patients hospitalized for sepsis, 120 (14.5%) had a concomitant AMI (37.5% women; median age 65 years; median Sequential Organ Failure Assessment [SOFA] score 8). Severe ischaemic events occurred in 15 patients (12.5%), and 39 (33%) died in hospital. Neither the GRACE score (median 192, interquartile range 154-223) nor the TIMI score (median 3, interquartile range 2-4) was associated with occurrence of severe ischaemic events. Only the GRACE score was associated with in-hospital mortality (odds ratio 1.01, 95% confidence interval 1.00-1.02 per 1 point increase). Multivariable analysis identified previous aspirin use and SOFA score as independent factors associated with in-hospital mortality.GRACE and TIMI scores did not predict in-hospital severe ischaemic events and mortality in patients with AMI during sepsis. Among individual components of both scores, previous aspirin use was associated with poor prognosis. However, because of lack of statistical power, we cannot formally rule out the usefulness of these scores in this setting.

Published
2021
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6. Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study

Author

Franck Verdonk, Lucile Picard, Thomas Lescot, Eileen Sung Tsai, Nathanael Lapidus, Pierre Belnou, Alain Sautet, Francis Bonnet, Julien Gaillard, Claire Debes, Service des Soins Intensifs [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, Service de Chirurgie Orthopédique et Traumatologie [CHU Saint-Antoine], Hôpital Américain de Paris, Sorbonne Université - Faculté de Médecine (SU FM), and Sorbonne Université (SU)

Subjects
medicine.medical_specialty, Multivariate analysis, lcsh:Medicine, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, risk factors, ambulatory surgery, patient management, business.industry, Incidence (epidemiology), lcsh:R, 030208 emergency & critical care medicine, Hand surgery, Retrospective cohort study, General Medicine, block failure, medicine.disease, 3. Good health, Patient management, Substance abuse, Emergency medicine, Ambulatory, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, regional anesthesia, Cohort study
Abstract

Regional anesthesia (RA) is an anesthetic technique essential for the performance of ambulatory surgery. Failure rates range from 6% to 20%, and the consequences of these failures have been poorly investigated. We determined the incidence and the impact of regional block failure on patient management in the ambulatory setting. This retrospective cohort study includes all adult patients who were admitted to a French University Hospital (H&ocirc, pital Saint-Antoine, AP-HP) between 1 January 2016 and 31 December 2017 for unplanned ambulatory distal upper limb surgery. Univariate and stepwise multivariate analyses were performed to determine factors associated with block failure. Among the 562 patients included, 48 (8.5%) had a block failure. RA failure was associated with a longer surgery duration (p = 0.02), more frequent intraoperative analgesics administration (p &lt, 0.01), increased incidence of unplanned hospitalizations (p &lt, 0.001), and a 39% prolongation of Post-Anesthesia Care Unit (PACU) length of stay (p &lt, 0.0001). In the multivariate analysis, the risk factors associated with block failure were female sex (p = 0.04), an American Society of Anesthesiologists (ASA) score &gt, 2 (p = 0.03), history of substance abuse (p = 0.01), and performance of the surgery outside of the specific ambulatory surgical unit (p = 0.01). Here, we have documented a significant incidence of block failure in ambulatory hand surgery, with impairment in the organization of care. Identifying patients at risk of failure could help improve their management, especially by focusing on providing care in a dedicated ambulatory circuit.

Published
2020
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7. Impact of delayed patient flow on surgical outcomes after hip fracture

Author

Franck Verdonk, Nathanael Lapidus, Thomas Lescot, Ines da Costa, Elsa Bourcier, Laura Moisi, Francis Bonnet, Anne Soulier, Pierre Belnou, Alain Sautet, and Eileen Sung Tsai

Subjects
Male, medicine.medical_specialty, Time Factors, Treatment outcome, MEDLINE, Hemorrhage, Outcome assessment, Time-to-Treatment, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Text mining, 030202 anesthesiology, Outcome Assessment, Health Care, Health care, medicine, Humans, 030212 general & internal medicine, Aged, Aged, 80 and over, Hip fracture, Hip Fractures, business.industry, Recovery of Function, Middle Aged, medicine.disease, Patient flow, Treatment Outcome, Anesthesiology and Pain Medicine, Physical therapy, Female, Observational study, France, business
Published
2021
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8. GS-18-Preventive administration of ursodeoxycholic acid after liver transplantation for primary biliary cholangitis prevents disease recurrence and prolongs graft survival

Author

Alexie Bosch, Falk Rauchfuss, Olivier Chazouillères, Maren H. Harms, Conti Filomena, Gideon M. Hirschfield, Martina Sterneck, Palak J. Trivedi, Bettina E. Hansen, Albert Parés, Pierre Belnou, Maryam Ebadi, Thorburn Douglas, Maria Francesca Donato, Sascha Chopra, Annarosa Floreani, Christoph Schramm, Frederik Nevens, Jorn C Goet, Jérôme Dumortier, Dietmar Jacob, Federica Malinverno, Tony Bruns, Christophe Corpechot, V. Xavier, Emiliano Giostra, Henk R. van Buuren, Anna Reig, Philipp A. Reuken, Francesco Russo, Raoul Poupon, Olivier Boillot, Aldo J. Montano-Loza, Fabrice Carrat, Andrew Mason, Natalie Van den Ende, Dennis Eurich, Patrick McDowell, and Davide Roccarina

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, medicine.medical_treatment, medicine, Graft survival, Disease, Liver transplantation, business, Gastroenterology, Ursodeoxycholic acid, medicine.drug
Published
2019
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