Impact de la dexaméthasone sur l’insuffisance rénale aiguë liée à la COVID-19 en réanimation

Introduction L’insuffisance rénale aiguë (IRA) chez les patients atteints de COVID-19 en réanimation est fréquente (> 50 %). Un processus inflammatoire spécifique avait été suggéré dans la physiopathologie de l’IRA. L’objectif de cette étude était d’examiner l’impact de la DXM sur l’incidence de l’IRA induite par la COVID-19. Description Étude prospective multicentrique dans deux unités de soins intensifs françaises du 1er mars 2020 au 21 août 2021. Méthodes Tous les patients admis pour un COVID-19 sévère ont été inclus. La DXM a été exclusivement utilisée à partir de la deuxième vague. L’insuffisance rénale aiguë a été définie selon la classification KDIGO. Les patients ayant eu de la DXM avant ou le jour de l’IRA ont été exclus de l’analyse. Résultats Au total, 1014 patients ont été inclus. La DXM a été administrée chez 635/1014 (63 %). L’âge moyen était de 63±12 ans, 520/1014 ; 75/1014 (7 %) souffraient d’une maladie rénale chronique (MRC) antérieure et 385/1014 (38 %) ont eu besoin d’une ventilation mécanique invasive (MV) dans les 24 premières heures. La mortalité en soins intensifs était de 264/1014 (26 %). L’insuffisance rénale aiguë était présente chez 735/1014 (73 %) patients : 284/735 (39 %), 195/735 (27 %) et 256/735 (35 %) présentaient respectivement une insuffisance rénale aiguë KDIGO 1, 2 et 3 et 88/735 (12 %) ont eu besoin d’épuration extra-rénale. Parmi les 635 patients qui ont reçu du DXM, l’utilisation de la DXM (OR=0,26 [0,17–0,40]) et du tocilizumab (OR=0,16 [0,03–0,74]) était indépendamment associée à une diminution du risque d’IRA (Tableau 1). Conclusion Dans notre étude, l’exposition au DXM et au tocilizumab était indépendamment associée à une diminution de l’incidence de l’IRA. Ces résultats soutiennent l’hypothèse que l’IRA induite par le COVID-19 est partiellement secondaire à un processus inflammatoire.

Lessons learned from the COVID-19 pandemic: emphasizing the emerging role and perspectives from artificial intelligence, mobile health, and digital laboratory medicine

SARS-CoV-2, the new coronavirus causing COVID-19, is one of the most contagious disease of past decades. COVID-19 is different only in that everyone is encountering it for the first time during this pandemic. The world has gone from complete ignorance to a blitz of details in a matter of months. The foremost challenge that the scientific community faces is to understand the growth and transmission capability of the virus. As the world grapples with the global pandemic, people are spending more time than ever before living and working in the digital milieu, and the adoption of Artificial Intelligence (AI) is propelled to an unprecedented level especially as AI has already proven to play an important role in counteracting COVID-19. AI and Data Science are rapidly becoming important tools in clinical research, precision medicine, biomedical discovery and medical diagnostics. Machine learning (ML) and their subsets, such as deep learning, are also referred to as cognitive computing due to their foundational basis and relationship to cognition. To date, AI based techniques are helping epidemiologists in projecting the spread of virus, contact tracing, early detection, monitoring, social distancing, compiling data and training of healthcare workers. Beside AI, the use of telemedicine, mobile health or mHealth and the Internet of Things (IOT) is also emerging. These techniques have proven to be powerful tools in fighting against the pandemic because they provide strong support in pandemic prevention and control. The present study highlights applications and evaluations of these technologies, practices, and health delivery services as well as regulatory and ethical challenges regarding AI/ML-based medical products. © 2021 International Federation of Clinical Chemistry and Laboratory Medicine. All rights reserved.

Cytokine storm induced coagulopathy in septic shock and critical Covid-19: Head-to-head comparison

Background: Septic shock generates an important inflammatory reaction, endothelial activation and a procoagulant state leading to microvascular thrombosis and subsequent organ impairment [1]. Similarly, a severe inflammatory reaction and a coagulopathy with pulmonary micro-thrombosis eventually leading to acute lung injury, is a typical feature of critical form of Coronavirus disease 2019 (Covid-19) [2]. Our aim was to compare coagulation, platelet activation and plateletsneutrophils interplay between control, septic shock and critical Covid-19 patients. Methods/Materials: A total of 118 patients were included in our prospective, monocentric, observational study between February 2019 and June 2020. Septic shock (n=48) and Covid-19 (n=22) patients were consecutively included at admission in our ICU department. Control patients (n=48) with matched gender and co-morbidities were recruited at central lab consultation. Results: Septic shock patients had worse severity scores due to multiple organ failure (assessed by APACHE II and SOFA score) whereas Covid-19 patients had more severe respiratory failure and a longer ICU length-ofstay (Table 1). At the time of inclusion, CRP and lymphocyte count were comparable between septic shock and Covid-19 patients. White cell count ad neutrophil count was higher for septic shock patients. Analysis of coagulation showed a prolonged INR, TT and aPTT in septic shock although only INR was prolonged in Covid-19. Thrombin antithrombin complex (TATc) formation was similar in both pathologies, whereas consumption of antithrombin III (ATIII) and D-dimers formation was more pronounced in septic shock. Platelet count was lower in septic shock and platelet activation, assessed via plasmatic levels of soluble P-selectin (sCD62P) and Trem-like transcript 1 (sTLT-1), was more important in septic shock. Neutrophil activation and NETosis, evaluated by levels of circulating myeloperoxidase (MPO) and citrullinated histone 3 (H3-Cit), was similarly increased in both groups (Figure 1). Conclusions: This study confirmed an activation of coagulation cascade, platelet activation and NETosis in both septic shock and critical Covid-19, compared with control patients. Importantly, the extent of these changes was similar or less pronounced in critical COVID-19 compared with septic shock.

Head-to-head comparison of cytokines storm-induced coagulopathy in septic shock and COVID-19

Background : Since December 2019, the coronavirus disease 2019 (Covid-19) is the main health concern around the world. Host immune response to the virus is variable and can induce a dysregulated inflammatory response associated with venous and arterial thrombosis called Covid-19 associated coagulopathy (CAC). During septic shock, inflammatory reaction generates endothelial activation and procoagulant state with microvascular thrombi inducing disseminated intravascular coagulation (DIC). Although CAC and DIC induce altered coagulation and fibrinolytic responses, their clinical outcomes are different. Aims : We investigated and compared coagulopathy between septic shock and critical Covid-19 patients. Methods : Septic shock patients were diagnosed following the Survival Sepsis Campaign guidelines. They were admitted in intensive care unit (ICU) and included in the study within 2 days after admission. Covid-19 patients were admitted in ICU for severe Acute Respiratory Distress Syndrome (ARDS) due to SARS-Cov2 infection and included within 2 days after admission. Patient's plasma was isolated and used to measure circulating biomarkers by ELISA. Results : We observed an increase in vWF and TFPI in both septic and Covid-19 patients compared to controls, highlighting endothelial damage. Interestingly, circulating TF was only elevated in Covid-19 patients. Platelet activation differed between the two cohorts of patients. P-selectin and Trem-like transcript 1 were specifically heightened in septic shock whereas CD40L was only augmented in Covid-19. Coagulation markers were increased in a diseasedependent way, with PAI-1, tPA and D-Dimers higher in septic shock and fibrinogen level, higher in Covid-19. Conclusions : Covid-19 patients had longer length-of-stay with more pronounced respiratory failure. This strong lung disruption overtime induced plasmatic tissue factor release with sustained inflammatory response characterized by sCD40L and fibrinogen secretion. Given the similarities between Covid-19 and septic shock regarding fibrinolysis and coagulation, but not platelet activation, endothelium seems to play a central role in Covid-19 and might explain the differences between CAC and DIC.

Do fully automated immunoassays for the evaluation of the immune response to SARS-CoV-2 are commutable?

On December 30, 2019, the city of Wuhan, China, experienced an outbreak of unexplained pneumonia. From January 7, 2020, a new betacoronavirus, severe acute respiratory syndrome coronavirus was identified (SARS-CoV-2). The World Health Organization (WHO) has since declared a pandemic with millions of confirmed cases worldwide. As part of the fight against the epidemic, laboratories have a critical role in assessing the reliability of new serological assays before taking part of diagnostic protocols or made available broader to the community and to evaluate commutability between assays. The aim of this study was to perform a comparison between two automated assays for SARS-CoV-2 IgG testing, the MAGLUMI ® 800 and the LIAISON ® XL. Among the patients confirmed positive for COVID-19, the two automated assays were significantly correlated (r = 0.811; p < 0.0001). The overall concordance made for MAGLUMI 2019-nCoV IgG positive/negative vs. LIAISON® SARS-CoV-2 IgG positive/negative results was 79% (Index Kappa of Cohen). We list the discrepancies between the two analyzers among the 44 tested patients. In conclusion, the overall agreement between the two automated assays for SARS-CoV-2 was good. However, the MAGLUMI assay might be more sensitive at the early stages of antibody development and there is a lack of specificity with LIAISON XL.

Caracterisation de l'insuffisance renale aigue chez les patients de reanimation atteints du COVID-19.

Declaration de liens d'interets: Sebastien Rubin declare des liens d'interets avec Sanofi. Alexandre Boyer declare des liens d'interets avec Gilead and Basilea. Les autres auteurs declarent ne pas avoir de liens d'interets. Copyright © 2020

Artificial intelligence in health care: La Machine, le Médecin et Moi or the world of S.A.R.R.A.?

In La Machine, le Médecin et Moi [1], I painted a picture of the uses of AI in health care. The present article takes a look at some of the observations made in this book from the angle of mental health. I propose a vision resolutely oriented toward the positive regulation of the use of these innovations in order to achieve efficiency gains within our healthcare system and above all an improvement in the quality of care. From this perspective, and contrary to certain received ideas, psychiatry is likely to be one of the most advanced areas of application of AI in health care. The technological responses to the COVID-19 pandemic show that we are very close to tipping over into the dystopia that I outlined in the two-volume speculative fiction novel S.A.R.R.A. [2]. To overcome these risks, we propose via the Ethik-IA initiative the rapid deployment of methodologies linked to the Human Guarantee of AI: to open ourselves up to innovation while regulating its risks. Copyright © 2020 John Libbey Eurotext. En La Máquina, el Médico y Yo, establecía un cuadro de los casos de uso de la IA en el ámbito de la salud. Este artículo de ahora retoma cierto número de constataciones que aparecían en esta obra centrándose en el enfoque de la salud mental. Propongo una perspectiva resuelta mente orientada hacia la regulación positivo del despliegue de estas innovaciones para alcanzar logros de eficiencia dentro de nuestro sistema de salud y sobre todo una mejora de la calidad de la atención a los pacientes. Desde este punto de vista, la psiquiatría es susceptible de constituir, al contrario de ciertos tópicos, uno de los puntos más avanzados de aplicación de la IA en la salud. Las respuestas tecnológicas aportadas a la pandemia de la Kobe-19 muestran que estamos muy cerca de un vuelco hacia la Dystopia que dibujo en los dos tomos de la ficción de anticipación S.A.R.R.A. Para acotar estos riesgos, proponemos con Ethik-IA el despliegue rápido de metodologías de garantía humana de la IA: para abrirse a la innovación a la vez que se regulan sus riesgos. Copyright © 2020 John Libbey Eurotext.

SARS-CoV-2 seroprevalence in a Belgian cohort of patients with cystic fibrosis.

BACKGROUND: In Belgium, COVID-19 epidemy began on February 4, 2020 with a peak on April 10, 2020. Patients with cystic fibrosis (CF) followed in the Cliniques universitaires Saint-Luc were rapidly isolated before the government lockdown. METHODS: After the peak of the epidemy, we measured anti-SARS-CoV-2 IgM and IgG antibodies in 149 patients and collected clinical data. RESULTS: Only 3 asymptomatic patients presented IgG against the virus. In one patient hospitalized for COVID-19 (positive molecular testing), we did not detect any anti-SARS-CoV-2 antibodies, as in thirty-five other symptomatic patients considered as possible cases. CONCLUSIONS: Even if respiratory symptoms linked to CF are frequent and compatible with COVID-19, anti-SARS-CoV-2 IgG antibodies were detected only in 3 asymptomatic patients. This reassuring study concerning the risk of COVID-19 in patients with CF illustrates the difficulty to distinguish COVID-19 symptoms from respiratory exacerbations and the need of generalized molecular testing to make a precise diagnosis.