Hopital Cochin Hotel Dieu

Saint-Jacques-de-la-Lande, France

Hopital Cochin Hotel Dieu

Saint-Jacques-de-la-Lande, France
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Freund Y.,University Pierre and Marie Curie | Chenevier-Gobeaux C.,Hopital Cochin Hotel Dieu | Bonnet P.,University Pierre and Marie Curie | Claessens Y.-E.,University of Paris Descartes | And 8 more authors.
Critical Care | Year: 2011

Introduction: Recently, newer assays for cardiac troponin (cTn) have been developed which are able to detect changes in concentration of the biomarker at or below the 99th percentile for a normal population. The objective of this study was to compare the diagnostic performance of a new high-sensitivity troponin T (HsTnT) assay to that of conventional cTnI for the diagnosis of acute myocardial infarction (AMI) according to pretest probability (PTP).Methods: In consecutive patients who presented to our emergency departments with chest pain suggestive of AMI, levels of HsTnT were measured at presentation, blinded to the emergency physicians, who were asked to estimate the empirical PTP of AMI. The discharge diagnosis was adjudicated by two independent experts on the basis of all available data.Results: A total of 317 patients were included, comprising 149 (47%) who were considered to have low PTP, 109 (34%) who were considered to have moderate PTP and 59 (19%) who were considered to have high PTP. AMI was confirmed in 45 patients (14%), 22 (9%) of whom were considered to have low to moderate PTP and 23 (39%) of whom were considered to have high PTP (P < 0.001). In the low to moderate PTP group, HsTnT levels ≥ 0.014 μg/L identified AMI with a higher sensitivity than cTnI (91%, 95% confidence interval (95% CI) 79 to 100, vs. 77% (95% CI 60 to 95); P = 0.001), but the negative predictive value was not different (99% (95% CI 98 to 100) vs. 98% (95% CI 96 to 100)). There was no difference in area under the receiver operating characteristic (ROC) curve between HsTnT and cTnI (0.93 (95% CI 0.90 to 0.98) vs. 0.94 (95% CI 0.88 to 0.97), respectively).Conclusions: In patients with low to moderate PTP of AMI, HsTnT is slightly more useful than cTnI. Our results confirm that the use of HsTnT has a higher sensitivity than conventional cTnI. © 2011 Freund et al.; licensee BioMed Central Ltd.


Freund Y.,University Pierre and Marie Curie | Chenevier-Gobeaux C.,Hopital Cochin Broca Hotel Dieu | Leumani F.,University Pierre and Marie Curie | Claessens Y.-E.,Hopital Cochin Hotel Dieu | And 7 more authors.
American Journal of Emergency Medicine | Year: 2012

Background: In combination with cardiac troponin, heart-type fatty acid binding protein (h-FABP) - a biomarker of myocardial necrosis - offers the possibility of rapidly eliminating the diagnosis of acute myocardial infarction (AMI). Objective: The main objective of this study was to assess the incremental value of h-FABP to cardiac troponin for a rapid elimination of AMI, according to the pretest probability (PTP) of AMI. Methods: In consecutive patients presenting to emergency departments (ED) with chest pain less than 6 hours suggestive of AMI, h-FABP levels were measured, blinded to the ED physicians, who were asked to quote the PTP of AMI. The discharge diagnosis was adjudicated by 2 independent experts, blind to the h-FABP level. Results: Three hundred seventeen patients (mean age of 57 years) were included in whom 149 had (47%) low, 117 (37%)moderate, and 51 (16%) high PTP. The final diagnosis was AMI in 45 patients (14%), including 16 STEMIs (5%). The negative predictive value for diagnostic elimination ofAMI of an h-FABP less than 3μg/L, combined with a negative cTnI was not higher than that of cardiac troponin I (cTnI) alone (96% [95% confidence interval, 93%-98%] vs 95% [93%-98%]), regardless of the PTP). Even in the low-PTP group, we did not demonstrate a significant improvement in negative predictive value with the addition of h-FABP, compare with that of cTnI alone (100% [97%-100%] vs 99% [96%-100%]). Conclusion: In triage of patients with chest pain, use of h-FABP does not provide useful additional information to cTnI for excluding the diagnosis of ST-elevation myocardial infarction and non-ST-elevation myocardial infarction diagnosis, whatever the PTP. © 2012 Elsevier Inc. All rights reserved.


Freund Y.,University Pierre and Marie Curie | Chenevier-Gobeaux C.,Hopital Cochin Hotel Dieu | Claessens Y.-E.,University of Paris Descartes | Leumani F.,Service dAccueil des Urgences | And 8 more authors.
Intensive Care Medicine | Year: 2012

Background: Newer assays (high-sensitivity troponin T, HsTnT) and biomarkers (copeptin) have recently improved the management of chest pain in the Emergency Department. Objectives: To assess the negative predictive value (NPV) of the combination of HsTnT and copeptin for the diagnosis of acute myocardial infarction (AMI). Methods: In consecutive patients presenting at three emergency departments with chest pain (<6 h) suggestive of AMI, HsTnT and copeptin were measured at presentation, blinded to the emergency physicians. The medical management of patients was left to the discretion of the attending physicians according to the suspected diagnosis and the result of conventional troponin I (cTn I) assay. The discharge diagnosis was adjudicated by two independent experts using all available data. Results: Three hundred seventeen patients were included. AMI was confirmed in 45 patients (14%), 13 had STEMI (ST elevation MI) and 32 NSTEMI (non-ST elevation MI). A copeptin level <10.7 pmol/l in combination with a HsTnT <0.014 μg/l correctly ruled out AMI with a higher sensitivity than cTnI : 1.00 (95% confidence interval: [0.90-1.00]) versus 0.71 [0.55-0.84], p < 0.001. We also observed a significant gain in NPV: 1.00 [0.96-1.00] for copeptin + HsTnT versus 0.95 [0.92-0.97] for cTnI alone (p = 0.03). Conclusion: Copeptin in association with HsTnT is a fast and reliable tool to rule out AMI, with a sensitivity and NPV of 1.00 in our sample. Interventional studies are warranted to confirm these findings. © 2012 Copyright jointly held by Springer and ESICM.


Chenevier-Gobeaux C.,Hopital Cochin Hotel Dieu | Freund Y.,University Pierre and Marie Curie | Claessens Y.-E.,Groupe Hospitalier Cochin Broca Hotel Dieu | Claessens Y.-E.,University of Paris Descartes | And 8 more authors.
International Journal of Cardiology | Year: 2013

Background: Copeptin, in combination with conventional troponin (cTn), has been suggested as a means of rapid rule out of the diagnosis of acute myocardial infarction (AMI). This study aims to assess the value of copeptin for rule out of AMI, according to the pre-test probability (PTP). Methods: In a prospective multicentric study, we enrolled patients presenting into emergency departments with chest pain < 6 h, copeptin was measured, and PTP was quoted. The discharge diagnosis was adjudicated by 2 independent experts using all available data, including cTnI. Results: 317 patients were included: 148 (46%) had low, 110 (35%) moderate and 59 (19%) high PTP. Final diagnosis was AMI in 45 patients (14%). Median copeptin level was higher in AMI patients compared with that in patients having other diagnoses (23.2 vs. 9.9 pmol/L, p = 0.01). A copeptin level ≥ 10.7 pmol/L in combination with cTnI detected AMI with higher sensitivity than for cTnI alone (98 [87-100] vs. 71 [55-83] %, p = 0.001), whatever the PTP. The negative predictive value of the combination copeptin + cTnI was increased, compared to that of cTnI alone (99 [97-100] vs. 95 [92-97] %, p < 0.05). Conclusions: In triage of chest pain patients, the additional use of copeptin with conventional cTnI might allow a rapid and reliable rule out of the diagnosis of AMI regardless of the PTP. © 2011 Elsevier Ireland Ltd.


Boitard C.,Hopital Cochin HOtel Dieu | Boitard C.,French Institute of Health and Medical Research | Boitard C.,University of Paris Descartes
Diabetes and Metabolism | Year: 2013

Type 1 diabetes (T1D) is an autoimmune disease characterized by the activation of lymphocytes against pancreatic β cells. Landmarks in the history of T1D were the description of insulitis and of islet cell autoantibodies, and report an association between T1D and a limited number of HLA alleles. Another step was the study of T-lymphocytes, now known to be central to the disease process of T1D whether in mice or men. In humans, T-lymphocytes, and especially CD8+ T-cells, are predominant in insulitis. The characterization of antigenic fragments-peptides-recognized by T-cells paves the way towards new assays for predicting T1D and its prevention using antigen- or peptide-specific immunotherapy, while avoiding side effects that may counteract the limited efficacy of immunosuppression and immunomodulation in preserving β-cells from autoimmune destruction in recent-onset T1D patients. The current need for new preclinical models for testing strategies of antigen-specific immune tolerance is also highlighted. © 2013 Elsevier Masson SAS.


Malnutrition (undernutrition) is common in hospital inpatients. However, its prevalence and consequences are underestimated. Malnutrition is an independent factor of morbidity and mortality, generating high hospital overcosts. It is important to examine four separate issues requiring the use of different methods for their assessment, namely the nutritional risk, the severity of malnutrition, the risk of associated complications, and the efficacy of renutrition programs.


Chenevier-Gobeaux C.,Hopital Cochin Hotel Dieu | Guerin S.,Hopital Cochin Hotel Dieu | Andre S.,University of Paris Descartes | Ray P.,Hopital Pitie Salpetriere | And 5 more authors.
Clinical Chemistry | Year: 2010

BACKGROUND: Although renal dysfunction influences the threshold values of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in diagnosis of cardiac-related dyspnea (CRD), its effects on midregional pro-atrial natriuretic peptide (MR-proANP) threshold values are unknown. We evaluated the impact of renal function on MR-proANP concentrations and compared our results to those of BNP and NT-proBNP. METHODS: MR-proANP, BNP, and NT-proBNP concentrations were measured in blood samples collected routinely from dyspneic patients admitted to the emergency department. Patients were subdivided into tertiles based on their estimated glomerular filtration rate [eGFR, in mL·min-1·(1.73 m2)-1]: tertiles 1 (<44.3), 2 (44.3-58.5), and 3 (≥58.6). RESULTS: Of 378 patients studied, 69% (n = 260) had impaired renal function [<60 mL·min -1·(1.73 m2)-1] and 30% (n = 114) had CRD. MR-proANP, BNP, and NT-proBNP concentrations were significantly increased in patients with impaired renal function. In each tertile, all peptides remained significantly increased in CRD patients by comparison with non-CRD patients. By ROC analysis, MR-proANP, BNP, and NT-proBNP threshold values for the diagnosis of CRD increased as eGFR decreased from tertile 3 to tertile 1. Areas under the ROC curve for all peptides were significantly lower in tertile 1. Using adapted thresholds, MR-proANP, BNP, and NT-proBNP remained independently predictive of CRD, even in tertile 1 patients. CONCLUSIONS: Renal function influences optimum cutoff points of MR-proANP for the diagnosis of CRD. With use of an optimum threshold value adapted to the eGFR category, MR-proANP remains as effective as BNP and NT-proBNP in independently predicting a diagnosis of CRD in the emergency department. © 2010 American Association for Clinical Chemistry.


Although renal dysfunction influences the threshold values of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in diagnosis of cardiac-related dyspnea (CRD), its effects on midregional pro-atrial natriuretic peptide (MR-proANP) threshold values are unknown. We evaluated the impact of renal function on MR-proANP concentrations and compared our results to those of BNP and NT-proBNP.MR-proANP, BNP, and NT-proBNP concentrations were measured in blood samples collected routinely from dyspneic patients admitted to the emergency department. Patients were subdivided into tertiles based on their estimated glomerular filtration rate [eGFR, in mL min(-1) (1.73 m(2))(-1)]: tertiles 1 (<44.3), 2 (44.3-58.5), and 3 (58.6).Of 378 patients studied, 69% (n = 260) had impaired renal function [<60 mL min(-1) (1.73 m(2))(-1)] and 30% (n = 114) had CRD. MR-proANP, BNP, and NT-proBNP concentrations were significantly increased in patients with impaired renal function. In each tertile, all peptides remained significantly increased in CRD patients by comparison with non-CRD patients. By ROC analysis, MR-proANP, BNP, and NT-proBNP threshold values for the diagnosis of CRD increased as eGFR decreased from tertile 3 to tertile 1. Areas under the ROC curve for all peptides were significantly lower in tertile 1. Using adapted thresholds, MR-proANP, BNP, and NT-proBNP remained independently predictive of CRD, even in tertile 1 patients.Renal function influences optimum cutoff points of MR-proANP for the diagnosis of CRD. With use of an optimum threshold value adapted to the eGFR category, MR-proANP remains as effective as BNP and NT-proBNP in independently predicting a diagnosis of CRD in the emergency department.

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