P Jaquet1, E de Montmollin1,2, C Dupuis1,2, C Sazio3, M Conrad4, V Susset5, S Demeret6, J M Tadie7, L Argaud8, F Barbier9, B Sarton10, R Chabane11, D Daubin12, N Brulé13, N Lerolle14, M Alves15, D Da Silva16, A El Kalioubi17, S Silva10, P Bailly18, M Wolff1, L Bouadma1,2, J F Timsit1,2, R Sonneville19,20. 1. Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France. 2. UMR 1137, IAME, Paris Diderot University, Paris, France. 3. Medical Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France. 4. Medical Intensive Care Unit, Central Hospital, Nancy University Hospitals, Nancy, France. 5. Polyvalent Intensive Care Unit, Chambery Hospital, Chambery, France. 6. Neurologic Intensive Care Unit, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France. 7. Medical Intensive Care Unit, Pontchaillou University Hospital, Rennes, France. 8. Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France. 9. Medical Intensive Care Unit, La Source Hospital, Orléans, France. 10. Intensive Care Unit, Purpan University Hospital, Toulouse, France. 11. Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 12. Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France. 13. Medical Intensive Care Unit, Nantes University Hospital, Nantes, France. 14. Medical Intensive Care Unit, CHU Angers, Angers University Hospital, Angers, France. 15. Polyvalent Intensive Care Unit, Poissy-Saint-Germain-en-Laye Hospital, Poissy, France. 16. Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France. 17. Medical Intensive Care Unit, Roger Salengro University Hospital, Lille, France. 18. Medical Intensive Care Unit, La Cavale Blanche University Hospital, Brest, France. 19. Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France. romain.sonneville@aphp.fr. 20. UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France. romain.sonneville@aphp.fr.
Abstract
PURPOSE: We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS: We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS: Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS: In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.
PURPOSE: We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS: We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS: Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS: In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.
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Authors: Benjamine Sarton; Pierre Jaquet; Djida Belkacemi; Etienne de Montmollin; Fabrice Bonneville; Charline Sazio; Aurelien Frérou; Marie Conrad; Delphine Daubin; Russell Chabanne; Laurent Argaud; Frédéric Dailler; Noëlle Brulé; Nicolas Lerolle; Quentin Maestraggi; Julien Marechal; Pierre Bailly; Keyvan Razazi; Francois Mateos; Bertrand Guidet; Albrice Levrat; Vincent Susset; Alexandre Lautrette; Jean-Paul Mira; Ahmed El Kalioubie; Alexandre Robert; Alexandre Massri; Jean François Albucher; Jean Marc Olivot; Jean Marie Conil; Lila Boudma; Jean-François Timsit; Romain Sonneville; Stein Silva Journal: JAMA Netw Open Date: 2021-07-01