{"id":2024,"date":"2015-10-01T01:00:00","date_gmt":"2015-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/enquete-de-pratique-albu-live-sur-lutilisation-de-lalbumine-humaine-chez-le-patient-cirrhotique-en-france-des-resultats-qui-interrogent\/"},"modified":"2018-10-20T18:40:15","modified_gmt":"2018-10-20T16:40:15","slug":"enquete-de-pratique-albu-live-sur-lutilisation-de-lalbumine-humaine-chez-le-patient-cirrhotique-en-france-des-resultats-qui-interrogent","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/enquete-de-pratique-albu-live-sur-lutilisation-de-lalbumine-humaine-chez-le-patient-cirrhotique-en-france-des-resultats-qui-interrogent\/","title":{"rendered":"Enqu\u00eate de pratique ALBU-LIVE sur l\u2019utilisation de l\u2019albumine humaine chez le patient cirrhotique en France: des r\u00e9sultats qui interrogent."},"content":{"rendered":"<p><strong>2015<\/strong><\/p>\n<p><em>A. Garioud1, J.-F. Cadranel1, A. Pauwels2, T. Th\u00e9venot3, A. Louvet4, T. Dao5, S. Pol6, N. Talbodec7, C. Bureau8, D. Thabut9, L. Elkrief10, T.Antonini11, V. Jouannaud12, G. Macaigne13, B. Bernard-Chabert14, L. Alric15, N. Carbonell16, G.-P. Pageaux17, L. Bettan18, H. Labadie19, P. Nahon20, R. Bader21, J.-P.Zarski22, B. Hanslik23, V. de L\u00e9dinghen24, J. Denis25.<\/p>\n<p>1 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, d\u2019Alcoologie et de Nutrition, Groupe Hospitalier Public du Sud de l\u2019Oise (GHPSO) \u2013 Creil,  2 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie \u2013 Gonesse,  3 \u2013 Universit\u00e9 de Franche-Comt\u00e9 et CHRU Jean Minjoz \u2013 Besan\u00e7on,  4 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHRU Claude Huriez \u2013 Lille,  5 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHU \u2013 Caen,  6 \u2013 Service d\u2019H\u00e9patologie, CHU Cochin \u2013 Paris,  7 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHG \u2013 Tourcoing,  8 \u2013 Service d\u2019H\u00e9patologie, CHU \u2013 Toulouse,  9 \u2013 Service d\u2019H\u00e9patologie, CHU La Piti\u00e9-Salp\u00eatri\u00e8re, Paris,  10 \u2013 Service d\u2019H\u00e9patologie, CHU Beaujon \u2013 Clichy-la-Garenne,  11 \u2013 Service d\u2019H\u00e9patologie, CHB \u2013 Villejuif, 12 &#8211; Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHG \u2013 Montfermeil, 13 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHG \u2013 Lagny-sur-Marne, 14 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHU \u2013 Reims, 15 \u2013 Service de M\u00e9decine interne, CHU \u2013 Toulouse, 16 \u2013 Service d\u2019H\u00e9patologie, CHU Saint-Antoine \u2013 Paris, 17 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHU \u2013 Montpellier, 18 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHG \u2013 Villeneuve-Saint-Georges, 19 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHG \u2013 Saint-Denis, 20 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHU Jean Verdier \u2013 Bondy, 21 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHG \u2013 Mulhouse, 22 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CHU \u2013 Grenoble,  23 \u2013 CREGG \u2013 Montpellier,  24 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie et AFEF, CHU \u2013 Pessac,  25 \u2013 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, CH Sud Franciilien  et ANGH \u2013 Corbeil-Essonnes.<\/em><\/p>\n<p><strong> <\/strong>&#8211; \u00a02015-04-30 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Introduction:<br \/>\nLa prescription d\u2019albumine humaine (Alb) a consid\u00e9rablement augment\u00e9 ces derni\u00e8res ann\u00e9es dans la prise en charge des complications de la cirrhose. Son co\u00fbt est \u00e9lev\u00e9. Trois indications sont valid\u00e9es : la ponction d\u2019ascite \u00e9vacuatrice (PA), l\u2019infection du liquide d\u2019ascite (ILA) et le syndrome h\u00e9pato-r\u00e9nal (SHR) de type 1, pour lesquelles des recommandations ont \u00e9t\u00e9 publi\u00e9es. L\u2019objectif principal de cette enqu\u00eate \u00e9tait d\u2019\u00e9valuer les pratiques des h\u00e9pato-gastroent\u00e9rologues fran\u00e7ais en mati\u00e8re de prescription d\u2019albumine chez les patients cirrhotiques. Les objectifs secondaires \u00e9taient d\u2019\u00e9valuer le degr\u00e9 de syst\u00e9matisation de ces pratiques et de rechercher des diff\u00e9rences selon le lieu d\u2019exercice ou le statut des praticiens.<\/p>\n<p>Mat\u00e9riel et m\u00e9thode:<br \/>\nTous les praticiens \u2013 PH, PU-PH, attach\u00e9s, temps plein ou temps partiel ; CCA, assistants, internes, FFI \u2013 des services d\u2019H\u00e9pato-gastroent\u00e9rologie de CHU et de CHG et tous les gastroent\u00e9rologues lib\u00e9raux fran\u00e7ais ont \u00e9t\u00e9 contact\u00e9s et relanc\u00e9s individuellement pour r\u00e9pondre \u00e0 un questionnaire comportant des questions ouvertes ou ferm\u00e9es sur leurs pratiques de prescription dans 1) les trois indications valid\u00e9es et 2) d\u2019autres situations cliniques o\u00f9 l\u2019utilisation de l\u2019Alb n\u2019est pas valid\u00e9e mais a fait l\u2019objet de publications. L\u2019enqu\u00eate a \u00e9t\u00e9 r\u00e9alis\u00e9e de mani\u00e8re prospective entre le 1er avril et le 10 ao\u00fbt 2014. L\u2019analyse des r\u00e9ponses a \u00e9t\u00e9 faite \u00e0 l\u2019aide du logiciel Statview et les comparaisons de sous-groupes \u00e0 l\u2019aide du test du chi-2.  <\/p>\n<p>R\u00e9sultats:<br \/>\n55% des praticiens ont r\u00e9pondu \u00e0 l\u2019enqu\u00eate et les 451 r\u00e9ponses re\u00e7ues ont \u00e9t\u00e9 analys\u00e9es. L\u2019\u00e2ge moyen des praticiens \u00e9tait de 40,0 [20-67] ans.<br \/>\nPonction d\u2019ascite : 99,6% des praticiens effectuent une compensation apr\u00e8s PA (syst\u00e9matique pour un volume soustrait &#8805; 5 litres pour 97,6%). Pour 87,8% des praticiens, elle est faite exclusivement avec de l\u2019Alb ; pour 12%, une g\u00e9latine (53,5%), un HEA (34,9%) et le s\u00e9rum physiologique (24,1%) peuvent \u00eatre utilis\u00e9s. En cas d\u2019utilisation d\u2019Alb, la dose est fixe pour 84,6% des praticiens (1 flacon pour 3 litres  soustraits dans 2\/3 des cas). La compensation a lieu pendant (52,6%) ou apr\u00e8s (32,3%) la PA.<br \/>\nInfection du liquide d\u2019ascite : 94% des praticiens utilisent l\u2019Alb en association avec l\u2019antibioth\u00e9rapie (syst\u00e9matiquement dans 92,5% des cas). Le protocole de r\u00e9f\u00e9rence [1] (1,5g\/kg \u00e0 J1 &#8211; 1g\/kg \u00e0 J3) n\u2019est suivi que dans 56,2% des cas, plus souvent par les PH-CHU que par les PH-CHG (60,3% vs 42,1% ; p=0,015). En cas d\u2019ILA avec ascite tendue, les PH-CHG font plus souvent une PA que les PH-CHU (89,9% vs 76,6% ; p&lt;0,03), mais ils augmentent moins souvent la dose d\u2019Alb (44,8% vs 66,1% ; p&lt;0,01).<br \/>\nSHR type 1 : seulement 66,5% des praticiens effectuent une perfusion d\u2019Alb pour confirmer le diagnostic, les PH-CHU plus souvent que les PH-CHG (81,2% vs 57,8% ; p=0,0006). Pour le traitement, 84% des praticiens associent l\u2019Alb au m\u00e9dicament vasopresseur (syst\u00e9matiquement dans 86,8% des cas). Concernant la dose et la dur\u00e9e d\u2019administration de l\u2019Alb, les r\u00e9ponses sont extr\u00eamement vari\u00e9es.<br \/>\nAutres situations cliniques : l\u2019Alb est utilis\u00e9e par 23,5% des praticiens en cas d\u2019infection bact\u00e9rienne s\u00e9v\u00e8re hors ILA, 47,9% en cas d\u2019hyponatr\u00e9mie s\u00e9v\u00e8re, et 43,9% en cas d\u2019hypoalbumin\u00e9mie s\u00e9v\u00e8re. Apr\u00e8s ponction pleurale pour hANydrothorax, 65,9% des praticiens prescrivent une perfusion d\u2019Alb, principalement en fonction du volume soustrait (90,9%) et de la s\u00e9v\u00e9rit\u00e9 de la cirrhose (55,2%). Enfin, 19,1% des praticiens utilisent l\u2019Alb dans d\u2019autres circonstances (remplissage vasculaire, OMI r\u00e9sistants aux diur\u00e9tiques, insuffisance r\u00e9nale aigu\u00eb hors SHR).<\/p>\n<p>Conclusions:<br \/>\nSi la prescription de l\u2019Alb est conforme aux recommandations pour la PA, cette enqu\u00eate montre que : 1) le protocole de r\u00e9f\u00e9rence pour l\u2019ILA n\u2019est utilis\u00e9 que par 56% des praticiens ; 2) les modalit\u00e9s d\u2019utilisation de l\u2019Alb dans le SHR de type 1 sont tr\u00e8s h\u00e9t\u00e9rog\u00e8nes ; 3) l\u2019utilisation de l\u2019Alb chez le patient cirrhotique d\u00e9passe largement le cadre des indications valid\u00e9es.<\/p>\n<p>R\u00e9f\u00e9rences:<br \/>\n1. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol, 2010;53(3):397-417.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2015 A. Garioud1, J.-F. Cadranel1, A. Pauwels2, T. Th\u00e9venot3, A. Louvet4, T. Dao5, S. Pol6, N. Talbodec7, C. Bureau8, D. Thabut9, L. Elkrief10, T.Antonini11, V. Jouannaud12, G. Macaigne13, B. Bernard-Chabert14, L. Alric15, N. Carbonell16, G.-P. Pageaux17, L. Bettan18, H. Labadie19, P. Nahon20, R. Bader21, J.-P.Zarski22, B. Hanslik23, V. de L\u00e9dinghen24, J. Denis25. 1 \u2013 Service [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[],"tags":[26],"class_list":["post-2024","post","type-post","status-publish","format-standard","hentry","tag-26"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Enqu\u00eate de pratique ALBU-LIVE sur l\u2019utilisation de l\u2019albumine humaine chez le patient cirrhotique en France: des r\u00e9sultats qui interrogent. - Abstracts des congr\u00e8s de l&#039;ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/enquete-de-pratique-albu-live-sur-lutilisation-de-lalbumine-humaine-chez-le-patient-cirrhotique-en-france-des-resultats-qui-interrogent\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Enqu\u00eate de pratique ALBU-LIVE sur l\u2019utilisation de l\u2019albumine humaine chez le patient cirrhotique en France: des r\u00e9sultats qui interrogent. - 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