Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study

• Published in: Intensive care medicine Vol. 45; no. 8; pp. 1103 - 1111
• Main Authors: Jaquet, P., de Montmollin, E., Dupuis, C., Sazio, C., Conrad, M., Susset, V., Demeret, S., Tadie, J. M., Argaud, L., Barbier, F., Sarton, B., Chabane, R., Daubin, D., Brulé, N., Lerolle, N., Alves, M., Da Silva, D., Kalioubi, A. El, Silva, S., Bailly, P., Wolff, M., Bouadma, L., Timsit, J. F., Sonneville, R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2019; Springer; Springer Nature B.V
• Subjects: Aged; Anesthesiology; Body temperature; Brain; Cohort analysis; Cohort Studies; Coma; Critical Care Medicine; Emergency Medicine; Encephalitis; Encephalitis, Herpes Simplex - complications; Encephalitis, Herpes Simplex - epidemiology; Female; Fever; France - epidemiology; Herpes simplex; Herpes simplex encephalitis; Herpes viruses; Hospitalization - statistics & numerical data; Humans; Intensive; Intensive care; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Lesions; Magnetic resonance imaging; Male; Mechanical ventilation; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Original; Outcome Assessment, Health Care - statistics & numerical data; Pain Medicine; Patient admissions; Patient outcomes; Pediatrics; Physical Functional Performance; Pneumology/Respiratory System; Regression analysis; Retrospective Studies; Sensitivity analysis; Temperature effects; Ventilation; France; Herpes simplex; Encephalitis; ICU; Fever; Functional outcome
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-019-05684-0

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.