Factors associated with hospital admission in hereditary angioedema attacks: a multicenter prospective study.
BACKGROUND
Acute attacks of hereditary angioedema are characterized by recurrent localized edema. These attacks can be life threatening and are associated with substantial morbidity and mortality.


OBJECTIVE
To determine factors associated with hospital admission of patients with an acute attack of hereditary angioedema presenting at the emergency department.


METHODS
This was a multicenter prospective observational study of consecutive patients (January 2011 through December 2013) experiencing an acute hereditary angioedema attack and presenting at the emergency department at 1 of 4 French reference centers for bradykinin-mediated angioedema. Attacks requiring hospital admission were compared with those not requiring admission.


RESULTS
Of 57 attacks in 29 patients, 17 (30%) led to hospital admission. In multivariate analysis, laryngeal and facial involvements were associated with hospital admission (odds ratio 18.6, 95% confidence interval 3.9-88; odds ratio 7.7, 95% confidence interval 1.4-43.4, respectively). Self-injection of icatibant at home was associated with non-admission (odds ratio 0.06, 95% confidence interval 0.01-0.61). The course was favorable in all 57 cases. No upper airway management was required.


CONCLUSIONS
Most patients attended the emergency department because they were running out of medication and did not know that emergency treatment could be self-administered. Risk factors associated with hospital admission were laryngeal and facial involvement, whereas self-injection of icatibant was associated with a return home.
Service des Urgences, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Université Paris 13, Bondy, France; SAMU-SMUR 93, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Groupe hospitalier Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Paris 13, Bobigny, France. Electronic address: nicolas.javaud@lmr.aphp.fr.
Nicolas
N
Javaud
Département d'Endocrinologie Gynécologique, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel Dieu, Université Paris 5, Paris, France.
Anne
A
Gompel
Service de Médecine Interne, Centre de Référence sur les angioedèmes à kinines (CRéAk), CHU de Grenoble, Grenoble, France.
Laurence
L
Bouillet
Service de Médecine Interne, Centre de Référence sur les angioedèmes à kinines (CRéAk), CHU de Grenoble, Grenoble, France.
Isabelle
I
Boccon-Gibod
Service des Urgences, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel Dieu, Université Paris 5, Paris, France.
Delphine
D
Cantin
Service des Urgences, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Université de Lille, CHRU de Lille, Lille, France.
Nadia
N
Smaiti
Service des Urgences, Centre de Référence sur les angioedèmes à kinines (CRéAk), CHU de Grenoble, Grenoble, France.
Françoise
F
Carpentier
Unité de Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Groupe hospitalier Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Paris 13, Bobigny, France.
Marouane
M
Boubaya
Service de Médecine Interne, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Université de Lille, CHRU de Lille, Lille, France.
David
D
Launay
Service des Urgences, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Université Paris 13, Bondy, France; SAMU-SMUR 93, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Groupe hospitalier Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Paris 13, Bobigny, France.
Frédéric
F
Adnet
Service de Médecine Interne, Centre de Référence associé sur les angioedèmes à kinines (CRéAk), Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Université Paris 13, Bondy, France.
Olivier
O
Fain
D000328:Adult; D054179:Angioedemas, Hereditary / Q000188:drug therapy* / Q000473:pathology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001920:Bradykinin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D065094:Bradykinin B2 Receptor Antagonists / Q000627:therapeutic use; D050718:Complement C1 Inhibitor Protein / Q000235:genetics; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D065094:Bradykinin B2 Receptor Antagonists; D050718:Complement C1 Inhibitor Protein; C065679:icatibant; D001920:Bradykinin