Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Recherche de profils de candidats à risque par calcul de regroupement flou relationnel

International audienceThis article proposes to study answer profiles of candidates in the results of the selection contest for student pilots. The aim is to extract risky profiles that match the profiles of candidates who previously failed the practical training. To extract these profiles, data mining tools are used.We also use a new form of fuzzy clustering in order to measure the relevance of such profiles.Cet article propose d'étudier les profils de réponses des candidats aux tests du concours des ´ Elèves Pilotes de Ligne de l'ENAC afin d'extraire les profils à risque qui correspondent à des profils des candidats qui ont précédemment échoué lors de la formation pratique. Pour extraire ces profils, des outils de fouille de données sont utilisés. De plus, on utilise une nouvelle technique de classification floue afin de mesurer la pertinence de tels profils

Recherche de profils de candidats à risque par calcul de regroupement flou relationnel

International audienceThis article proposes to study answer profiles of candidates in the results of the selection contest for student pilots. The aim is to extract risky profiles that match the profiles of candidates who previously failed the practical training. To extract these profiles, data mining tools are used.We also use a new form of fuzzy clustering in order to measure the relevance of such profiles.Cet article propose d'étudier les profils de réponses des candidats aux tests du concours des ´ Elèves Pilotes de Ligne de l'ENAC afin d'extraire les profils à risque qui correspondent à des profils des candidats qui ont précédemment échoué lors de la formation pratique. Pour extraire ces profils, des outils de fouille de données sont utilisés. De plus, on utilise une nouvelle technique de classification floue afin de mesurer la pertinence de tels profils

Recherche de profils de candidats à risque par calcul de regroupement flou relationnel

International audienceThis article proposes to study answer profiles of candidates in the results of the selection contest for student pilots. The aim is to extract risky profiles that match the profiles of candidates who previously failed the practical training. To extract these profiles, data mining tools are used.We also use a new form of fuzzy clustering in order to measure the relevance of such profiles.Cet article propose d'étudier les profils de réponses des candidats aux tests du concours des ´ Elèves Pilotes de Ligne de l'ENAC afin d'extraire les profils à risque qui correspondent à des profils des candidats qui ont précédemment échoué lors de la formation pratique. Pour extraire ces profils, des outils de fouille de données sont utilisés. De plus, on utilise une nouvelle technique de classification floue afin de mesurer la pertinence de tels profils

Approche des forçages anthropo-climatiques des paysages protohistoriques du plateau de Corent (Auvergne) et de ses marges par l’analyse de registres sédimentaires palustres complémentaires

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Approche des forçages anthropo-climatiques des paysages protohistoriques du plateau de Corent (Auvergne) et de ses marges par l’analyse de registres sédimentaires palustres complémentaires

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An integrated geoarchaeological approach to assess human forcing on landscape : evolution of an Iron Age oppidum (Auvergne, France)

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An integrated geoarchaeological approach to assess human forcing on landscape: evolution of an Iron Age oppidum (Auvergne, France)

International audienc

An integrated geoarchaeological approach to assess human forcing on landscape : evolution of an Iron Age oppidum (Auvergne, France)

International audienc