Frédéric Pène

Pierre and Marie Curie University - Paris 6, Lutetia Parisorum, Île-de-France, France

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Publications (78)389.46 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background.Cardiac involvement is a major cause of mortality in thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed due to sub-clinical injuries. Cardiac troponin-I (cTnI) on admission could improve early diagnosis of cardiac involvement and have a prognostic value.Objectives.To assess the predictive value of cTnI-I in TTP for death or refractoriness.Patients/Methods.The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS13 deficiency (<10%) and included in the registry of the French reference center for thrombotic microangiopathies. Centralized cTnI measurements were performed from frozen serum on admission.Results.Between January, 2003 and December, 2011, 133 patients with TTP (mean age, 48±17 year-old) had available cTnI measurement on admission. Thirty-two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI (>0.1μg/L) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. Main outcomes were death (25%) and refractoriness (17%). Age (P=0.02) and cTnI level (P=0.002) showed the greatest impact on survival. A cTnI level >0.25 μg/L was the only independent factor in predicting death (Odds-ratio [OR] 2.87; 95% confidence interval [CI]: 1.13-7.22; P=0.024) and/or refractoriness (OR 3.03; 95%CI: 1.27-7.3; P=0.01).Conclusions.CTnI >0.25 μg/L at presentation in TTP appears as an independent factor associated with a threefold increase in death risk or refractoriness. Therefore, cTnI levels should be considered as part of prognostic indicator in patients diagnosed with TTP.This article is protected by copyright. All rights reserved.
    Journal of Thrombosis and Haemostasis 11/2014; · 6.08 Impact Factor
  • Frédéric Pène, Jorge I F Salluh, Thomas Staudinger
    Intensive Care Medicine 08/2014; · 5.54 Impact Factor
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    ABSTRACT: Infectious diseases remain a major public health issue in both developing and developed countries. For instance, there is still a high rate of morbidity and mortality due to seasonal influenza outbreaks and severe bacterial sepsis, despite major advances in their prevention and treatment. It is now clear that severe influenza and bacterial infections promote susceptibility for superinfections worsening the prognosis. Various immune defects acquired during severe infection may result in complex immunosuppression and may affect both innate and adaptive components. Some animal models of these common clinical situations have demonstrated the increased susceptibility of infected hosts to secondary infectious insult and allowed assessing the regulatory mechanisms. Such pathophysiological advances may help create new immunomodulatory therapeutics for infected patients exposed to severe secondary sepsis.
    Medecine et maladies infectieuses. 08/2014;
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    ABSTRACT: Determinants of outcome and long-term survival are unknown in elderly patients successfully resuscitated after out-of-hospital cardiac arrest. Our aim was to identify factors associated with short- and long-term neurologic outcome in such patients.
    Critical care medicine. 07/2014;
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    ABSTRACT: We sought to identify risk factors for mechanical ventilation in patients with malignancies and acute respiratory failure (ARF).
    Respiratory care 07/2014; · 2.03 Impact Factor
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    ABSTRACT: Little attention has been given to ARDS in cancer patients, despite their high risk for pulmonary complications. We sought to describe outcomes in cancer patients with ARDS meeting the Berlin definition.
    Intensive care medicine. 06/2014;
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    ABSTRACT: L’intoxication à l’éthylène glycol est rare, mais son diagnostic est fondamental afin de débuter les thérapeutiques spécifiques. Nous rapportons le cas d’un patient admis en réanimation pour coma avec acidose métabolique majeure, causé par une intoxication grave à l’éthylène glycol. La gazométrie artérielle initial, analysée à l’aide de l’appareil de biochimie délocalisée disponible dans le service de réanimation, révélait une hyperlactatémie majeure, plus tard infirmée par un autre dosage pratiqué dans le service de biochimie. Une interférence entre les métabolites de l’éthylène glycol et la technique de dosage de certains appareils de biochimie délocalisée était à l’origine de cette fausse hyperlactatémie. L’hyperlactatémie artéfactuelle reflétait le taux d’éthylène glycol, suggérant que cette interférence pourrait être utilisée à des fins de suivi de l’évolution sous traitement des concentrations de l’alcool toxique, sans recours aux dosages coûteux et peu disponibles.
    Annales francaises d'anesthesie et de reanimation 04/2014; · 0.77 Impact Factor
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    ABSTRACT: The influence of blood glucose (BG) level during the post-resuscitation period after out-of-hospital cardiac arrest (OHCA) is still debated. To evaluate the relationship between blood glucose level and outcome, we included the median glycemia and its maximal amplitude over the first 48 h following ICU admission in an analysis of outcome predictors. We conducted a database study in a cardiac arrest center in Paris, France. Between 2006 and 2010, we included 381 patients who were all resuscitated from an OHCA. A moderate glycemic control was applied in all patients. The median glycemia and the largest change over the first 48 h were included in a multivariate analysis that was performed to determine parameters associated with a favorable outcome. Of the 381 patients, 136 (36 %) had a favorable outcome (CPC 1-2). Median BG level was 7.6 mmol/L (6.3-9.8) in patients with a favorable outcome compared to 9.0 mmol/L (IQR 7.1-10.6) for patients with an unfavorable outcome (p < 0.01). Median BG level variation was 7.1 (4.2-11) and 9.6 (5.9-13.6) mmol/L in patients with and without a favorable outcome, respectively (p < 0.01). In multivariate analysis, an increased median BG level over the first 48 h was found to be an independent predictor of poor issue [OR = 0.43; 95 % CI (0.24-0.78), p = 0.006]. Finally a progressive increase in median BG level was associated with a progressive increase in the proportion of patients with a poor outcome. We observed a relationship between high blood glucose level and outcome after cardiac arrest. These results suggest the need to test a strategy combining both control of glycemia and minimization of glycemic variations for its ability to improve post-resuscitation care.
    European Journal of Intensive Care Medicine 03/2014; · 5.17 Impact Factor
  • Journal of Clinical Oncology 03/2014; · 18.04 Impact Factor
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    ABSTRACT: BACKGROUND: Infectious events have been reported as major environmental triggers of thrombotic thrombocytopenic purpura (TTP). We detail here the potential association between infections and TTP.
    Transfusion 02/2014; 54(2):389-397. · 3.53 Impact Factor
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    ABSTRACT: Les maladies infectieuses demeurent un problème majeur de santé publique, y compris dans les pays développés. Par exemple, les épidémies grippales et les infections bactériennes demeurent grevées d’une morbi-mortalité importante malgré les avancées réalisées dans la prévention et le traitement de ces maladies. Il est maintenant clairement établi que les infections grippales et bactériennes graves induisent une susceptibilité accrue à des infections secondaires qui grèvent significativement le pronostic. En effet, au cours des états infectieux graves, diverses anomalies immunologiques acquises peuvent aboutir à une immunodépression complexe qui affecte à la fois les composants de l’immunité innée et de l’immunité adaptive. Des modèles animaux modélisant ces situations cliniques communes ont permis de mettre en évidence la susceptibilité accrue de l’animal infecté à une agression infectieuse secondaire et d’évaluer les mécanismes qui régulent ces phénomènes. Ces avancées physiopathologiques permettent maintenant d’envisager des perspectives thérapeutiques immunomodulatrices chez les patients septiques exposés à des complications infectieuses secondaires.
    Médecine et Maladies Infectieuses. 01/2014;
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    ABSTRACT: In between innate and adaptive immunity, the recently identified innate-like mucosal-associated invariant T (MAIT) lymphocytes display specific reactivity to non-streptococcal bacteria. Whether they are involved in bacterial sepsis has not been investigated. We aimed to assess the number and the time course of circulating innate-like T lymphocytes (MAIT, NKT and γδ T cells) in critically ill septic and non-septic patients and to establish correlations with the further development of intensive care unit (ICU)-acquired infections. We prospectively enrolled consecutive patients with severe sepsis and septic shock. Controls were critically ill patients with non-septic shock and age-matched healthy subjects. Circulating innate-like lymphocytes were enumerated using a flow cytometry assay at day 1, 4 and 7. One hundred and fifty six patients (113 severe bacterial infections, 36 non-infected patients and 7 patients with severe viral infections) and 26 healthy subjects were enrolled into the study. Patients with severe bacterial infections displayed an early decrease in MAIT cell count [median 1.3/mm(3); interquartile range (0.4-3.2)] as compared to control healthy subjects [31.1/mm(3) (12.1-45.2)], but also to non-infected critically ill patients [4.3/mm(3) (1.4-13.2)] (P < 0.0001 for all comparisons). In contrast NKT and γδ T cell counts did not differ between patients groups. The multivariate analysis identified non-streptococcal bacterial infection as an independent determinant of decrease in MAIT cell count. Furthermore, the incidence of ICU-acquired infections was higher in patients with persistent MAIT cell depletion. This large human study provides valuable information about MAIT cells in severe bacterial infections. The persistent depletion of MAIT cells is associated with the further development of ICU-acquired infections.
    European Journal of Intensive Care Medicine 12/2013; · 5.17 Impact Factor
  • Nephrology 12/2013; 18(12):844. · 1.69 Impact Factor
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    Frédéric Pène, Dominique D Benoit
    European Journal of Intensive Care Medicine 07/2013; · 5.17 Impact Factor
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    ABSTRACT: Purpose:Few studies have evaluated outcomes of neutropenic patients admitted to the ICU at the onset of acute respiratory failure (ARF). The main objective of this study was to describe outcomes and to identify early predictors of hospital mortality in critically ill cancer patients with ARF during chemotherapy-induced neutropenia. Patients and Methods:Retrospective analysis of prospectively collected data extracted from two recent prospective multicentre studies. We included neutropenic adults admitted to the ICU for ARF. Results: Of the 123 study patients, 107 patients (87%) had haematological malignancies; 78 (64%) were male, median age was 57 years (44-62), and median LOD score at ICU admission was 6 (4-9). ICU and hospital mortality rates were 42% and 77%, respectively. Endotracheal mechanical ventilation was an independent risk factor for hospital mortality (odds ratio [OR], 7.73; 95% confidence interval [95%CI], 2.52-23.69); two factors independently protected from hospital mortality, namely, ICU admission for ARF during neutropenia recovery (OR, 0.23; 95%CI, 0.07-0.73) and steroid therapy before ICU admission (OR, 0.35; 95%CI, 0.11-0.95). Conclusion: Our study demonstrates a meaningful ICU survival in the studied population and identified factors associated with ICU and hospital mortality. Further work is needed to address the reasons for the high post-ICU mortality rate after ARF.
    Minerva anestesiologica 07/2013; · 2.82 Impact Factor
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    ABSTRACT: PURPOSEPatients with hematologic malignancies are increasingly admitted to the intensive care unit (ICU) when life-threatening events occur. We sought to report outcomes and prognostic factors in these patients. PATIENTS AND METHODS Ours was a prospective, multicenter cohort study of critically ill patients with hematologic malignancies. Health-related quality of life (HRQOL) and disease status were collected after 3 to 6 months.ResultsOf the 1,011 patients, 38.2% had newly diagnosed malignancies, 23.1% were in remission, and 24.9% had received hematopoietic stem-cell transplantations (HSCT, including 145 allogeneic). ICU admission was mostly required for acute respiratory failure (62.5%) and/or shock (42.3%). On day1, 733 patients (72.5%) received life-supporting interventions. Hospital, day-90, and 1-year survival rates were 60.7%, 52.5%, and 43.3%, respectively. By multivariate analysis, cancer remission and time to ICU admission less than 24 hours were associated with better hospital survival. Poor performance status, Charlson comorbidity index, allogeneic HSCT, organ dysfunction score, cardiac arrest, acute respiratory failure, malignant organ infiltration, and invasive aspergillosis were associated with higher hospital mortality. Mechanical ventilation (47.9% of patients), vasoactive drugs (51.2%), and dialysis (25.9%) were associated with mortality rates of 60.5%, 57.5%, and 59.2%, respectively. On day 90, 80% of survivors had no HRQOL alterations (physical and mental health similar to that of the overall cancer population). After 6 months, 80% of survivors had no change in treatment intensity compared with similar patients not admitted to the ICU, and 80% were in remission. CONCLUSION Critically ill patients with hematologic malignancies have good survival, disease control, and post-ICU HRQOL. Earlier ICU admission is associated with better survival.
    Journal of Clinical Oncology 06/2013; · 18.04 Impact Factor
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    ABSTRACT: INTRODUCTION: The overall outcome of septic shock has been recently improved. We sought to determine whether this survival gain extends to the high-risk subgroup of patients with cirrhosis. METHODS: Cirrhotic patients with septic shock admitted to a medical intensive care unit (ICU) during two consecutive periods (1997-2004 and 2005-2010) were retrospectively studied. RESULTS: 47 and 42 cirrhotic patients presented with septic shock in 1997-2004 and 2005-2010, respectively. The recent period differed from the previous one by implementation of adjuvant treatments of septic shock including albumin infusion as fluid volume therapy, low-dose glucocorticoids and intensive insulin therapy. ICU and hospital survival markedly improved over time (40% in 2005-2010 vs. 17% in 1997-2004, p=0.02 and 29% in 2005-2010 vs. 6% in 1997-2004, p=0.009, respectively). Furthermore, this survival gain in the latter period was sustained for six months (survival rate 24% in 2005-2010 vs. 6% in 1997-2004, p=0.06). After adjustment with age, the liver disease stage (Child-Pugh score) and the critical illness severity score (SOFA score), ICU admission between 2005 and 2010 remained an independent favorable prognostic factor (odds ratio [OR] 0.09, confidence interval [CI] 95% 0.02-0.4, p=0.004). The stage of the underlying liver disease was also independently associated with hospital mortality (Child-Pugh score: OR 1.42 per point, CI 95% 1.06-1.9, p=0.018). CONCLUSIONS: In the light of advances in management of both cirrhosis and septic shock, survival of such patients substantially increased over the recent years. The stage of the underlying liver disease and the related therapeutic options should be included in the decision-making process for ICU admission.
    Critical care (London, England) 04/2013; 17(2):R78. · 4.72 Impact Factor
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    ABSTRACT: INTRODUCTION: Despite experimental evidence, clinical demonstration of acute state of oxidative stress and inflammation during post-cardiac arrest syndrome is lacking. Plasma level of thioredoxin (TRX), a redox-active protein induced under conditions of oxidative stress and inflammation, is increased in various critical care conditions. We determined plasma TRX concentrations after cardiac arrest and assessed relationships with severity and outcome. METHODS: Retrospective study of consecutive patients admitted to a single academic intensive care unit (ICU) for out-of-hospital cardiac arrest (07/2006-03/2008). Plasma levels of TRX were measured at admission, day (D) 1, 2 and 3. RESULTS: Of 176 patients included, median TRX values measured in ICU survivors and non-survivors were, respectively: 22 ng/mL [7.8-77] vs 72.4 [21.9-117.9] at admission (p<0.001); 5.9 [3.5-25.5] vs 23.2 [5.8-81.4] at D1 (p=0.003); 10.8 [3.6-50.8] vs 11.7 [4.5-66.4] at D2 (p=0.22); and 16.7 [5.3-68.3] vs 17 [4.3-62.9] at D3 (p=0.96). Patients dying within 24h had significantly (p<0.001) higher TRX levels (118.6 ng/mL [94.8-280]) than those who died after 24h or survived (50.8 [13.9-95.7] and 22 [7.8-77]). The area under the ROC curve to predict early death was 0.84 [0.76-0.91]. TRX levels on admission were significantly correlated with "low flow" duration (p=0.003), sequential organ failure assessment (SOFA) score (p<0.001), and blood lactate concentration (p<0.001), but not with "no flow" duration or simplified acute physiology score (SAPS) 2 score. TRX levels and admission arterial pO^2 correlated negatively (r=-0.17, p=0.03). Finally, cardiac arrest with cardiac etiology exhibited lower levels of TRX than in case of extra-cardiac cause (46 ng/mL [11-104] vs 68 [42-137], p=0.01). CONCLUSIONS: Our data show for the first time that TRX levels were elevated early following cardiac arrest, suggestive of oxidative stress and inflammation occurring with this condition. Highest values were found in the most severe patients. TRX could be a useful tool for further exploration and comprehension of post-cardiac arrest syndrome.
    Critical care (London, England) 01/2013; 17(1):R18. · 4.72 Impact Factor
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    ABSTRACT: PURPOSE: Increased therapeutic intensity has translated into better survival at a price of infectious and toxic life threatening complications, chiefly affecting the lungs. Yet, no study specifically evaluated outcomes in cancer patients admitted to the ICU for septic shock of pulmonary origin. METHODS: Multicentre cohort study of cancer patients admitted to the ICU for septic shock and pneumonia between 1998 and 2008. Independent determinants of hospital mortality were assessed using a multivariate logistic regression model. Prognostic impact of persistence or acquisition of organ failures was evaluated by survival conditional probabilities. RESULTS: Over the 10-y study period, 218 patients were included. Hematologic malignancy (mostly non-Hodgkin lymphoma and acute leukemia) affected 84%, and solid tumors (mostly lung cancer) 16% of patients. Chemotherapy was recently administered in 89% of patients and 24.5% of patients were recipients of hematopoietic stem cell transplantation (35 autologous, 18 allogeneic). At the time of ICU admission, 60% of patients were in partial or complete remission. All patients received vasopressors, invasive mechanical ventilation was needed in 78.4% and dialysis in 30% of patients. ICU and hospital mortality were 56.4% and 62.4%, respectively. Independent risk factors for hospital mortality were age>60years, time between first symptoms and ICU admission, use of invasive mechanical ventilation, need for invasive mechanical ventilation after use of non invasive ventilation, and coma. Analysis of survival probability showed there was no temporal threshold after which persistence or gain of organ dysfunction indicated no hope for survival. CONCLUSION: Survival in cancer patients with septic shock from pulmonary origin is substantial, even when organ dysfunctions are not rapidly reversible. Delayed ICU management is an independent predictor of death. Studies assessing survival benefits from early ICU management are warranted.
    Shock (Augusta, Ga.) 01/2013; · 2.87 Impact Factor
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    ABSTRACT: PURPOSE: External cooling is largely employed to induce hypothermia in comatose survivors of cardiac arrest (CA), but can fail to reach the target temperature in a reasonable time. We aimed to assess the rate of failure of external cooling after CA and to determine failure predictors. METHODS: The study was a retrospective review of a prospectively acquired database in the setting of a 24-bed ICU in a university hospital. All consecutive patients admitted for CA from May 2002 to April 2010 and treated by external cooling were considered. Patients who were already hypothermic on admission, patients dying within 24 h, patients cooled by an internal technique and patients in whom hypothermia had not been attempted were not studied. External cooling failure was defined as the inability to reach a temperature below 34 °C during the first 12 h after CA onset. RESULTS: Among 1,036 patients admitted to the ICU, 594 were included in the analysis and in 191 (32 %) the target temperature could not be achieved within the 12 h following CA. Independent risk factors for external cooling failure were an early coronary angiography intervention (OR 3.75, p < 0.001), a high body weight (OR 1.02 per kilogram, p = 0.007), a high temperature on ICU admission (OR 1.47 per degree, p = 0.001) and a long delay between collapse and the start of cooling (OR 1.15, p = 0.05). Conversely, early haemodialysis (OR 0.27, p < 0.001) and male gender (OR 0.47, p = 0.02) were significantly associated with cooling success. CONCLUSION: External cooling failure occurred in nearly one-third of patients with CA and was associated with easily identified risk factors. This emphasizes the interest in early cooling and alternative techniques in these patients.
    European Journal of Intensive Care Medicine 01/2013; · 5.17 Impact Factor

Publication Stats

1k Citations
389.46 Total Impact Points

Institutions

  • 2014
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2004–2014
    • Institut Cochin
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier de Versailles
      Versailles, Île-de-France, France
  • 2005–2013
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • Hôpital Avicenne – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bobigny, Île-de-France, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2006–2012
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      Lutetia Parisorum, Île-de-France, France
  • 2002–2012
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculty of medicine
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • National Institute of Allergy and Infectious Diseases
      • Laboratory of Immunoregulation
      Maryland, United States
  • 2006–2011
    • Université Paris Descartes
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France