Fabrice Bruneel

Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study

BACKGROUND Hydroxyethylstarch used for volume restoration in brain-dead kidney donors has been associated with impaired kidney function in the transplant recipients. We undertook a multicentre randomised study to assess the frequency of acute renal failure (ARF) in patients with severe sepsis or septic shock treated with hydroxyethylstarch or gelatin. METHODS Adults with severe sepsis or septic shock were enrolled prospectively in three intensive-care units in France. They were randomly assigned 6% hydroxyethylstarch (200 kDa, 0.60-0.66 substitution) or 3% fluid-modified gelatin. The primary endpoint was ARF (a two-fold increase in serum creatinine from baseline or need for renal replacement therapy). Analyses were by intention to treat. FINDINGS 129 patients were enrolled over 18 months. Severity of illness and serum creatinine (median 143 [IQR 88-203] vs 114 [91-175] micromol/L) were similar at baseline in the hydroxyethylstarch and gelatin groups. The frequencies of ARF (27/65 [42%] vs 15/64 [23%], p=0.028) and oliguria (35/62 [56%] vs 23/63 [37%], p=0.025) and the peak serum creatinine concentration (225 [130-339] vs 169 [106-273] micromol/L, p=0.04) were significantly higher in the hydroxyethylstarch group than in the gelatin group. In a multivariate analysis, risk factors for acute renal failure included mechanical ventilation (odds ratio 4.02 [95% CI 1.37-11.8], p=0.013) and use of hydroxyethylstarch (2.57 [1.13-5.83], p=0.026). INTERPRETATIONS The use of this preparation of hydroxyethylstarch as a plasma-volume expander is an independent risk factor for ARF in patients with severe sepsis or septic shock.

Guidelines on the management of infectious encephalitis in adults

Recommandations de prise en charge des encéphalites infectieuses de l’adulte J.P. Stahl a,∗,1, P. Azouvi b, F. Bruneel c, T. De Broucker d, X. Duval e, B. Fantin f, N. Girard g, J.L. Herrmann h, J. Honnorat i, M. Lecuit j,k, A. Mailles l,1, L. Martinez-Almoyna m, P. Morand n, L. Piroth o, P. Tattevin p,1, The reviewing group2 a Infectiologie, université et CHU Grenoble Alpes, 38700 La Tronche, France b Réhabilitation neurologique, centre hospitalier de Garches, 92380 Garches, France c Service de réanimation, centre hospitalier de Versailles, 78150 Le Chesnay, France d Neurologie, centre hospitalier de Saint-Denis, 93200 Saint-Denis, France e Thérapeutique, CHU Bichat, 75018 Paris, France f IAME, UMR 1137, Inserm, médecine interne, hôpital Beaujon, université Paris Diderot, Sorbonne Paris Cité, AP–HP, 75013 Paris, France g Neuroradiologie, hôpital La Timone, 13385 Marseille, France h Microbiologie, hôpital Raymond-Poincaré, 92380 Garches, France i Neurologie, hôpital neurologique, CHU de Lyon, 69002 Lyon, France j Unité de biologie des infections, institut Pasteur, CNR et CCOMS Listeria, Inserm U1117, 75015 Paris, France k Department of infectious diseases and tropical medicine, institut imagine, Paris Descartes university, Sorbonne Paris Cité, Necker-Enfants–Malades university hospital, Assistance publique–Hôpitaux de Paris, 75015 Paris, France l Direction des maladies infectieuses, santé publique, 94415 Saint-Maurice, France m Neurologie, hôpital Nord, 13015 Marseille, France n Virologie, université et CHU Grenoble Alpes, 38700 La Tronche, France o Infectiologie, CHU de Dijon, 21000 Dijon, France p Infectiologie, CHU de Rennes, 35000 Rennes, France