Allyn Jérôme, Miailhe Arnaud-Félix, Delmas Benjamin, Marti Lucas, Allou Nicolas, Jabot Julien, Reignier Jean
Réanimation Polyvalente, Centre hospitalier universitaire Félix Guyon, La Réunion, Bellepierre Saint-Denis cedex, France.
Département d'Informatique Clinique, Centre hospitalier universitaire Félix Guyon, La Réunion, Bellepierre Saint-Denis cedex, France.
PLoS Negl Trop Dis. 2024 Apr 10;18(4):e0012084. doi: 10.1371/journal.pntd.0012084. eCollection 2024 Apr.
Leptospirosis is an anthropozoonosis that occurs worldwide but is more common in tropical regions. Severe forms may require intensive care unit (ICU) admission. Whether the clinical patterns and outcomes differ between tropical and non-tropical regions with similar healthcare systems is unclear. Our objective here was to address this issue by comparing two cohorts of ICU patients with leptospirosis managed in mainland France and in the overseas French department of Réunion, respectively.
METHODOLOGY/PRINCIPAL FINDINGS: We compared two retrospective cohorts of patients admitted to intensive care for severe leptospirosis, one from Reunion Island in the Indian Ocean (tropical climate) and the other from metropolitan France (temperate climate). Chi-square and Student's t tests were used for comparisons. After grouping the two cohorts, we also performed multiple correspondence analysis and hierarchical clustering to search for distinct clinical phenotypes. The Réunion and Metropolitan France cohorts comprised 128 and 160 patients respectively. Compared with the Réunion cohort, the metropolitan cohort had a higher mean age (42.5±14.1 vs. 51.4±16.5 years, p<0.001). Severity scores, length of stay and mortality did not differ between the two cohorts. Three phenotypes were identified: hepato-renal leptospirosis (54.5%) characterized by significant hepatic, renal and coagulation failure, with a mortality of 8.3%; moderately severe leptospirosis (38.5%) with less severe organ failure and the lowest mortality rate (1.8%); and very severe leptospirosis (7%) manifested by neurological, respiratory and cardiovascular failure, with a mortality of 30%.
CONCLUSIONS/SIGNIFICANCE: The outcomes of severe leptospirosis requiring ICU admission did not differ between tropical and temperate regions with similar healthcare access, practices, and resources, despite some differences in patient characteristics. The identification of three different clinical phenotypes may assist in the early diagnosis and management of severe leptospirosis.
钩端螺旋体病是一种人兽共患病，在全球范围内均有发生，但在热带地区更为常见。严重形式的钩端螺旋体病可能需要入住重症监护病房（ICU）。在拥有相似医疗体系的热带和非热带地区，其临床模式和结局是否存在差异尚不清楚。我们在此的目的是通过比较分别在法国本土和法属海外省留尼汪岛接受治疗的两组钩端螺旋体病ICU患者队列来解决这一问题。
方法/主要发现：我们比较了两组因严重钩端螺旋体病入住重症监护病房的回顾性队列患者，一组来自印度洋的留尼汪岛（热带气候），另一组来自法国本土（温带气候）。采用卡方检验和学生t检验进行比较。在将两组队列合并后，我们还进行了多重对应分析和层次聚类，以寻找不同的临床表型。留尼汪岛队列和法国本土队列分别包含128例和160例患者。与留尼汪岛队列相比，法国本土队列的平均年龄更高（42.5±14.1岁对51.4±16.5岁，p<0.001）。两组队列的严重程度评分、住院时间和死亡率并无差异。确定了三种表型：肝-肾型钩端螺旋体病（54.5%），其特征为严重的肝、肾和凝血功能衰竭，死亡率为8.3%；中度严重钩端螺旋体病（38.5%），器官功能衰竭较轻，死亡率最低（1.8%）；以及极严重钩端螺旋体病（7%），表现为神经、呼吸和心血管功能衰竭，死亡率为30%。
结论/意义：尽管患者特征存在一些差异，但在拥有相似医疗可及性、医疗实践和资源的热带和温带地区，需要入住ICU的严重钩端螺旋体病的结局并无差异。三种不同临床表型的确定可能有助于严重钩端螺旋体病的早期诊断和管理。
