Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study
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.
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.
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.
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.
KeywordsEncephalitis Herpes simplex Fever Functional outcome ICU
ENCEPHALITICA study group: Julien Marechal, M.D. (Medical Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France). Bruno Mourvillier, M.D., (Medical Intensive Care Unit, CHU de Reims, Reims, France). Frederic Dailler, M.D., (Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon, France). Fabrice Bruneel, M.D. (Medical Intensive Care Unit, André Mignot Hospital, Versailles, France). Alexandre Lautrette, M.D., Ph.D. (Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France). Emmanuel Novy, M.D. (Polyvalent Intensive Care Unit, Mercy Hospital CHR Metz-Thionville, Ars-Laquenexy, France). Bertrand Guidet, M.D. PhD. (Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France). François Mateos, M.D. (Intensive care Unit, Centre hospitalier Saint-Brieuc, Saint-Brieuc, France). Clément Brault, M.D. (Department of Intensive Care Medicine, Amiens-Picardie University Hospital, Amiens, France). Quentin Maestraggi, M.D. (Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital Strasbourg, France). Keyvan Razazi, M.D. (Medical Intensive Care Unit, hopitaux Universitaires Henri Mondor, Créteil, France). Jean-Pierre Quenot, M.D. (Medical Intensive Care Unit, Centre Hospitalo-Universitaire de Dijon, Dijon, France). Aurélie Joret, M.D. (Medical Intensive Care Unit, CHU de Caen, Caen, France). Albrice Levrat, M.D. (Intensive care unit, Centre Hospitalier Annecy-Genevois, Annecy, France). Alexandre Massri, M.D. (Intensive Care Unit, Centre Hospitalier Francois Mitterand Pau, France). Alexandre Robert, M.D. (Medical Intensive Care Unit, Hôpital de l’Archet 1, CHU de Nice, Nice, France). Damien Contou, M.D. (Polyvalent Intensive Care Unit, Centre Hospitalier Victor Dupouy, Argenteuil, France). Jean-Paul Mira, M.D. Ph.D. (Medical Intensive Care Unit, Cochin University Hospital, Paris, France). Gaudry Stephane, M.D., Ph.D. (Polyvalent Intensive Care Unit, Louis Mourier University Hospital, Colombes, France). Guillaume Voiriot, M.D., Ph.D. (Polyvalent Intensive Care Unit, Centre Hospitalier Universitaire Tenon, Paris, France). Asael Berger, M.D. (Intensive Care Unit, Centre Hospitalier de Haguenau, Haguenau, France). Vincent Das, M.D., Ph.D. (Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France). Nicolas Engrand, M.D. (Neurosurgical Intensive Care Unit, Fondation ophtalmologique Adolphe Rotschild, Paris, France. Martin Murgier, M.D. (Intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France). Shidasp Siami, M.D. (Polyvalent ICU, Centre Hospitalier Sud Essone Dourdan-Etampes-Siège, Etampes, France). Sami Hraiech, M.D., Ph.D. (Medical Intensive Care Unit, Aix-Marseille Universite, Hopital Nord, Marseille, France). Eric Mariotte, M.D. (Medical ICU, Saint-Louis Hospital, Paris, France). Claire Ragot, M.D. (Medical-Surgical ICU, Robert Boulin Hospital, Libourne, France). Annabelle Stoclin, M.D. (Intensive Care Unit, Institut Gustave Roussy, Villejuif, France). Pierre Trouiller, M.D. (Intensive Care Unit, Antoine Béclère Hospital, Clarmart, France). Mathieu Schmidt, M.D., Ph.D. (Medical Intensive Care Unit, Hôpital Pitié–Salpêtrière, AP-HP, Paris, France).
Compliance with ethical standards
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 16.Vincent JL, Moreno R, Takala J et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710CrossRefGoogle Scholar
- 24.Chow FC, Glaser CA, Sheriff H et al (2015) Use of clinical and neuroimaging characteristics to distinguish temporal lobe herpes simplex encephalitis from its mimics. Clin Infect Dis 60:1377–1383Google Scholar