Browsing by Author "Duarte, Kevin"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Association between red blood cell transfusion and adverse clinical outcomes is Independent of cardiac history: a multicenter observational InPUT study analysis
    (2025) Kimmoun, Antoine; Girerd, Nicolas; Duarte, Kevin; Bruno, Jolie; Schenk, Jimmy; Levy, Bruno; Baudry, Guillaume; Raasveld, Senta J.; de Bruin, Sanne; Reuland, Merijn C.; van den Oord, Claudia; Schaap, Caroline M.; Bakker, Jan; Cecconi, Maurizio; Feldheiser, Aarne; Meier, Jens; McQuilten, Zoe; Müller, Marcella C. A.; Scheeren, Thomas W. L.; Aubron, Cécile; Flint, Andrew W. J.; Hamid, Tarikul; Piagnerelli, Michaël; Mahečić, Tina T.; Benes, Jan; Russell, Lene; Aguirre-Bermeo, Hernan; Triantafyllopoulou, Konstantina; Chantziara, Vasiliki; Gurjar, Mohan; Myatra, Sheila N.; Pota, Vincenzo; Elhadi, Muhammed; Gawda, Ryszard; Mourisco, Mafalda; Lance, Marcus; Neskovic, Vojislava; Podbregar, Matej; Llau, Juan V.; Quintana-Diaz, Manual; Cronhjort, Maria; Pfortmueller, Carmen A.; Yapici, Nihan; Nielsen, Nathan; Shah, Akshay; de Grooth, Harm-Jan; Vlaar, Alexander P. J.; Mebazaa, Alexandre
    Purpose Red-blood-cell (RBC) transfusion is one of the most frequent interventions in critical care patients. While patients with acute cardiac conditions are more likely to receive transfusions at higher haemoglobin thresholds than other critically ill patients, data on RBC transfusion practice for critically ill patients with pre-existing cardiac conditions are scarce. Methods Using the International Point-Prevalence Study of Intensive-Care Unit Transfusion Practices cohort, weighted logistic regression investigated the association between the RBC units transfused and the primary composite outcome of 28-day mortality, new-onset acute kidney injury or ventilatory weaning failure. Interactions with cardiac history (acute coronary syndrome and/or heart failure) were tested. Results Cardiac history was present in 746 of 3643 patients (20%) and 894 of 3643 (25%) received at least one RBC unit. Transfusion rates were similar in patients with and without cardiac history (25% vs. 24%; p = 0.51). Among transfused patients, median nadir haemoglobin during ICU stay was slightly higher in those with cardiac history (7.6 g/dL vs. 7.4 g/dL respectively; p = 0.007), whereas stated haemoglobin transfusion threshold did not statistically differ (8.5 g/dL vs. 8.0 g/dL; p = 0.11). Each additional RBC unit increased the odds of the composite outcome in the whole cohort (2.18, 95% CI 1.85–2.56, p < 0.0001), without interaction with cardiac history (p = 0.44). Conclusions RBC transfusion was commonly and similarly prescribed in critically ill patients with or without cardiac history. Each additional unit was associated with a worse outcome with no evidence of differential effect due to cardiac history. Trial registration NL9049 (Dutch Trial Register), registered on 16 November 2020. Graphical Abstract
  • Thumbnail Image
    Item
    Serial daily lactate levels association with 30-day outcome in cardiogenic shock patients treated with VA-ECMO: a post-hoc analysis of the HYPO-ECMO study
    (2024) Levy, Bruno; Girerd, Nicolas; Baudry, Guillaume; Duarte, Kevin; Cuau, Samuel; Bakker, Jan; Kimmoun, Antoine; HYPO-ECMO; ECMO Network
    Reliable predictors of outcomes in venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy are limited. While elevated lactate levels over time have been linked to outcomes in cardiogenic shock (CS), their significance in VA-ECMO-treated patients remains inconclusive. Methods We conducted a post hoc analysis of data from the HYPO-ECMO trial, which compared normothermia to moderate hypothermia in CS patients supported by VA-ECMO. We examined daily lactate levels collected over a week to assess their correlation with 30-day mortality. Results Among the 318 out of 334 patients (95%) with baseline lactate measurements, 66 had normal levels (< 2.2 mmol/l, 21%). No difference was found in lactate course between moderate hypothermia and normothermia groups. Lactate levels were consistently higher in non-survivors at each time point (p = 0.0002). Baseline hyperlactatemia was associated with an increased risk of death (Hazard Ratio [HR]: 1.85 (1.12–3.05), p = 0.016). When considering all time points, lactate levels during the ICU stay were significantly and gradually associated with a higher risk of death (p < 0.0001). In the overall population, a decrease in lactate levels was not linked to 30-day mortality. However, patients with baseline hyperlactatemia exhibited a more significant decrease in lactate levels from day one to seven (p < 0.0001). In this group, survivors had a significantly greater decrease in lactate levels at day 1 compared to non-survivors (63% (48–77) versus 57% (21–75), p = 0.026). Patients experiencing a secondary increase in lactate (24%) had a worse prognosis (Hazard Ratio: 1.78 (1.21–2.61), p = 0.004), regardless of both baseline lactate levels and the occurrence of severe ischemic adverse events (intestinal and/or limb ischemia). Conclusions The consistent and significant association between lactate levels, whether assessed at baseline or during ICU treatment, and the risk of mortality underscores the pivotal prognostic relevance of lactate levels in patients with CS undergoing VA-ECMO therapy. The study findings provide some novel insights, regarding the trend profile and the relevance of a second peak during the 7 day period after ECMO start. Trial Registration identifier NCT02754193 registered on 2016–04–12.