Université Paris Cité, INSERM UMR 1137, 75018, Paris, France.
APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 75018, Paris, France.
Intensive Care Med. 2023 May;49(5):517-529. doi: 10.1007/s00134-023-07032-9. Epub 2023 Apr 6.
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, and at least two of the following criteria: fever, seizures, focal neurological deficit, abnormal neuroimaging, and/or electroencephalogram. The primary endpoint was poor functional outcome at 3 months, defined by a score of three to six on the modified Rankin scale. Multivariable analyses stratified on centers investigated ICU admission variables associated with the primary endpoint.
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.
我们旨在描述需要重症监护的严重脑膜脑炎患者的结局。
我们在 7 个国家的 68 个中心进行了一项前瞻性多中心国际队列研究（2017-2020 年）。纳入标准为：急性脑病发作（格拉斯哥昏迷量表 [GCS] 评分 [Formula: see text] 13）、脑脊液白细胞增多 [Formula: see text] 5 个细胞/mm3，至少有以下两个标准的成年人：发热、癫痫发作、局灶性神经功能缺损、异常神经影像学和/或脑电图；入住重症监护病房（ICU）的脑膜脑炎患者。主要终点为 3 个月时功能不良结局，定义为改良 Rankin 量表评分为 3 至 6 分。多变量分析分层于中心，研究了与主要终点相关的 ICU 入院变量。
在纳入的 599 名患者中，589 名（98.3%）完成了 3 个月的随访并纳入分析。总体而言，这些患者确定了 591 种病因，分为五组：急性细菌性脑膜炎（n=247，41.9%）；病毒性、亚急性细菌性、真菌/寄生虫感染性脑炎（n=140，23.7%）；自身免疫性脑炎（n=38，6.4%）；肿瘤/中毒性脑炎（n=11，1.9%）；和原因不明性脑炎（n=155，26.2%）。总体而言，298 名患者（50.5%，95%CI 46.6-54.6%）有不良功能结局，包括 152 例死亡（25.8%）。与不良功能结局相关的变量包括年龄>60 岁（OR 1.75，95%CI 1.22-2.51）、免疫抑制（OR 1.98，95%CI 1.27-3.08）、从入院到入住 ICU 的时间>1 天（OR 2.02，95%CI 1.44-2.99）、GCS 运动评分 [Formula: see text] 3（OR 2.23，95%CI 1.49-3.45）、偏瘫/偏瘫（OR 2.48，95%CI 1.47-4.18）、呼吸衰竭（OR 1.76，95%CI 1.05-2.94）和心血管衰竭（OR 1.72，95%CI 1.07-2.75）。相反，入住 ICU 时使用第三代头孢菌素（OR 0.54，95%CI 0.37-0.78）和阿昔洛韦（OR 0.55，95%CI 0.38-0.80）具有保护作用。
脑膜脑炎是一种严重的神经系统综合征，与 3 个月时的高死亡率和残疾率相关。可以改善的可操作因素包括从入院到入住 ICU 的时间、早期抗菌治疗以及在入院时检测呼吸和心血管并发症。
