Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study
Identifieur interne : 004753 ( Main/Exploration ); précédent : 004752; suivant : 004754Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study
Auteurs : James S. Krinsley [États-Unis] ; Moritoki Egi [Japon] ; Alex Kiss [Canada] ; Amin N. Devendra [États-Unis] ; Philipp Schuetz [Suisse] ; Paula M. Maurer [États-Unis] ; Marcus J. Schultz [Pays-Bas] ; Roosmarijn Tm Van Hooijdonk [Pays-Bas] ; Morita Kiyoshi [Japon] ; Iain Mj Mackenzie [Royaume-Uni] ; Djillali Annane [France] ; Peter Stow [Australie] ; Stanley A. Nasraway [États-Unis] ; Sharon Holewinski [États-Unis] ; Ulrike Holzinger [Autriche] ; Jean-Charles Preiser [Belgique] ; Jean-Louis Vincent [Belgique] ; Rinaldo Bellomo [Australie]Source :
- Critical Care [ 1364-8535 ] ; 2013.
Abstract
Hyperglycemia, hypoglycemia, and increased glycemic variability have each been independently associated with increased risk of mortality in critically ill patients. The role of diabetic status on modulating the relation of these three domains of glycemic control with mortality remains uncertain. The purpose of this investigation was to determine how diabetic status affects the relation of hyperglycemia, hypoglycemia, and increased glycemic variability with the risk of mortality in critically ill patients.
This is a retrospective analysis of prospectively collected data involving 44,964 patients admitted to 23 intensive care units (ICUs) from nine countries, between February 2001 and May 2012. We analyzed mean blood glucose concentration (BG), coefficient of variation (CV), and minimal BG and created multivariable models to analyze their independent association with mortality. Patients were stratified according to the diagnosis of diabetes.
Among patients without diabetes, mean BG bands between 80 and 140 mg/dl were
independently associated with decreased risk of mortality, and mean BG bands
Although hyperglycemia, hypoglycemia, and increased glycemic variability is each independently associated with mortality in critically ill patients, diabetic status modulates these relations in clinically important ways. Our findings suggest that patients with diabetes may benefit from higher glucose target ranges than will those without diabetes. Additionally, hypoglycemia is independently associated with increased risk of mortality regardless of the patient's diabetic status, and increased glycemic variability is independently associated with increased risk of mortality among patients without diabetes.
See related commentary by Krinsley,
See related commentary by Finfer and Billot,
Url:
DOI: 10.1186/cc12547
PubMed: 23452622
PubMed Central: 3733432
Affiliations:
- Australie, Autriche, Belgique, Canada, France, Japon, Pays-Bas, Royaume-Uni, Suisse, États-Unis
- Angleterre, Floride, Hollande-Septentrionale, Massachusetts, Midlands de l'Ouest, Ontario, Vienne (Autriche), Île-de-France
- Amsterdam, Birmingham, Garches, Toronto, Vienne (Autriche)
- Université de Toronto
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mortality in critically ill patients: an international multicenter cohort study</title><author><name sortKey="Krinsley, James S" sort="Krinsley, James S" uniqKey="Krinsley J" first="James S" last="Krinsley">James S. Krinsley</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Critical Care, Stamford Hospital and Columbia University College of Physicians and Surgeons, 190 West Broad Street, Stamford, CT, 06902, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Critical Care, Stamford Hospital and Columbia University College of Physicians and Surgeons, 190 West Broad Street, Stamford, CT, 06902</wicri:regionArea><wicri:noRegion>06902</wicri:noRegion></affiliation></author><author><name sortKey="Egi, Moritoki" sort="Egi, Moritoki" uniqKey="Egi M" first="Moritoki" last="Egi">Moritoki Egi</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikatachou, Okayama, 700-8525, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikatachou, Okayama, 700-8525</wicri:regionArea><wicri:noRegion>700-8525</wicri:noRegion></affiliation></author><author><name sortKey="Kiss, Alex" sort="Kiss, Alex" uniqKey="Kiss A" first="Alex" last="Kiss">Alex Kiss</name><affiliation wicri:level="4"><nlm:aff id="I3">Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M6, Ontario, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M6, Ontario</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Devendra, Amin N" sort="Devendra, Amin N" uniqKey="Devendra A" first="Amin N" last="Devendra">Amin N. Devendra</name><affiliation wicri:level="2"><nlm:aff id="I4">Medical/Surgical Intensive Care Unit, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL 33756, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical/Surgical Intensive Care Unit, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL 33756</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Schuetz, Philipp" sort="Schuetz, Philipp" uniqKey="Schuetz P" first="Philipp" last="Schuetz">Philipp Schuetz</name><affiliation wicri:level="1"><nlm:aff id="I5">Privat Dozent for Endocrinology and Internal Medicine, Medical University Department, Kantonsspital Aarau, Tellstrasse CH -5001 Aarau, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Privat Dozent for Endocrinology and Internal Medicine, Medical University Department, Kantonsspital Aarau, Tellstrasse CH -5001 Aarau</wicri:regionArea><wicri:noRegion>Tellstrasse CH -5001 Aarau</wicri:noRegion></affiliation></author><author><name sortKey="Maurer, Paula M" sort="Maurer, Paula M" uniqKey="Maurer P" first="Paula M" last="Maurer">Paula M. Maurer</name><affiliation wicri:level="2"><nlm:aff id="I6">BayCare Health Systems, 300 Pinellas Street, Clearwater, FL 33756, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>BayCare Health Systems, 300 Pinellas Street, Clearwater, FL 33756</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Schultz, Marcus J" sort="Schultz, Marcus J" uniqKey="Schultz M" first="Marcus J" last="Schultz">Marcus J. Schultz</name><affiliation wicri:level="3"><nlm:aff id="I7">Department of Intensive Care, Academic Medical Center, Meibergrdeef 9, 1105AZ, Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Intensive Care, Academic Medical Center, Meibergrdeef 9, 1105AZ, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Van Hooijdonk, Roosmarijn Tm" sort="Van Hooijdonk, Roosmarijn Tm" uniqKey="Van Hooijdonk R" first="Roosmarijn Tm" last="Van Hooijdonk">Roosmarijn Tm Van Hooijdonk</name><affiliation wicri:level="3"><nlm:aff id="I7">Department of Intensive Care, Academic Medical Center, Meibergrdeef 9, 1105AZ, Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Intensive Care, Academic Medical Center, Meibergrdeef 9, 1105AZ, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Kiyoshi, Morita" sort="Kiyoshi, Morita" uniqKey="Kiyoshi M" first="Morita" last="Kiyoshi">Morita Kiyoshi</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikatachou, Okayama, 700-8525, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikatachou, Okayama, 700-8525</wicri:regionArea><wicri:noRegion>700-8525</wicri:noRegion></affiliation></author><author><name sortKey="Mackenzie, Iain Mj" sort="Mackenzie, Iain Mj" uniqKey="Mackenzie I" first="Iain Mj" last="Mackenzie">Iain Mj Mackenzie</name><affiliation wicri:level="3"><nlm:aff id="I8">Department of Anesthesia and Critical Care Medicine, University Hospital Birmingham NHS, Mindelsohn Way, Edgbaston, B15 2WB, Birmingham, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Anesthesia and Critical Care Medicine, University Hospital Birmingham NHS, Mindelsohn Way, Edgbaston, B15 2WB, Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author><author><name sortKey="Annane, Djillali" sort="Annane, Djillali" uniqKey="Annane D" first="Djillali" last="Annane">Djillali Annane</name><affiliation wicri:level="3"><nlm:aff id="I9">Critical Care Department, Service de Réanimation, Hopital Raymond Poincaré, Université de Versailles SQY, 104 Boulevard Raymond Poincare, 92830, Garches, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Critical Care Department, Service de Réanimation, Hopital Raymond Poincaré, Université de Versailles SQY, 104 Boulevard Raymond Poincare, 92830, Garches</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Garches</settlement></placeName></affiliation></author><author><name sortKey="Stow, Peter" sort="Stow, Peter" uniqKey="Stow P" first="Peter" last="Stow">Peter Stow</name><affiliation wicri:level="1"><nlm:aff id="I10">Intensive Care Unit, The Geelong Hospital, Barwon Health, Ryrie Street, Geelong, Victoria, 3220, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Intensive Care Unit, The Geelong Hospital, Barwon Health, Ryrie Street, Geelong, Victoria, 3220</wicri:regionArea><wicri:noRegion>3220</wicri:noRegion></affiliation></author><author><name sortKey="Nasraway, Stanley A" sort="Nasraway, Stanley A" uniqKey="Nasraway S" first="Stanley A" last="Nasraway">Stanley A. Nasraway</name><affiliation wicri:level="2"><nlm:aff id="I11">Surgical Intensive Care Units, Tufts Medical Center, 800 Washington Street, NEMC 4360, Boston, MA 02111, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Surgical Intensive Care Units, Tufts Medical Center, 800 Washington Street, NEMC 4360, Boston, MA 02111</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Holewinski, Sharon" sort="Holewinski, Sharon" uniqKey="Holewinski S" first="Sharon" last="Holewinski">Sharon Holewinski</name><affiliation wicri:level="2"><nlm:aff id="I11">Surgical Intensive Care Units, Tufts Medical Center, 800 Washington Street, NEMC 4360, Boston, MA 02111, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Surgical Intensive Care Units, Tufts Medical Center, 800 Washington Street, NEMC 4360, Boston, MA 02111</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Holzinger, Ulrike" sort="Holzinger, Ulrike" uniqKey="Holzinger U" first="Ulrike" last="Holzinger">Ulrike Holzinger</name><affiliation wicri:level="3"><nlm:aff id="I12">Medical Intensive Care Unit, Department of Medicine III, Division of Gastroenterology and Hepatology, ICU 13H1, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria</nlm:aff><country xml:lang="fr">Autriche</country><wicri:regionArea>Medical Intensive Care Unit, Department of Medicine III, Division of Gastroenterology and Hepatology, ICU 13H1, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement></placeName></affiliation></author><author><name sortKey="Preiser, Jean Charles" sort="Preiser, Jean Charles" uniqKey="Preiser J" first="Jean-Charles" last="Preiser">Jean-Charles Preiser</name><affiliation wicri:level="3"><nlm:aff id="I13">Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, 1070, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, 1070</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement></placeName></affiliation></author><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="3"><nlm:aff id="I13">Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, 1070, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, 1070</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement></placeName></affiliation></author><author><name sortKey="Bellomo, Rinaldo" sort="Bellomo, Rinaldo" uniqKey="Bellomo R" first="Rinaldo" last="Bellomo">Rinaldo Bellomo</name><affiliation wicri:level="1"><nlm:aff id="I14">Department of Intensive Care, Austin Hospital and Monash University, Studley Road, Heidelberg, Victoria, 3084, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Intensive Care, Austin Hospital and Monash University, Studley Road, Heidelberg, Victoria, 3084</wicri:regionArea><wicri:noRegion>3084</wicri:noRegion></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Hyperglycemia, hypoglycemia, and increased glycemic variability have each been
independently associated with increased risk of mortality in critically ill
patients. The role of diabetic status on modulating the relation of these three
domains of glycemic control with mortality remains uncertain. The purpose of this
investigation was to determine how diabetic status affects the relation of
hyperglycemia, hypoglycemia, and increased glycemic variability with the risk of
mortality in critically ill patients.</p></sec><sec><title>Methods</title><p>This is a retrospective analysis of prospectively collected data involving 44,964
patients admitted to 23 intensive care units (ICUs) from nine countries, between
February 2001 and May 2012. We analyzed mean blood glucose concentration (BG),
coefficient of variation (CV), and minimal BG and created multivariable models to
analyze their independent association with mortality. Patients were stratified
according to the diagnosis of diabetes.</p></sec><sec><title>Results</title><p>Among patients without diabetes, mean BG bands between 80 and 140 mg/dl were
independently associated with decreased risk of mortality, and mean BG bands
<underline>></underline>140 mg/dl, with increased risk of mortality. Among patients with
diabetes, mean BG from 80 to 110 mg/dl was associated with increased risk of
mortality and mean BG from 110 to 180 mg/dl with decreased risk of mortality. An
effect of center was noted on the relation between mean BG and mortality.
Hypoglycemia, defined as minimum BG <70 mg/dl, was independently associated
with increased risk of mortality among patients with and without diabetes and
increased glycemic variability, defined as CV <underline>></underline>20%, was independently
associated with increased risk of mortality only among patients without diabetes.
Derangements of more than one domain of glycemic control had a cumulative
association with mortality, especially for patients without diabetes.</p></sec><sec><title>Conclusions</title><p>Although hyperglycemia, hypoglycemia, and increased glycemic variability is each
independently associated with mortality in critically ill patients, diabetic
status modulates these relations in clinically important ways. Our findings
suggest that patients with diabetes may benefit from higher glucose target ranges
than will those without diabetes. Additionally, hypoglycemia is independently
associated with increased risk of mortality regardless of the patient's diabetic
status, and increased glycemic variability is independently associated with
increased risk of mortality among patients without diabetes.</p><p>See related commentary by Krinsley,
<ext-link ext-link-type="uri" xlink:href="http://ccforum.com/content/17/2/131">http://ccforum.com/content/17/2/131</ext-link></p><p>See related commentary by Finfer and Billot,
<ext-link ext-link-type="uri" xlink:href="http://ccforum.com/content/17/2/134">http://ccforum.com/content/17/2/134</ext-link></p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Dungan, Km" uniqKey="Dungan K">KM Dungan</name></author><author><name sortKey="Braithwaite, Ss" uniqKey="Braithwaite S">SS Braithwaite</name></author><author><name sortKey="Preiser, Jc" uniqKey="Preiser J">JC Preiser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Krinsley, Js" uniqKey="Krinsley J">JS Krinsley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Falciglia, M" uniqKey="Falciglia M">M Falciglia</name></author><author><name sortKey="Freyberg, Rw" uniqKey="Freyberg R">RW Freyberg</name></author><author><name sortKey="Almenoff, Pl" uniqKey="Almenoff P">PL Almenoff</name></author><author><name sortKey="D Alessio, Da" uniqKey="D Alessio D">DA 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Watada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Risso, A" uniqKey="Risso A">A Risso</name></author><author><name sortKey="Mercuri, F" uniqKey="Mercuri F">F Mercuri</name></author><author><name sortKey="Quagliaro, L" uniqKey="Quagliaro L">L Quagliaro</name></author><author><name sortKey="Damante, G" uniqKey="Damante G">G Damante</name></author><author><name sortKey="Ceriello, A" uniqKey="Ceriello A">A Ceriello</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Qaseem, A" uniqKey="Qaseem A">A Qaseem</name></author><author><name sortKey="Humphrey, Ll" uniqKey="Humphrey L">LL Humphrey</name></author><author><name sortKey="Chou, R" uniqKey="Chou R">R Chou</name></author><author><name sortKey="Snow, V" uniqKey="Snow V">V Snow</name></author><author><name sortKey="Shekelle, P" uniqKey="Shekelle P">P Shekelle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Joseph, Ji" uniqKey="Joseph J">JI Joseph</name></author><author><name sortKey="Hipszer, B" uniqKey="Hipszer B">B Hipszer</name></author><author><name sortKey="Mraovic, B" uniqKey="Mraovic B">B Mraovic</name></author><author><name sortKey="Chervoneva, I" uniqKey="Chervoneva I">I Chervoneva</name></author><author><name sortKey="Joseph, M" uniqKey="Joseph M">M Joseph</name></author><author><name sortKey="Grunwald, Z" uniqKey="Grunwald Z">Z Grunwald</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Australie</li><li>Autriche</li><li>Belgique</li><li>Canada</li><li>France</li><li>Japon</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Floride</li><li>Hollande-Septentrionale</li><li>Massachusetts</li><li>Midlands de l'Ouest</li><li>Ontario</li><li>Vienne (Autriche)</li><li>Île-de-France</li></region><settlement><li>Amsterdam</li><li>Birmingham</li><li>Garches</li><li>Toronto</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="États-Unis"><noRegion><name sortKey="Krinsley, James S" sort="Krinsley, James S" uniqKey="Krinsley J" first="James S" last="Krinsley">James S. Krinsley</name></noRegion><name sortKey="Devendra, Amin N" sort="Devendra, Amin N" uniqKey="Devendra A" first="Amin N" last="Devendra">Amin N. Devendra</name><name sortKey="Holewinski, Sharon" sort="Holewinski, Sharon" uniqKey="Holewinski S" first="Sharon" last="Holewinski">Sharon Holewinski</name><name sortKey="Maurer, Paula M" sort="Maurer, Paula M" uniqKey="Maurer P" first="Paula M" last="Maurer">Paula M. Maurer</name><name sortKey="Nasraway, Stanley A" sort="Nasraway, Stanley A" uniqKey="Nasraway S" first="Stanley A" last="Nasraway">Stanley A. Nasraway</name></country><country name="Japon"><noRegion><name sortKey="Egi, Moritoki" sort="Egi, Moritoki" uniqKey="Egi M" first="Moritoki" last="Egi">Moritoki Egi</name></noRegion><name sortKey="Kiyoshi, Morita" sort="Kiyoshi, Morita" uniqKey="Kiyoshi M" first="Morita" last="Kiyoshi">Morita Kiyoshi</name></country><country name="Canada"><region name="Ontario"><name sortKey="Kiss, Alex" sort="Kiss, Alex" uniqKey="Kiss A" first="Alex" last="Kiss">Alex Kiss</name></region></country><country name="Suisse"><noRegion><name sortKey="Schuetz, Philipp" sort="Schuetz, Philipp" uniqKey="Schuetz P" first="Philipp" last="Schuetz">Philipp Schuetz</name></noRegion></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Schultz, Marcus J" sort="Schultz, Marcus J" uniqKey="Schultz M" first="Marcus J" last="Schultz">Marcus J. Schultz</name></region><name sortKey="Van Hooijdonk, Roosmarijn Tm" sort="Van Hooijdonk, Roosmarijn Tm" uniqKey="Van Hooijdonk R" first="Roosmarijn Tm" last="Van Hooijdonk">Roosmarijn Tm Van Hooijdonk</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Mackenzie, Iain Mj" sort="Mackenzie, Iain Mj" uniqKey="Mackenzie I" first="Iain Mj" last="Mackenzie">Iain Mj Mackenzie</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Annane, Djillali" sort="Annane, Djillali" uniqKey="Annane D" first="Djillali" last="Annane">Djillali Annane</name></region></country><country name="Australie"><noRegion><name sortKey="Stow, Peter" sort="Stow, Peter" uniqKey="Stow P" first="Peter" last="Stow">Peter Stow</name></noRegion><name sortKey="Bellomo, Rinaldo" sort="Bellomo, Rinaldo" uniqKey="Bellomo R" first="Rinaldo" last="Bellomo">Rinaldo Bellomo</name></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Holzinger, Ulrike" sort="Holzinger, Ulrike" uniqKey="Holzinger U" first="Ulrike" last="Holzinger">Ulrike Holzinger</name></region></country><country name="Belgique"><region name="Vienne (Autriche)"><name sortKey="Preiser, Jean Charles" sort="Preiser, Jean Charles" uniqKey="Preiser J" first="Jean-Charles" last="Preiser">Jean-Charles Preiser</name></region><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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