Fibroblast growth factor 23 in acute burn patients: Novel insights from an intact-form assay.
ROUSSEAU, Anne-Françoise ; ; DELANAYE, Pierre et al
in Burns : Journal of the International Society for Burn Injuries (in press)
INTRODUCTION: Fibroblast growth factor 23 (FGF23) is a key regulator in phosphate and vitamin D metabolism When measured with c-terminal assay, it has been shown to be increased following burn. Progress ... [more ▼]
INTRODUCTION: Fibroblast growth factor 23 (FGF23) is a key regulator in phosphate and vitamin D metabolism When measured with c-terminal assay, it has been shown to be increased following burn. Progress in understanding FGF23 physiology has emphasized the importance of assessing the intact form of FGF23. METHODS: The present cohort study is a complementary analysis of a previously published work. Patients >18 years, admitted within 24h after injury with burn surface area (BSA) >10% were included. C-terminal (c-term) and intact (i) FGF23 assay were performed at admission and every week during 4 weeks of follow-up. Inflammation and iron status were assessed at the same time points. RESULTS: Twenty patients were initially included and 12 were followed until day 28. The c-term FGF23 tended to gradually increase during the 4 weeks of follow-up while iFGF23 was quite stable into normal ranges. Iron status showed a typical inflammatory profile. C-term FGF23 was significantly positively correlated with c-reactive protein (CRP) and negatively correlated with iron levels. iFGF23 was not correlated with CRP or iron. CONCLUSION: FGF23 status following burn is characterized by a dissociation between c-term FGF23 and iFGF23. The hypothesis of an increased cleavage may be raised. Respective role of inflammation and iron levels in such deregulation need to be specified. Both c-term and intact assays should be performed in further studies aiming to increase knowledge on FGF23 regulation and effects in burn patients. [less ▲]Detailed reference viewed: 16 (0 ULg)
Incidence of bone fractures after critical illness
ROUSSEAU, Anne-Françoise ; Michel, Laure ; Bawin, Maxime et al
in Intensive Care Medicine Experimental (2016), 4(Suppl 1), 1131Detailed reference viewed: 17 (6 ULg)
Bone markers during acute burn care: Relevance to clinical practice?
ROUSSEAU, Anne-Françoise ; Damas, Pierre ; DELANAYE, Pierre et al
in Burns : Journal of the International Society for Burn Injuries (2016)
OBJECTIVE: Bone changes are increasingly described after burn. How bone markers could help to detect early bone changes or to screen burn patients at higher risk of demineralization is still not made ... [more ▼]
OBJECTIVE: Bone changes are increasingly described after burn. How bone markers could help to detect early bone changes or to screen burn patients at higher risk of demineralization is still not made clear. We performed an observational study assessing the changes in serum bone markers after moderate burn. METHODS: Adults admitted in the first 24h following burn extended on >10% body surface area were included. Serum levels of collagen type 1 cross-linked C-telopeptide (CTX), tartrate-resistant acid phosphatase 5b (TRAP), type 1 procollagen N-terminal (P1NP) and bone alkaline phosphatase (b-ALP) were measured at admission and every week during the first month. Data are expressed as median [min-max]. RESULTS: Bone markers were measured in 20 patients: 18 men, 2 women (including one post-menopausal). Age was 46 [19-86] years old, burn surface area reached 15 [7-85] %. Twelve patients completed the study. All biomarkers mainly remained into normal ranges during evolution. A huge variability was observed regarding biomarkers evolution. Patient's evolution was not linear and could fluctuate from a decrease to an increase of blood concentrations. There was not necessarily a consistency between the two formation or the two resorption markers. Variations observed between two consecutive measurements were lesser than the accepted critical difference in almost one third of the cases. CONCLUSIONS: Considering available data, role and interest of bone markers in management of burn related bone disease remain unclear. [less ▲]Detailed reference viewed: 11 (1 ULg)
Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.
VERCHEVAL, Christelle ; Gillet, Marie-Claire ; MAES, Nathalie et al
in European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology (2016), 35(9), 14951500
This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was ... [more ▼]
This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liege, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 +/- 10.4 % vs. 90.3 +/- 6.6 %, p = 0.0013; antibiotics documented 87.9 +/- 9.0 % vs. 95.6 +/- 5.1 %, p < 0.0001; and duration or review date documented 31.9 +/- 15.4 % vs. 67.7 +/- 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators. [less ▲]Detailed reference viewed: 12 (7 ULg)
Elevated basal levels of platelet-bound fibrinogen predict the occurrence of sepsis in ICU: a prospective study.
Delierneux, Céline ; LAYIOS, Nathalie ; Hego, Alexandre et al
Conference (2015, October 19)Detailed reference viewed: 39 (6 ULg)
Vitamin D status after a high dose of cholecalciferol in healthy and burn subjects
ROUSSEAU, Anne-Françoise ; DAMAS, Pierre ; LEDOUX, Didier et al
in Burns : Journal of the International Society for Burn Injuries (2015), 41(5), 1028-1034
Background: Burn patients are at risk of vitamin D (VD) deficiency and may benefit from its pleiotropic effects as soon as acute phase. Aim of this observational study was to assess effects of a ... [more ▼]
Background: Burn patients are at risk of vitamin D (VD) deficiency and may benefit from its pleiotropic effects as soon as acute phase. Aim of this observational study was to assess effects of a cholecalciferol (VD3) bolus on VD status in adult burn patients (Group B, GB) after admission, compared to healthy subjects (Group H, GH). Methods: Both groups received an oral dose of 100,000 IU VD3. Blood samples were collected before (D0) and 7 days (D7) after bolus to measure 250H-D, 1,25(OH)2-D, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). Albumin (ALB) and VD binding protein (DBP) were measured and used to calculate free 25OH-D level. Data were expressed as median (min–max) or proportions. Results: A total of 49 subjects were included: 29 in GH and 20 in GB. At D0, prevalence of VD deficiency was higher in GB: 25OH-D was 21.5 (10.1–46.3) ng/ml in GH vs 11 (1.8–31.4) ng/ml in GB. DBP and ALB were lower in GB. At D7, DBP was stable in both groups while ALB decreased in GB. 25OH-D increased by 66.6 (13.5–260.3)% in GH. In GB, changes in 25OH-D extended from 36.7% to 333.3% with a median increase of 33.1%. Similar changes were observed in each group for free 25OH-D. High FGF23 levels were observed in GB. Conclusions: This study highlighted the differences in VD status and in response to a high dose VD3 in burn patients when compared to healthy patients. Pitfalls in VD status assessment are numerous during acute burn care: 25OH-D measurement needs cautious interpretation and interest of free 25OH-D is still questionable. They should not prevent burn patients to receive VD supplements during acute care. Higher doses than general recommendations should probably be considered. [less ▲]Detailed reference viewed: 33 (15 ULg)
Prospective analysis of platelet activation markers to predict severe infection and mortality in intensive care units
Delierneux, Céline ; LAYIOS, Nathalie ; Hego, Alexandre et al
Poster (2015, June 23)Detailed reference viewed: 29 (4 ULg)
effects of cholecaciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: a one-year pilot randomized controlled trial in adults with severe burns
ROUSSEAU, Anne-Françoise ; FOIDART-DESSALLE, Marguerite ; LEDOUX, Didier et al
in Burns : Journal of the International Society for Burn Injuries (2015), 41(2), 317-325
Objective: Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess ... [more ▼]
Objective: Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess effects of a cholecalciferol (VD3) supplementation and an optimized calcium (Ca) regimen on vitamin D (VD) status, bone and muscle health during sequelar stage of burn injury. Design: Monocentric randomized controlled trial. Methods: Fifteen adults with thermal burns dating from 2 to 5 years were randomized into two groups. For 12 months, they either received a quarterly IM injection of 200,000 IU VD3 and daily oral Ca (Group D) or placebo (Group P). VD status and bone remodeling markers were assessed every 3 months. Knee muscle strength and bone mineral density were, respectively, assessed using isokinetic dynamometry and dual X-ray absorptiometry at initiation (M0) and completion (M12) of the protocol. Results: Of all the patients, 66% presented with VD deficiency and 53% (with 3 men <40 y) were considered osteopenic at inclusion. After one year, calcidiol levels significantly increased in Group D to reach 40 (37–61) ng/ml. No significant change in bone health was observed in both groups while Group D significantly improved quadriceps strength when tested at high velocity. Conclusions: This VD3 supplementation was safe and efficient to correct hypovitaminosis D in burn adults. When combined with optimized Ca intakes, it demonstrated positive effects on muscle health but not on bone health. A high prevalence of hypovitaminosis D and osteopenia in these patients, as well as their wide range of muscle performances, seem to be worrying when considering rehabilitation and quality of life. [less ▲]Detailed reference viewed: 47 (14 ULg)
Prevention of ventilator-associated pneumonia and ventilator-associated conditions: A randomized controlled trial with subglottic secretion suctioning
DAMAS, Pierre ; FRIPPIAT, Frédéric ; ANCION, Arnaud et al
in Critical Care Medicine (2015), 43(1), 22-30Detailed reference viewed: 93 (37 ULg)
Critical care and vitamin D status assessment: What about immunoassays and calculated free 25OH-D?
ROUSSEAU, Anne-Françoise ; DAMAS, Pierre ; JANSSENS, Marc et al
in Clinica Chimica Acta (2014), 437Detailed reference viewed: 21 (1 ULg)
Use of a pediatric oxygenator integrated in a veno-venous hemofiltration circuit to remove CO2 : a case report in a severe burn patient with refractory hypercapnia.
ROUSSEAU, Anne-Françoise ; DAMAS, Pierre ; RENWART, Ludovic et al
in Burns : Journal of the International Society for Burn Injuries (2014), 40(7), 57-60Detailed reference viewed: 24 (7 ULg)
INCIDENCE AND RISK FACTORS FOR EARLY RENAL DYSFUNCTION AFTER LIVER TRANSPLANTATION
WIESEN, Patricia ; ; VAN CAUWENBERGE, Isabelle et al
in Intensive Care Medicine (2014, October), 40(S1), 1740628
INTRODUCTION. Renal dysfunction often occurred after liver transplantation. OBJECTIVES. The aim of the study was to determine its incidence and its risk factors in a clinical series at the University ... [more ▼]
INTRODUCTION. Renal dysfunction often occurred after liver transplantation. OBJECTIVES. The aim of the study was to determine its incidence and its risk factors in a clinical series at the University Hospital of Liege, Belgium. METHODS. Orthotopic liver transplantations performed from January 2006 until Sep- tember 2012 were retrospectively reviewed (n = 187). Patients, with no renal replacement therapy (RRT) before transplantation were classified in four groups according to their highest creatinine plasma level during the first postoperative week. First group had a cre- atinine level below 12 mg/l, the second group between 12 and 20 mg/l, the third group between 20 and 35 mg/l, and the fourth above 35 mg/l. In addition, patients who needed RRT during the first week after transplantation were also classified in the fourth group. Preoperative and perioperative parameters were tested as risk factors: age, sex, body mass index (BMI), length of hospital preoperative stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with ß-blocker, converting enzyme inhibitor, or non steroidal antiinflammatory drugs, preoperative creatinine and bilirubine level, postop- erative lactate level, need for postoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative peaks in bilirubine and transam- inase levels, postoperative hemoglobin level, amount of perioperative blood transfusions, type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. RESULTS. There were 78 patients in group 1 (41.7 %), 46 in group 2 (24.6 %), 38 in group 3 (20.3 %) and 25 in group 4 (13.4 %). Eighteen patients required RRT: 13 (7 %) during the first week after transplantation (group 4), the 5 others after the first week after transplan- tation (2 in group 1 and 2, and 1 in group 3). There were 7 (3.7 %) early deaths within 28 days after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubine, transaminase, and hemoglobin levels. The need for transfusion of each type of products also affected renal dysfunction. The ordinal logistic analysis pointed out the BMI (OR = 1.1, p = 0.004), preoperative creatinine level (OR = 11.1, p \ 0.0001), use of vasopressor (OR = 3.31, p = 0.0002), maximal postop- erative bilirubine level (OR = 1.44, p = 0.044) and minimal postoperative hemoglobin level (OR 0.059 p = 0.0005). CONCLUSIONS. More than half of liver transplanted patients experienced some degree of early renal dysfunction after transplantation. Risk factors are preoperative renal dysfunction, and mainly perioperative circulatory instability requiring the use of vasopressor and post- operative anemia. [less ▲]Detailed reference viewed: 59 (13 ULg)
Evaluation of Temocillin for treatment of nosocomial infections
LAYIOS, Nathalie ; CIUTEA, Mirela ; et al
in Intensive Care Medecine (2014), 40(supplément 1), 1940704Detailed reference viewed: 50 (18 ULg)
Modelled target attainment after meropenem infusion in patients with severe nosocomial pneumonia: the PROMESSE study.
FRIPPIAT, Frédéric ; ; Seidel, Laurence et al
in Journal of Antimicrobial Chemotherapy (2014), 70
OBJECTIVES: The objective of this study was to propose an optimal treatment regimen of meropenem in critically ill patients with severe nosocomial pneumonia. PATIENTS AND METHODS: Among 55 patients in ... [more ▼]
OBJECTIVES: The objective of this study was to propose an optimal treatment regimen of meropenem in critically ill patients with severe nosocomial pneumonia. PATIENTS AND METHODS: Among 55 patients in intensive care treated with 1 g of meropenem every 8 h for severe nosocomial pneumonia, 30 were assigned to intermittent infusion (II; over 0.5 h) and 25 to extended infusion (EI; over 3 h) groups. Based on plasma and epithelial lining fluid (ELF) concentrations determined at steady-state, pharmacokinetic modelling and Monte Carlo simulations were undertaken to assess the probability of attaining drug concentrations above the MIC for 40%-100% of the time between doses (%T > 1-fold and 4-fold MIC), for 1 or 2 g administered by either method. RESULTS: Penetration ratio, measured by the ELF/plasma ratio of AUCs, was statistically higher in the EI group than in the II group (mean +/- SEM: 0.29 +/- 0.030 versus 0.20 +/- 0.033, P = 0.047). Considering a maximum susceptibility breakpoint of 2 mg/L, all dosages and modes of infusions achieved 40%-100% T > 1-fold MIC in plasma, but none did so in ELF, and only the 2 g dose over EI achieved 40%-100% T > 4-fold MIC in plasma. CONCLUSIONS: The optimum regimen to treat severe nosocomial pneumonia was 2 g of meropenem infused over 3 h every 8 h. This regimen achieved the highest pharmacodynamic targets both in plasma and in ELF. [less ▲]Detailed reference viewed: 77 (27 ULg)
Effect of gamma-hydroxybutyrate on keratinocytes proliferation: a preliminary prospective controlled study in severe burn patients.
ROUSSEAU, Anne-Françoise ; ; et al
in International Journal of Critical Illness and Injury Science (2014), 4(2), 108-113Detailed reference viewed: 32 (14 ULg)
Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versus serum creatinine
DELANAYE, Pierre ; CAVALIER, Etienne ; et al
in BMC Nephrology (2014), 15(9), 1471-2369Detailed reference viewed: 23 (8 ULg)
Does comfort therapy during controlled donation after circulatory death shorten the life of potential donors?
LEDOUX, Didier ; DELBOUILLE, Marie-Hélène ; DE ROOVER, Arnaud et al
in Clinical transplantation (2014), 28(1), 47-51
INTRODUCTION: Controlled donation after circulatory death (DCD) remains ethically controversial. The authors developed a controlled DCD protocol in which comfort therapy is regularly used. The aim of this ... [more ▼]
INTRODUCTION: Controlled donation after circulatory death (DCD) remains ethically controversial. The authors developed a controlled DCD protocol in which comfort therapy is regularly used. The aim of this study was to determine whether this policy shortens the DCD donors' life. METHODS: The authors retrospectively analyzed prospectively collected data on patients proposed for DCD at the University Hospital of Liege, Belgium, over a 56-month period. The survival duration of these patients, defined as duration between the time of proposal for DCD and the time of circulatory arrest, was compared between patients who actually donated organs and those who did not. RESULTS: About 128 patients were considered for controlled DCD and 54 (43%) became donors. Among the 74 non-donor patients, 34 (46%) objected to organ donation, 38 patients (51%) were denied by the transplant team for various medical reasons, and two potential DCD donors did not undergo procurement due to logistical and organizational reasons. The survival durations were similar in the DCD donor and non-donor groups. No non-donor patient survived. CONCLUSIONS: Survival of DCD donors is not shortened when compared with non-donor patients. These data support the ethical and respectful approach to potential DCD donors in the authors' center, including regular comfort therapy. [less ▲]Detailed reference viewed: 42 (9 ULg)
Catastrophic antiphospholipid syndrome : case reports and review of the literature
; LAYIOS, Nathalie ; DAMAS, Pierre
in Acta Anaesthesiologica Belgica (2014), 65Detailed reference viewed: 32 (5 ULg)
Effect of optimized cholecalciferol and calcium intakes on bone mineral density: a randomized controlled trial in adult burns during sequelae stage.
ROUSSEAU, Anne-Françoise ; FOIDART-DESSALLE, Marguerite ; REMY, Christophe et al
in Nutrients (2014), 6Detailed reference viewed: 27 (7 ULg)