AV¶ÌÊÓƵ

Frequent Conditions in Internal Medicine

Research subjects

Several conditions are highly prevalent in internal medicine (IM) inpatients and require continuous improvement in their management. Heart failure (HF), thrombosis-associated disorders and pneumomia are three major themes of clinical or translational research in our team.  Risk prediction, a historical landmark in the division of IM is perpetuated in these areas. Lastly, we have developed a line of training and clinical research for point of care ultranosography (POCUS) that is currently reaching a long-awaited implementation in internal medicine along with a structured assessment of the added values of POCUS for the diagnosis and management of the aforementioned conditions.

1.       Heart failure led by Prof Sebastian Carballo, in collaboration with Prof Jérôme Stirnemann and Prof Nicolas Garin (part time 20% in our division): Acute and decompensated HF is one the syndromes leading to the most hospalizations. Management of these patients is often challenging and improvements are needed to improve clinical outcomes, decrease lengths of stay and re-admissions. A better understanding of HF phenotypes (reduced or preserved ejection fraction) is also a major challenge.

Current projects include a large prospective cohort study () including 1’000 patients hospitalized with decompensated HF, with a detailed clinical phenotype and a biobank,and a 5 year follow-up.

2.       Thrombosis and antithrombotics led by Prof Jean-Luc Reny, in collaboration with Dr Pauline Darbellay-Farhoumand, Dr  Chrisotphe Marti, and Dr Jean Terrier) : Thrombosis-associated disorders are by themselves the leading cause of death in high- and middle income countries. Antithrombotic drugs are also a leading cause of adverse events and hospitalisations.

The following topics are addressed:

a.       A meta-analysis approach regarding the management of anticoagulants and thrombolytics and risk stratification alowing the generation of important data for guidelines on pulmonary embolism (PE), in cancer associated thrombosis and recently in thromboprohpylaxis. These specific topics are coordinated by Dr Christophe Marti, in relation with the Evidence Based Medicine group.

b.       Risk prediction for VTE and thromboprophylaxis (TPX) in IM patients: we collaborate to two observational studies on the validation of existing scores (multicentric RISE study ) and a local TPX study to implement an automated prescription aid for medical thromboprophylaxis. These projects are locally led by Dr Pauline Darbellay-Farhoumand in collaboration with external research groups

c.        Antithrombotic drugs: Prof JL Reny’s line of translational research on the study on antiplatelet drug response (see the Geneva Platelet Group /GenevaPlateletGroup/home/) has extended with the development of new models (physiologically based pharmacokinetic – PBPK- and population pharmacokinetic – PopPK – models) for the prediction of drug exposure for direct oral anticoagulants and P2Y12 inhibitors in hospitalized patients (OptimAT study, ). Dr Jean Terrier will be taking the lead on this topic.

d.       Thrombotic risk in patients with nephrotic syndrome: will better pathophysiological insight improve current predictive tools ? by Prof T. Mavrakanas and Dr J Terrier in collaboration with the nephrology division at HUG and Mc Gill in Montreal (T Mavrakanas transferred to McGill in December 2020 as assistant professor). Inclusions in this study have been completed and analyses are ongoing.

3.       Respiratory conditions led by Prof Jérôme Stirnemann in collaboration with Prof Nicolas Garin and Dr Anne Rossel : Pneumonia and chronic obstructive pulmonrary disease are among our top diagnosis in IM.

The Following topics are addressed:

a.       The PneumOld-CT trial () showed the added value of low dose lung CT for the diagnosis of pneumonia. The Octoplus IICT (supported by the SNSF) addresses the comparative diagnostic strategies based on chest X-Rays, chest CT scan and POCUS.

b.        Research on COPD is starting here and is coordinated by Anne Rossel, IM and intensive care physician who developed competencies in this fields during a research and clinical stay in London. This research is conducted in collaboration with the pneumonology and intensive care divisions.

4.       POCUS led by Dr Olivier Grosgurin in collaboration with Dr Antonio Leidi: this subgroup has built a structured post-graduate training dedicated to Point-Of-Care UltraSonography for our physicians in training and certified IM physicians. They have performed a prospective study on the validation of simplifed POCUS evaluation of B-lines in acute heart failure (Pre-Icar-US study, ) providing data for the multicentric Icar-US RCT that will start at the end of 2024.

5.       COVID-19 led by Dr Christophe Marti for local studies conducted within the intermediate care unit, the IM division and the hospital in collaboration with several other investigators from the IM division. International research and guidelines on COVID-19 are addressed in the EBM research group led by Prof Thomas Agoritsas.

Bibliometric data according to the Google Scholar (reference source for UNIGE)

A common group for the division of IM has been created, , covering all three research groups, including the present one. As members of this “frequent conditions in IM” can also collaborate in the two other research group of IM this common SMIG group allows a direct access to each individual investigator.

Current funding

R&D hospital program; SGAIM foundation; SSC ;  AV¶ÌÊÓƵ of Manchester; SNSF; IM private funding; HUG Private foundation

Collaborations : there is an intense internal collaobaration among  all investigators of this subgroup and the other two research groups in internal medicine. Other formal collaborations are local with several HUG divisions (angiology and hemostasis, pharmacology, infectious diseases, cardiology…), national (CHUV, UNIL, Inselspital, Rennaz, Lugano…) and International (U Manchester, U Rhode Island, U McGill, U Ottawa)

Selected relevant publications for each of the 5 sub-aereas

1.        Heart Failure : Prognostic Value of the Echocardiographic Probability of Pulmonary Hypertension in Patients with Acute Decompensated Heart Failure. Carballo S, Musso P, Garin N, Müller H, Serratrice J, Mach F, Carballo D, Stirnemann J. J Clin Med. 2019 Oct 15;8(10):1684.

2.        Thrombosis : Terrier, J., F. Gaspar, P. Gosselin, O. Raboud, C. Lenoir, V. Rollason, C. Csajka, C. Samer, P. Fontana, Y. Daali, and J. L. Reny. 2023. 'Apixaban and rivaroxaban's physiologically-based pharmacokinetic model validation in hospitalized patients: A first step for larger use of a priori modeling approach at bed side', CPT Pharmacometrics Syst Pharmacol, 12: 1872-83.

3.        Thrombosis : Mottier, D., P. Girard, F. Couturaud, K. Lacut, E. Le Moigne, N. Paleiron, D. Guellec, O. Sanchez, V. Cogulet, S. Laporte, G. Marhic, P. Mismetti, E. Presles, H. Robert-Ebadi, I. Mahe, L. Plaisance, J. L. Reny, P. Darbellay Farhoumand, C. Cuvelier, C. Le Henaff, Y. Lambert, M. Danguy des Deserts, C. Rousseau Legrand, S. Boutreux, Y. Bleher, R. Decours, A. Trinh-Duc, G. Armengol, Y. Benhamou, A. Daumas, S. L. Guyot, H. De Carvalho, B. Lamia, M. Righini, G. Meyer, and G. Le Gal. 2023. 'Enoxaparin versus Placebo to Prevent Symptomatic Venous Thromboembolism in Hospitalized Older Adult Medical Patients', NEJM Evid, 2: EVIDoa2200332.

4.        Pneumonia : Prendki, V., M. Scheffler, B. Huttner, N. Garin, F. Herrmann, J. P. Janssens, C. Marti, S. Carballo, X. Roux, C. Serratrice, J. Serratrice, T. Agoritsas, C. D. Becker, L. Kaiser, S. Rosset-Zufferey, V. Soulier, A. Perrier, J. L. Reny, X. Montet and J. Stirnemann (2018). "Low-dose computed tomography for the diagnosis of pneumonia in elderly patients: a prospective, interventional cohort study." Eur Respir J 51(5).

5.        Pneumonia: Garin, N., D. Genne, S. Carballo, C. Chuard, G. Eich, O. Hugli, O. Lamy, M. Nendaz, P. A. Petignat, T. Perneger, O. Rutschmann, L. Seravalli, S. Harbarth, and A. Perrier. 2014. 'beta-Lactam monotherapy vs beta-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial', JAMA Intern Med, 174: 1894-901.

6.        POCUS : Leidi, A., G. Soret, T. Mann, F. Koegler, M. Coen, A. Leszek, L. Dubouchet, A. Guillermin, M. Kaddour, F. Rouyer, C. Combescure, S. Carballo, J. L. Reny, C. Marti, J. Stirnemann, and O. Grosgurin. 2022. 'Eight versus 28-point lung ultrasonography in moderate acute heart failure: a prospective comparative study', Intern Emerg Med, 17: 1375-83.

7.        COVID-19 : Martin, J., C. Gaudet-Blavignac, C. Lovis, J. Stirnemann, O. Grosgurin, A. Leidi, A. Gayet-Ageron, A. Iten, S. Carballo, J. L. Reny, P. Darbellay-Fahroumand, A. Berner, and C. Marti. 2022. 'Comparison of prognostic scores for inpatients with COVID-19: a retrospective monocentric cohort study', BMJ Open Respir Res, 9.