Arnaud-Félix Miailhe1, Emmanuelle Mercier2, Adel Maamar3, Jean-Claude Lacherade4, Aurélie Le Thuaut5, Aurélie Gaultier5, Pierre Asfar6, Laurent Argaud7, Antoine Ausseur8, Adel Ben Salah9, Vlad Botoc10, Karim Chaoui11, Julien Charpentier12, Christophe Cracco13, Nicolas De Prost14, Marie-Line Eustache15, Alexis Ferré16, Elena Gauvin17, Suzanne Goursaud18, Maximilien Grall19, Philippe Guiot20, Maud Jonas21, Fabien Lambiotte22, Mickael Landais23, Jérémie Lemarié24,25,26, Olivier Lesieur27, Claire Lhommet28, Philippe Michel29, Yannick Monseau30, Sébastien Moschietto31, Saad Nseir32,33, David Osman34, Jérome Pillot35, Gaël Piton36, Nicholas Sedillot37, Michel Sirodot38, Didier Thevenin39, Lara Zafrani40, Yoann Zerbib41, Pascale Bourhy42, Jean-Baptiste Lascarrou1, Jean Reignier43,44,45. 1. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. 2. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP network, Tours, France. 3. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France. 4. Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France. 5. Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France. 6. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France. 7. Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 8. Service de Réanimation polyvalente, Centre Hospitalier de Cholet, Cholet, France. 9. Service de Réanimation polyvalente, Centre Hospitalier de Chartres, Chartres, France. 10. Service de Réanimation et surveillance continue, Centre Hospitalier de Saint Malo, Saint-Malo, France. 11. Service de Réanimation polyvalente, Centre Hospitalier de Cahors, Cahors, France. 12. Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France. 13. Service de réanimation polyvalente et surveillance continue, Centre Hospitalier d'Angoulême, Angoulême, France. 14. Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France. 15. Service de Réanimation polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France. 16. Service de Réanimation médico-chirurgicale, Centre hospitalier de Versailles, site André Mignot, Le Chesnay, France. 17. Service de Réanimation polyvalente, Centre Hospitalier de Niort, Niort, France. 18. Service de Réanimation médicale, Centre Hospitalier Universitaire de Caen, Caen, France. 19. Service de Réanimation médicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France. 20. Service de réanimation médicale, GHRMSA, Mulhouse, France. 21. Service de Réanimation polyvalente et USC, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France. 22. Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France. 23. Service de Réanimation polyvalente, Centre Hospitalier du Mans, Le Mans, France. 24. MD, INSERM, U1116, 54500, Vandoeuvre-lès-Nancy, France. 25. Université de Lorraine, Nancy, France. 26. Service de Réanimation Médicale, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France. 27. Service de Réanimation et surveillance continue, Hôpital Saint-Louis, La Rochelle, France. 28. Service de Réanimation polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France. 29. Service de réanimation médico-chirurgicale, Centre Hospitalier René-Dubos, Pontoise, France. 30. Service de Réanimation polyvalente, Centre Hospitalier de Périgueux, Périgueux, France. 31. Service de Médecine Intensive Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France. 32. Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Lille, Lille, France. 33. Faculté de Médecine, Université de Lille, Lille, France. 34. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France. 35. Service de réanimation polyvalente, Hôpital Saint-Léon, Centre hospitalier de la Côte Basque, Bayonne, France. 36. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France. 37. Service de réanimation polyvalente, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France. 38. Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy, Annecy, France. 39. Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France. 40. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France. 41. Service de Réanimation médicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France. 42. Unité de Biologie des Spirochètes, Institut Pasteur, Paris, France. 43. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. jean.reignier@chu-nantes.fr. 44. Université de Nantes, Nantes, France. jean.reignier@chu-nantes.fr. 45. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.
Abstract
PURPOSE: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone. METHODS: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes. RESULTS: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations. CONCLUSIONS: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
PURPOSE: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone. METHODS: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes. RESULTS: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations. CONCLUSIONS: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
Entities:
Keywords:
Intensive care unit; Mortality; Outcome; Severe leptospirosis; Temperate zone
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