Yves Cohen

Publications (83) View all

• Article: Diagnostic accuracy of early urinary index changes in differentiating transient from persistent acute kidney injury in critically ill patients: multicenter cohort study.

  Bertrand Pons, Alexandre Lautrette, Johanna Oziel, Jean Dellamonica, Regine Vermersch, Eric Ezingeard, Christophe Mariat, Gilles Bernardin, Fabrice Zeni, Yves Cohen, Bernard Tardy, Bertrand Souweine, Francois Vincent, Michael Darmon
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  ABSTRACT: INTRODUCTION: Urinary indices have limited effectiveness in separating transient from persistent acute kidney injury (AKI) in ICU patients. Their time-course may vary with the mechanism of AKI. The primary objective of this study was to evaluate the diagnostic value of changes over time of the usual urinary indices in separating transient from persistent AKI. METHODS: Observational prospective multicenter study performed in six ICUs. 244 consecutive patients including 97 without AKI, 54 with transient AKI, and 93 with persistent AKI were included. Urinary sodium, urea and creatinine were measured at ICU admission (H0) and on 6-hour urine samples during the first 24 ICU hours (H6, H12, H18, and H24). Transient AKI was defined as AKI with a cause for renal hypoperfusion and reversal within 3 days. RESULTS: Significant increases from H0 to H24 were noted in fractional excretion of urea (median, 31% [22-41] and 39% [29-48] at H24, P<0.0001], urinary urea/plasma urea (15 [7-28] and 20 [9-40], P<0.0001], and urinary creatinine/plasma creatinine (50 [24-101] and 57 [29-104], P=0.01]. Fractional excretion of sodium did not change significantly during the first 24 hours in the ICU (P=0.13). Neither urinary index values at ICU admission nor changes in urinary indices between H0 and H24 performed sufficiently well to recommend their use in clinical setting (AUC ROC [less than or equal to] 0.65). CONCLUSIONS: Although urinary indices at H24 performed slightly better than those at H0 in differentiating transient from persistent AKI, they remain insufficiently reliable to be clinically relevant.
  Critical care (London, England) 03/2013; 17(2):R56. · 4.61 Impact Factor
• Article: Incidence and outcome of contrast-associated acute kidney injury in a mixed medical-surgical ICU population: a retrospective study.

  Christophe Clec H, Dominique Razafimandimby, Mehdi Laouisset, Frank Chemouni, Yves Cohen
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  ABSTRACT: BACKGROUND: Contrast-enhanced radiographic examinations carry the risk of contrast-associated acute kidney injury (CA-AKI). While CA-AKI is a well-known complication outside the intensive care unit (ICU) setting, data on CA-AKI in ICU patients are scarce. Our aim was to assess the incidence and short-term outcome of CA-AKI in a mixed medical-surgical ICU population. METHODS: We conducted a single-center retrospective analysis between September 2006 and December 2008 on adult patients who underwent a contrast-enhanced computed tomography for urgent diagnostic purposes. CA-AKI was defined as either a relative increment in serum creatinine of >= 25% or an absolute increment in serum creatinine of >= 0.3 mg/dL within 48 hrs after contrast administration. ICU mortality rates of patients with and without CA-AKI were compared in univariate and multivariate analyses. The need for renal replacement therapy (RRT) was also recorded. RESULTS: CA-AKI occurred in 24/143 (16.8%) patients. Coexisting risk factors for kidney injury, such as sepsis, nephrotoxic drugs and hemodynamic failure were commonly observed in patients who developed CA-AKI. ICU mortality was significantly higher in patients with than in those without CA-AKI (50% vs 21%, p = 0.004). In multivariate logistic regression, CA-AKI remained associated with ICU mortality (odds ratio: 3.48, 95% confidence interval: 1.10-11.46, p = 0.04). RRT was required in 7 (29.2%) patients with CA-AKI. CONCLUSIONS: In our cohort, CA-AKI was a frequent complication. It was associated with a poor short-term outcome and seemed to occur mainly when multiple risk factors for kidney injury were present. Administration of ICM should be considered as a potential high-risk procedure and not as a routine innocuous practice in ICU patients.
  BMC Nephrology 02/2013; 14(1):31. · 2.18 Impact Factor
• Article: Procalcitonin levels to guide antibiotic therapy in adults with non-microbiologically proven apparent severe sepsis: a randomised controlled trial.

  Djillali Annane, Virginie Maxime, Jean Pierre Faller, Chaouki Mezher, Christophe Clec'h, Patricia Martel, Hélène Gonzales, Marc Feissel, Yves Cohen, Gilles Capellier, Miloud Gharbi, Olivier Nardi
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  ABSTRACT: Some patients with the phenotype of severe sepsis may have no overt source of infection or identified pathogen. We investigated whether a procalcitonin-based algorithm influenced antibiotic use in patients with non-microbiologically proven apparent severe sepsis. This multicentre, randomised, controlled, single-blind trial was performed in two parallel groups. Eight intensive care units in France. Adults with the phenotype of severe sepsis and no overt source of infection, negative microbial cultures from multiple matrices and no antibiotic exposure shortly before intensive care unit admission. The initiation and duration of antibiotic therapy was based on procalcitonin levels in the experimental arm and on the intensive care unit physicians' clinical judgement without reference to procalcitonin values in the control arm. The primary outcome was the proportion of patients on antibiotics on day 5 postrandomisation. Over a 3-year period, 62/1250 screened patients were eligible for the study, of whom 31 were randomised to each arm; 4 later withdrew their consent. At day 5, 18/27 (67%) survivors were on antibiotics in the experimental arm, versus 21/26 (81%) controls (p=0.24; relative risk=0.83, 95% CI: 0.60 to 1.14). Only 8/58 patients (13%) had baseline procalcitonin <0.25 µg/l; in these patients, physician complied poorly with the algorithm. In intensive care unit patients with the phenotype of severe sepsis or septic shock and without an overt source of infection or a known pathogen, the current study was unable to confirm that a procalcitonin-based algorithm may influence antibiotic exposure. However, the premature termination of the trial may not allow definitive conclusions.
  BMJ open. 01/2013; 3(2).
• Article: Efficacy of renal replacement therapy in critically ill patients: a propensity analysis.

  Christophe Clec'h, Michael Darmon, Alexandre Lautrette, Frank Chemouni, Elie Azoulay, Carole Schwebel, Anne-Sylvie Dumenil, Maite Garrouste-Orgeas, Dany Goldgran-Toledano, Yves Cohen, Jean-Francois Timsit
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  ABSTRACT: INTRODUCTION: Although renal replacement therapy (RRT) being a common procedure in critically ill patients with acute kidney injury (AKI), its efficacy remains uncertain. Patients who receive RRT usually have higher mortality rates than those who do not. However, many differences exist in severity patterns between patients with and those without RRT and available results are further confounded by treatment selection bias since no consensus on indications for RRT has been reached so far. Our aim was to account for these biases to accurately assess RRT efficacy, with special attention to RRT timing. METHODS: We performed a propensity analysis using data of the French longitudinal prospective multicenter Outcomerea database. Two propensity scores for RRT were built to match patients who received RRT to controls who did not despite having a close probability of receiving the procedure. AKI was defined according to RIFLE criteria. The association between RRT and hospital mortality was examined through multivariate conditional logistic regression analyses to control for residual confounding. Sensitivity analysis were conducted to examine the impact of RRT timing. RESULTS: Among the 2846 study patients, 545 (19%) received RRT. Crude mortality rates were higher in patients with than in those without RRT (38% vs 17.5%, p < 0.001). After matching and adjustment, RRT was not associated with a reduced hospital mortality. The two propensity models yielded concordant results. CONCLUSIONS: In our study population, RRT failed to reduce hospital mortality. This result emphasizes the need for randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.
  Critical care (London, England) 12/2012; 16(6):R236. · 4.61 Impact Factor
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  Available from: Yves Cohen

  Article: Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study

  Christophe Clec’h, Paul Simon, Aïcha Hamdi, Lilia Hamza, Philippe Karoubi, Jean-Philippe Fosse, Frédéric Gonzalez, François Vincent, Yves Cohen
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  ABSTRACT: ObjectiveWhether chest radiographs (CXRs) in mechanically ventilated patients should be routinely obtained or only when an abnormality is anticipated remains debated. We aimed to compare the diagnostic, therapeutic and outcome efficacy of arestrictive prescription of CXRs with that of aroutine prescription, focusing on delayed diagnoses and treatments potentially related to the restrictive prescription. DesignRandomized controlled trial. SettingIntensive care unit of the Avicenne Teaching Hospital, Bobigny, France. Patients and participantsAll consecutive patients mechanically ventilated for ≥ 48 h between January and June 2006. InterventionsPatients were randomly assigned to have daily routine CXRs (routine prescription group) or clinically indicated CXRs (restrictive prescription group). Measurements and resultsFor each CXR, aquestionnaire was completed addressing the reason for the CXR, the new findings, and any subsequent therapeutic intervention. The endpoints were the rates of new findings, the rates of new findings that prompted therapeutic intervention, the rate of delayed diagnoses, and mortality. Eighty-four patients were included in the routine prescription group and 81 in the restrictive prescription group. The rates of new findings and the rates of new findings that prompted therapeutic intervention in the restrictive prescription group and in the routine prescription group were 66% vs. 7.2% (p < 0.0001), and 56.4% vs. 5.5% (p < 0.0001) respectively. The rate of delayed diagnoses in the restrictive prescription group was 0.7%. Mortality was similar. ConclusionsRestrictive use of CXRs in mechanically ventilated patients was associated with better diagnostic and therapeutic efficacies without impairing outcome.
  Intensive Care Medicine 04/2012; 34(2):264-270. · 5.40 Impact Factor