Clinical features and outcome of patients with acute respiratory failure revealing anti-synthetase or anti-MDA-5 dermato-pulmonary syndrome: a French multicenter retrospective ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-09-11

AUTHORS

Constance Vuillard, Marc Pineton de Chambrun, Nicolas de Prost, Claude Guérin, Matthieu Schmidt, Auguste Dargent, Jean-Pierre Quenot, Sébastien Préau, Geoffrey Ledoux, Mathilde Neuville, Guillaume Voiriot, Muriel Fartoukh, Rémi Coudroy, Guillaume Dumas, Eric Maury, Nicolas Terzi, Yacine Tandjaoui-Lambiotte, Francis Schneider, Maximilien Grall, Emmanuel Guérot, Romaric Larcher, Sylvie Ricome, Raphaël Le Mao, Gwenhaël Colin, Christophe Guitton, Lara Zafrani, Elise Morawiec, Marie Dubert, Olivier Pajot, Hervé Mentec, Gaëtan Plantefève, Damien Contou

ABSTRACT

BACKGROUND: Anti-synthetase (AS) and dermato-pulmonary associated with anti-MDA-5 antibodies (aMDA-5) syndromes are near one of the other autoimmune inflammatory myopathies potentially responsible for severe acute interstitial lung disease. We undertook a 13-year retrospective multicenter study in 35 French ICUs in order to describe the clinical presentation and the outcome of patients admitted to the ICU for acute respiratory failure (ARF) revealing AS or aMDA-5 syndromes. RESULTS: From 2005 to 2017, 47 patients (23 males; median age 60 [1st-3rd quartiles 52-69] years, no comorbidity 85%) were admitted to the ICU for ARF revealing AS (n = 28, 60%) or aMDA-5 (n = 19, 40%) syndromes. Muscular, articular and cutaneous manifestations occurred in 11 patients (23%), 14 (30%) and 20 (43%) patients, respectively. Seventeen of them (36%) had no extra-pulmonary manifestations. C-reactive protein was increased (139 [40-208] mg/L), whereas procalcitonine was not (0.30 [0.12-0.56] ng/mL). Proportion of patients with creatine kinase ≥ 2N was 20% (n = 9/47). Forty-two patients (89%) had ARDS, which was severe in 86%, with a rate of 17% (n = 8/47) of extra-corporeal membrane oxygenation requirement. Proportion of patients who received corticosteroids, cyclophosphamide, rituximab, intravenous immunoglobulins and plasma exchange were 100%, 72%, 15%, 21% and 17%, respectively. ICU and hospital mortality rates were 45% (n = 21/47) and 51% (n = 24/47), respectively. Patients with aMDA-5 dermato-pulmonary syndrome had a higher hospital mortality than those with AS syndrome (n = 16/19, 84% vs. n = 8/28, 29%; p = 0.001). CONCLUSIONS: Intensivists should consider inflammatory myopathies as a cause of ARF of unknown origin. Extra-pulmonary manifestations are commonly lacking. Mortality is high, especially in aMDA-5 dermato-pulmonary syndrome. More... »

PAGES

87

Journal

TITLE

Annals of Intensive Care

ISSUE

1

VOLUME

8

Author Affiliations

  • Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69 rue du Lieutenant Colonel Prudhon, 95100 Argenteuil, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire Pitié-Salpétrière – Assistance Publique Hôpitaux de Paris, 47-83 boulevard de l’Hôpital, 75013 Paris, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire Henri Mondor – Assistance Publique Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
  • INSERM 955, Créteil, France
  • Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire François Mitterrand de Dijon, 14 rue Paul Gaffarel, 21000 Dijon, France
  • Service de Réanimation, Centre Hospitalier Régional Universitaire de Lille, 2 avenue Oscar Lambret, 59000 Lille, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire Bichat Claude-Bernard – Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris, France
  • Service de Réanimation médico-chirurgicale, Centre Hospitalier Universitaire Tenon – Assistance Publique Hôpitaux de Paris, 5 rue de la Chine, 75020 Paris, France
  • Service de Réanimation médicale, Centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France
  • Service de Réanimation médicale, Centre Hospitalier Universitaire Saint-Antoine – Assistance Publique Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
  • Service de Réanimation, Centre Hospitalier Universitaire de Grenoble Alpes, avenue Maquis du Grésivaudan, 38700 La Tronche, France
  • Service de Réanimation médico-chirurgicale, Centre Hospitalier Universitaire Avicennes – Assistance Publique Hôpitaux de Paris, 125 rue de Stalingrad, 93000 Bobigny, France
  • Service de Réanimation, Centre Hospitalier Universitaire de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, 1 rue de Germont, 76000 Rouen, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire Hôpital Européen Georges-Pompidou – Assistance Publique Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire de Montpellier, 191 avenue du Doyen Gaston Giraud, 34000 Montpellier, France
  • Service de Réanimation Polyvalente, Centre Hospitalier Robert-Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois, France
  • Service de Réanimation médicale, Centre Hospitalier Régional Universistaire de Brest, Site La Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
  • Service de réanimation médico-chirurgicale, Centre Hospitalier Départemental de Vendée, Les Oudairies, 85925 La Roche sur Yon Cedex 9, France
  • Service de Réanimation médico-chirurgicale, Centre Hospitalier du Mans, 194 avenue Rubillard, 72037 Le Mans, France
  • Service de Réanimation médicale, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France
  • Unité de Réanimation et de Surveillance continue, Service de Pneumologie et Réanimation médicale, Groupe hospitalier Pitié-Salpêtrière, 47-83 bd de l’hôpital, 75651 Paris, France
  • Service d’Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s13613-018-0433-3

    DOI

    http://dx.doi.org/10.1186/s13613-018-0433-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1106905301

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30203297


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    426 Service de Réanimation Médicale, Centre Hospitalier Universitaire Pitié-Salpétrière – Assistance Publique Hôpitaux de Paris, 47-83 boulevard de l’Hôpital, 75013 Paris, France
    427 Service de Réanimation médicale, Centre Hospitalier Universitaire Saint-Antoine – Assistance Publique Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
    428 Service de Réanimation médico-chirurgicale, Centre Hospitalier Universitaire Avicennes – Assistance Publique Hôpitaux de Paris, 125 rue de Stalingrad, 93000 Bobigny, France
    429 Service de Réanimation médico-chirurgicale, Centre Hospitalier Universitaire Tenon – Assistance Publique Hôpitaux de Paris, 5 rue de la Chine, 75020 Paris, France
    430 rdf:type schema:Organization
    431 grid-institutes:grid.7429.8 schema:alternateName INSERM 955, Créteil, France
    432 schema:name INSERM 955, Créteil, France
    433 Service de Réanimation Médicale, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France
    434 rdf:type schema:Organization
     




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