Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-Hôpitaux de Paris clinical data warehouse: a pilot study

Muriel Fartoukh; Guillaume Voiriot; Laurent Guérin; Jean Damien Ricard; Alain Combes; Morgane Faure; Sarah Benghanem; Etienne de Montmollin; Yacine Tandjaoui-Lambiotte; Antoine Vieillard-Baron; Eric Maury; Jean-Luc Diehl; Keyvan Razazi; Virginie Lemiale; Pierre Trouiller; Benjamin Planquette; Laurent Savale; Nicholas Heming; Jonathan Marey; AP-HP Clinical Data Warehouse; Fabrice Carrat; Nathanael Lapidus; EPIcuFLU_APHP Group

doi:10.1186/s13613-021-00884-8

Seasonal burden of severe influenza virus infection in the critically ill patients, using the Assistance Publique-Hôpitaux de Paris clinical data warehouse: a pilot study

Ann Intensive Care. 2021 Jul 29;11(1):117. doi: 10.1186/s13613-021-00884-8.

Authors

Muriel Fartoukh^{1

2}, Guillaume Voiriot^{3

4}, Laurent Guérin⁵, Jean Damien Ricard^{6

7}, Alain Combes^{8

9}, Morgane Faure^{10

11}, Sarah Benghanem¹², Etienne de Montmollin^{13

14}, Yacine Tandjaoui-Lambiotte¹⁵, Antoine Vieillard-Baron^{16

17

18}, Eric Maury^{19

20}, Jean-Luc Diehl^{21

22}, Keyvan Razazi^{23

24}, Virginie Lemiale^{25

26}, Pierre Trouiller²⁷, Benjamin Planquette^{28

29}, Laurent Savale^{30

31

32}, Nicholas Heming³³, Jonathan Marey³⁴; AP-HP Clinical Data Warehouse; Fabrice Carrat³⁵, Nathanael Lapidus³⁵; EPIcuFLU_APHP Group

Collaborators

Michel Djibré, Jean Louis Teboul, Jonathan Messika, Alexandre Demoule, Jean Paul Mira, Jean-François Timsit, Yves Cohen, Bernard Page, Armand Mekontso Dessap, Elie Azoulay, Olivier Sanchez, Marc Humbert, Djillali Annane, Nicolas Roche

Affiliations

¹ Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France. [email protected].
² Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Créteil, France. [email protected].
³ Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France.
⁴ Groupe de Recherche Clinique CARMAS, Collégium Gallilée, Créteil, France.
⁵ Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
⁶ Medical and Surgical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, 92700, Colombes, France.
⁷ Infection, Antimicrobials, Modelling and Evolution, IAME UMR 1137 Institut National de la Santé et de la Recherche Médicale, Université de Paris, 75018, Paris, France.
⁸ Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
⁹ INSERM-UMRS 1166, iCAN Institute of Cardiometabolism/Nutrition, Sorbonne Université, Paris, France.
¹⁰ Service de Médecine Intensive - Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
¹¹ UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France.
¹² Medical Intensive Care Unit, Groupe Hospitalier Paris Centre-Cochin University Hospital-Assistance Publique-Hôpitaux de Paris, Paris University, 75014, Paris, France.
¹³ UMR 1137, IAME, Université de Paris, Paris, France.
¹⁴ Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁵ Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, CHU Avicenne; INSERM U1272 Hypoxie & Poumon, Bobigny, France.
¹⁶ Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne Billancourt, France.
¹⁷ Faculty of Medicine Simone Veil, Saint Quentin en Yvelines, France.
¹⁸ Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Faculty of Paris Saclay, Villejuif, France.
¹⁹ Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75571, Paris, France.
²⁰ U 1136, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, 75012, Paris, France.
²¹ Service de Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
²² Faculty of Pharmacy, INSERM UMR-S1140, Paris Descartes University, Paris, France.
²³ Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
²⁴ Groupe de Recherche Clinique CARMAS, Université Paris Est Créteil, Créteil, France.
²⁵ Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.
²⁶ ECSTRA Team, Biostatistics and Clinical Epidemiology, Center of Epidemiology and Biostatistics Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale, Paris Diderot Sorbonne University, Paris, France.
²⁷ Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Paris Sud University, Clamart, France.
²⁸ Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 75015, Paris, France.
²⁹ Biosurgical Research Laboratory (Carpentier Foundation), Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, 75015, Paris, France.
³⁰ Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
³¹ Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
³² INSERM UMR_S 999, Le Kremlin-Bicêtre, France.
³³ General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.
³⁴ Service de Pneumologie, Institut Cochin, INSERM U1016, Université de Paris, Assitance Publique-Hôpitaux de Paris, Paris, France.
³⁵ Unité de Santé Publique, INSERM, Institut Pierre Louis d'Epidemiologie et de Sante Publique, Hopital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France.

Abstract

Purpose: At the critical care level, the flu surveillance system is limited in France, with heterogeneous regional modalities of implementation.

Materials, patients and methods: We aimed at assessing the relevance of the Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse for estimating the burden of the influenza epidemic on medical adult critical care units of the AP-HP, and outcome of patients during the flu season 2017-2018. This exploratory multi-site epidemiological study comprised all consecutive adult stays (n = 320) in 18 medical intensive care units (ICU) or intermediate care wards (ICW) for probable or confirmed Influenza virus infection during the 2017-2018 flu season.

Results: Patients admitted to ICU/ICW had low vaccination coverage (21%), required life support in 60% of cases, stayed in the ICU for a median of 8 days, and had high 28-day mortality rate (19.7%; 95% confidence interval 15.5-24.5). Early prognostic factors included age, core temperature, the acute organ failures score, and the early administration of antiviral therapy.

Conclusions: Data directly extracted from the electronic medical records stored in the data warehouse provide detailed clinical, care pathway and prognosis information. The real-time availability should enable to detect and assess the burden of the most severe cases. By a firmer and more acute monitoring and adjustment of care and patient management, hospitals could generate more ICU/ICW capacities, sensitize their emergency department and contribute to the recommendations from health authorities. This pilot study is of particular relevance in the context of emerging epidemics of severe acute respiratory diseases.

Keywords: Assistance Publique-Hôpitaux de Paris (AP-HP) clinical data warehouse; Critical care; Epidemic; Influenza; Prognosis.