Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.
UMR 1137, IAME, Paris Diderot University, Paris, France.
Intensive Care Med. 2019 Aug;45(8):1103-1111. doi: 10.1007/s00134-019-05684-0. Epub 2019 Jul 10.
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.
我们旨在研究体温和其他入院因素与需要入住 ICU 的成人单纯疱疹脑炎（HSE）患者结局的相关性。
我们对 2007 年至 2017 年间法国 47 家 ICU 中诊断为 HSE 的患者进行了一项回顾性多中心研究。发热定义为体温高于或等于 38.3°C。采用多变量逻辑回归分析确定与 90 天不良结局相关的因素，90 天不良结局定义为改良 Rankin 量表评分为 3-6（表明中度至重度残疾或死亡）。
总体而言，我们研究了格拉斯哥昏迷量表评分为 9（6-12）且入院时体温为 38.7（38.1-39.2）°C 的 259 例患者。90 天后，185 例（71%）患者预后不良，包括 44 例（17%）死亡。在校正年龄、发热（OR=2.21；95%CI 1.18-4.16）、机械通气（OR=2.21；95%CI 1.21-4.03）和 MRI 脑病变>3 个脑叶（OR=3.04；95%CI 1.35-6.81）后，这些因素与不良结局独立相关。相比之下，直接 ICU 入院（与最初入院到病房间接 ICU 入院相比）具有保护作用（OR=0.52；95%CI 0.28-0.95）。在校正入院前功能状态和 ICU 入院原因后进行的敏感性分析得出了类似的结果。
在需要入住 ICU 的成人 HSE 患者中，有几个入院因素与不良功能结局风险增加相关。确定潜在可改变的因素，即入院时体温升高和间接 ICU 入院，为进一步测试干预策略提供了机会。
