title: Bradykinin-mediated angioedema: factors associated with admission to an intensive care unit, a multicenter study.
abstract: OBJECTIVE
  Bradykinin-mediated angioedema is characterized by transient attacks of localized edema of subcutaneous or submucosal tissues and can be life-threatening when involving the upper airways. The aim of this study was to determine the features of acute attacks that might be associated with admission to an ICU.
  
  
  METHODS
  We carried out a retrospective, multicenter, observational study in consecutive patients attending one of six reference centers in France for acute bradykinin-mediated angioedema attacks. Patients had been hospitalized for an acute episode at least once previously. Acute attacks requiring ICU admission were compared with acute attacks that had not required ICU admission.
  
  
  RESULTS
  Overall, 118 acute attacks in 31 patients were analyzed (10 patients with hereditary angioedema, 19 patients with angiotensin-converting enzyme inhibitor-induced angioedema, and two patients with acquired C1-inhibitor deficiency angioedema). In multivariate analysis, upper airway involvement, corticosteroid, and C1-inhibitor concentrate administration were associated with ICU admission. Seven episodes (18%) needed airway protection. The evolution was favorable in 38 of 39 attacks warranting ICU admission: patients were able to get out of the service (mean ICU stay 4±5 days). One death was observed by asphyxiation because of laryngeal swelling.
  
  
  CONCLUSIONS
  Upper airway involvement is an independent risk factor for ICU admission. Corticosteroid use, which is an ineffective treatment, and C1-inhibitor concentrate use are factors for ICU admission. The presence of upper airway involvement should be a warning signal that the attack may be severe.
authors.affiliation: aEmergency Department bInternal Medicine, Reference Center for Angioedema (CRéAk), Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Groupe hospitalier Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Paris Bondy cSAMU-SMUR 93 dClinical Research Department, Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Groupe hospitalier Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Paris Bobigny eDepartment of Anesthesiology and Intensive care Unit fInternal Medicine, Reference Center for Angioedema (CRéAk), Hôpital Edouard-Herriot, Hospices civils de Lyon gInternal Medicine, Reference Center for Angioedema (CRéAk), CHU de Grenoble, Grenoble hDepartment of Dermatology iIntensive Care Unit, Reference Center for Angioedema (CRéAk), UNAM Université, Hôpital d'Angers, Cedex jDepartment of Dermatology, Reference Center for Angioedema (CRéAk), CHU Gabriel-Montpied, Clermont-Ferrand kInternal Medicine, Centre Hospitalier du Centre de Bretagne, Pontivy lInternal Medicine, CHU de Caen, Caen, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Javaud
authors.forename: Bernard
authors.initials: B
authors.lastname: Floccard
authors.forename: Florian
authors.initials: F
authors.lastname: Gontier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lapostolle
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boccon-Gibod
authors.forename: Ludovic
authors.initials: L
authors.lastname: Martin
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Amarger
authors.forename: Abdalia
authors.initials: A
authors.lastname: Boumedienne
authors.forename: Marouane
authors.initials: M
authors.lastname: Boubaya
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.forename: Brigitte
authors.initials: B
authors.lastname: Coppere
authors.forename: Yann
authors.initials: Y
authors.lastname: Ollivier
authors.forename: Laurence
authors.initials: L
authors.lastname: Bouillet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Adnet
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000328:Adult; D000368:Aged; D000799:Angioedema / Q000209:etiology / Q000628:therapy*; D054179:Angioedemas, Hereditary / Q000209:etiology / Q000628:therapy; D001920:Bradykinin / Q000502:physiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001920:Bradykinin