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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2015 ; 94
(45
): e1939
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gab.com Text
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English Wikipedia
Angioedema Related to Angiotensin-Converting Enzyme Inhibitors: Attack Severity,
Treatment, and Hospital Admission in a Prospective Multicenter Study
#MMPMID26559262
Javaud N
; Achamlal J
; Reuter PG
; Lapostolle F
; Lekouara A
; Youssef M
; Hamza L
; Karami A
; Adnet F
; Fain O
Medicine (Baltimore)
2015[Nov]; 94
(45
): e1939
PMID26559262
show ga
The number of cases of acquired angioedema related to angiotensin converting
enzyme inhibitors induced (ACEI-AAE) is on the increase, with a potential
concomitant increase in life-threatening attacks of laryngeal edema. Our
objective was to determine the main characteristics of ACEI-AAE attacks and, in
doing so, the factors associated with likelihood of hospital admission from the
emergency department (ED) after a visit for an attack.A prospective, multicenter,
observational study (April 2012-December 2014) was conducted in EDs of 4 French
hospitals in collaboration with emergency services (SAMU 93) and a reference
center for bradykinin-mediated angioedema. For each patient presenting with an
attack, emergency physicians collected demographic and clinical presentation
data, treatments, and clinical course. They recorded time intervals from symptom
onset to ED arrival and to treatment decision, from ED arrival to specific
treatment with plasma-derived C1-inhibitor (C1-INH) or icatibant, and from
specific treatment to onset of symptom relief. Attacks requiring hospital
admission were compared with those not requiring admission.Sixty-two eligible
patients with ACEI-AAE (56% men, median age 63 years) were included. Symptom
relief occurred significantly earlier in patients receiving specific treatment
than in untreated patients (0.5 [0.5-1.0] versus 3.9 [2.5-7.0] hours;
P?0.0001). Even though icatibant was injected more promptly than plasma-derived
C1-INH, there, however, was no significant difference in median time to onset of
symptom relief between the 2 drugs (0.5 [0.5-1.3] versus 0.5 [0.4-1.0] hours for
C1-INH and icatibant, respectively, P?=?0.49). Of the 62 patients, 27 (44%) were
admitted to hospital from the ED. In multivariate analysis, laryngeal involvement
and progressive swelling at ED arrival were independently associated with
admission (Odds ratio [95% confidence interval]?=?6.2 [1.3-28.2] and 5.9
[1.3-26.5], respectively). A favorable course was observed in all patients. Three
patients (5%) experienced a recurrence after angiotensin-converting enzyme
inhibitor discontinuation after a median follow-up of 18 (11-30) months.Two
severity criteria-laryngeal edema and the progression of the edema-were
independent factors associated with likelihood of hospital admission. Appropriate
specific treatments (plasma-derived C1-INH or icatibant) should be available in
EDs to prevent possibly life-threatening complications.