AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, DMU PARABOL, FHU PROMICE, Paris, France; Université de Paris, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; F-CRIN INICRCT Network, Nancy, France.
AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, DMU PARABOL, FHU PROMICE, Paris, France.
Burns. 2022 Aug;48(5):1155-1165. doi: 10.1016/j.burns.2021.09.009. Epub 2021 Sep 21.
The aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation.
Retrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes.
94 patients were included, mean age was 51 (39-64) years; median total body surface area burned was 36 (25-54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3-8] vs. 2 [1-4], p < 0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not.
Pulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.
本研究旨在描述并发肺部单纯疱疹病毒（HSV）再激活的危重症烧伤患者的流行率、特征和转归。
这是一项回顾性、单中心队列研究，纳入了 2013 年 1 月至 2017 年 4 月期间因疑似肺炎而行支气管肺泡灌洗且筛查 HSV 的连续接受治疗的严重烧伤患者。我们使用逻辑回归分析确定与 HSV 再激活和结局相关的因素。
共纳入 94 例患者，平均年龄为 51（39-64）岁；中位总体烧伤面积为 36（25-54）%，重症监护病房（ICU）死亡率为 38%。55 例（59%）患者发生肺部 HSV 再激活，30 例（55%）接受阿昔洛韦治疗。与未发生 HSV 再激活的患者相比，发生 HSV 再激活的患者病情更严重，入院时的 SOFA 评分更高（6[3-8]比 2[1-4]，p<0.0001）。多因素分析显示，性别、入院时 SOFA 评分和吸入性损伤与 HSV 再激活显著相关。仅当未发生 HSV 再激活时，感染性休克与 90 天死亡率相关。
肺部 HSV 再激活在重症烧伤患者中较为常见。初始严重程度和吸入性损伤是危险因素。抗病毒治疗与结局无关。
