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Herpes simplex encephalitis in France: incidence, 6-month rehospitalizations and mortality

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Abstract

Background

Herpes simplex encephalitis (HSE) is a disease with unfavorable vital and functional prognoses. There are no recent epidemiological data on HSE at a national level using real-life databases, especially in France. This study aimed to report the incidence, the clinical characteristics and outcomes of the patients with HSE.

Methods

We conducted a comprehensive retrospective cohort study on all patients hospitalized for HSE in France between 2015 and 2022 using national hospital discharge databases. Incidence, socio-demographic and clinical characteristics (including comorbidities, seizure, stays’ features, intensive care supports) were described. The short- (first stay) and long-term (6-month) outcomes were reported, in terms of mortality and rehospitalizations.

Results

1425 HSE patients were included (median age 67 [54–77] years old, M/F sex ratio 1.07), giving a mean yearly hospital incidence of 2.3 [2.1–2.5] per 1,000,000 inhabitants. 51.2% of the patients were admitted in ICU (n = 730), of whom 59.0% were mechanically ventilated. The overall mortality during the first stay was 14.3% (n = 204), up to 17.9% for ICU patients. Within 6 months, among the survivors, 10.1% had at least one rehospitalization related to HSE. At 6 months, 16.5% of all patients had died (n = 235), 20.8% for ICU patients.

Conclusion

In France, the incidence of hospitalizations for HSE was 2.3 per 1,000,000 inhabitants with more than half of the patients admitted in ICU and a 6-month in-hospital mortality about 16.5%. This real-life update on the characteristics and severe outcomes of the disease raises awareness among care practitioners, of the serious nature of the disease, and thus can lead to higher vigilance.

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Data availability

Restrictions apply to the availability of this data and so are not publicly accessible. However, data are available from the authors upon reasonable request and with permission of the institution.

Abbreviations

ATIH:

Agence Technique de l’Information sur l’Hospitalisation

CCAM:

Classification Commune des Actes Médicaux

CCI:

Charlson Comorbidity Index

CI:

Confidence interval

DNA PCR:

Polymerase chain reaction

HSE:

Herpes simplex encephalitis

ICD-10:

International Classification of Diseases 10th revision

ICP:

Intracranial pressure

ICU:

Intensive care unit

IQ:

Interquartile range

MV:

Mechanical ventilation

PMSI:

Programme de Médicalisation des Systèmes d’Information

PPV:

Positive predictive value

SAPS-II:

Simplified Acute Physiology Score II

SD:

Standard deviation

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Acknowledgements

We thank Romain Sonneville, M.D. PhD. (Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France) for his proofreading and resulting remarks.

Funding

This research received no specific funding from any agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France

    Ambre Sauvage, Emeline Laurent, Christophe Gaborit & Leslie Grammatico-Guillon

  2. University of Tours, Tours, France

    Ambre Sauvage & Leslie Grammatico-Guillon

  3. Research Team EA 7505 “Education, Ethics, Health”, University of Tours, Tours, France

    Emeline Laurent

  4. Intensive Care Unit, Tours University Hospital, Tours, France

    Antoine Guillon

  5. Research Center for Respiratory Diseases, INSERM U1100, Tours, France

    Antoine Guillon

  6. MAVIVH, INSERM U1259, Tours, France

    Leslie Grammatico-Guillon

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  1. Ambre Sauvage
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Contributions

AS, EL, AG and LGG conceived and designed the study, analyzed the data and wrote the first draft of the manuscript. AS and CG retrieved the data and formatted results. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leslie Grammatico-Guillon.

Ethics declarations

Ethical approval and consent to participate

No nominative, sensitive or personal data was collected. Our study involved the reuse of already recorded and anonymised data. The study is part of the French Reference Methodology MR-005 (declaration 2205437 v0 of August 22nd, 2018, subscribed by the Tours University Hospital), which requires neither information nor consent from the people included. Access to linked anonymous file in the PMSI databases was approved by the French National Commission for Data Protection and Liberties (Commission Nationale de l’Informatique et des Libertés).

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Not applicable.

Conflict of interest

The authors declare that they have no competing interests.

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Sauvage, A., Laurent, E., Gaborit, C. et al. Herpes simplex encephalitis in France: incidence, 6-month rehospitalizations and mortality. Infection (2024). https://doi.org/10.1007/s15010-024-02272-3

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