Clinical features, etiologies, and outcomes in adult patients with meningoencephalitis requiring intensive care (EURECA): an international prospective multicenter cohort study.
Encephalitis
Intensive care unit
Meningitis
Meningoencephalitis
Outcome
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
30
10
2022
accepted:
08
03
2023
medline:
25
5
2023
pubmed:
7
4
2023
entrez:
6
4
2023
Statut:
ppublish
Résumé
We aimed to characterize the outcomes of patients with severe meningoencephalitis requiring intensive care. We conducted a prospective multicenter international cohort study (2017-2020) in 68 centers across 7 countries. Eligible patients were adults admitted to the intensive care unit (ICU) with meningoencephalitis, defined by an acute onset of encephalopathy (Glasgow coma scale (GCS) score [Formula: see text] 13), a cerebrospinal fluid pleocytosis [Formula: see text] 5 cells/mm Among 599 patients enrolled, 589 (98.3%) completed the 3-month follow-up and were included. Overall, 591 etiologies were identified in those patients which were categorized into five groups: acute bacterial meningitis (n = 247, 41.9%); infectious encephalitis of viral, subacute bacterial, or fungal/parasitic origin (n = 140, 23.7%); autoimmune encephalitis (n = 38, 6.4%); neoplastic/toxic encephalitis (n = 11, 1.9%); and encephalitis of unknown origin (n = 155, 26.2%). Overall, 298 patients (50.5%, 95% CI 46.6-54.6%) had a poor functional outcome, including 152 deaths (25.8%). Variables independently associated with a poor functional outcome were age > 60 years (OR 1.75, 95% CI 1.22-2.51), immunodepression (OR 1.98, 95% CI 1.27-3.08), time between hospital and ICU admission > 1 day (OR 2.02, 95% CI 1.44-2.99), a motor component on the GCS [Formula: see text] 3 (OR 2.23, 95% CI 1.49-3.45), hemiparesis/hemiplegia (OR 2.48, 95% CI 1.47-4.18), respiratory failure (OR 1.76, 95% CI 1.05-2.94), and cardiovascular failure (OR 1.72, 95% CI 1.07-2.75). In contrast, administration of a third-generation cephalosporin (OR 0.54, 95% CI 0.37-0.78) and acyclovir (OR 0.55, 95% CI 0.38-0.80) on ICU admission were protective. Meningoencephalitis is a severe neurologic syndrome associated with high mortality and disability rates at 3 months. Actionable factors for which improvement could be made include time from hospital to ICU admission, early antimicrobial therapy, and detection of respiratory and cardiovascular complications at admission.
Identifiants
pubmed: 37022378
doi: 10.1007/s00134-023-07032-9
pii: 10.1007/s00134-023-07032-9
doi:
Banques de données
ClinicalTrials.gov
['NCT03144570']
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
517-529Subventions
Organisme : European Society of Intensive Care Medicine
ID : Established investigator award 2017
Investigateurs
Manuel Santafe
(M)
Roland Smonig
(R)
Damien Roux
(D)
Guillaume Voiriot
(G)
Bertrand Souweine
(B)
Keyvan Razazi
(K)
Thibault Ducrocq
(T)
Patricia Boronat
(P)
Nadia Aissaoui
(N)
Danielle Reuter
(D)
Alain Cariou
(A)
Philippe Mateu
(P)
Barabara Balandin Moreno
(BB)
Paula Vera
(P)
Estela Val Jordan
(EV)
François Barbier
(F)
Mickael Landais
(M)
Jeremy Bourenne
(J)
Antoine Marchalot
(A)
Mathilde Perrin
(M)
Benjamin Sztrympf
(B)
Carole Schwebel
(C)
Shakti Bedanta Mishra
(SB)
Patrick Chillet
(P)
Maelle Martin
(M)
Hugues Georges
(H)
Jean-Claude Lacherade
(JC)
Romaric Larcher
(R)
Gregory Papin
(G)
David Schnell
(D)
Sulekha Saxena
(S)
Frank Chemouni
(F)
Juliette Audibert
(J)
Eric Mariotte
(E)
Shidasp Siami
(S)
Italo Calamai
(I)
Cédric Bruel
(C)
Alexandre Massri
(A)
Jesus Priego
(J)
Xavier Souloy
(X)
Pascal Beuret
(P)
Bikram Kumar Gupta
(BK)
Thomas Ritzenthaler
(T)
Sami Hraiech
(S)
Aguila Radjou
(A)
M K Renuka
(MK)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.
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