Severe leptospirosis in non-tropical areas : a nationwide, multicentre, retrospective study in French ICUs
PURPOSE: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.
METHODS: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes.
RESULTS: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations.
CONCLUSIONS: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
| Errataetall: |
CommentIn: Intensive Care Med. 2019 Dec;45(12):1816-1818. - PMID 31686129 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:45 |
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| Enthalten in: |
Intensive care medicine - 45(2019), 12 vom: 31. Dez., Seite 1763-1773 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Miailhe, Arnaud-Félix [VerfasserIn] |
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| Links: |
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| Themen: |
Intensive care unit |
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| Anmerkungen: |
Date Completed 14.07.2020 Date Revised 14.07.2020 published: Print-Electronic CommentIn: Intensive Care Med. 2019 Dec;45(12):1816-1818. - PMID 31686129 Citation Status MEDLINE |
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| doi: |
10.1007/s00134-019-05808-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM302588582 |
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| 245 | 1 | 0 | |a Severe leptospirosis in non-tropical areas |b a nationwide, multicentre, retrospective study in French ICUs |
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| 500 | |a Date Completed 14.07.2020 | ||
| 500 | |a Date Revised 14.07.2020 | ||
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| 500 | |a CommentIn: Intensive Care Med. 2019 Dec;45(12):1816-1818. - PMID 31686129 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone | ||
| 520 | |a METHODS: LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes | ||
| 520 | |a RESULTS: The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations | ||
| 520 | |a CONCLUSIONS: Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Intensive care unit | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Outcome | |
| 650 | 4 | |a Severe leptospirosis | |
| 650 | 4 | |a Temperate zone | |
| 700 | 1 | |a Mercier, Emmanuelle |e verfasserin |4 aut | |
| 700 | 1 | |a Maamar, Adel |e verfasserin |4 aut | |
| 700 | 1 | |a Lacherade, Jean-Claude |e verfasserin |4 aut | |
| 700 | 1 | |a Le Thuaut, Aurélie |e verfasserin |4 aut | |
| 700 | 1 | |a Gaultier, Aurélie |e verfasserin |4 aut | |
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| 700 | 1 | |a Jonas, Maud |e verfasserin |4 aut | |
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| 700 | 1 | |a Landais, Mickael |e verfasserin |4 aut | |
| 700 | 1 | |a Lemarié, Jérémie |e verfasserin |4 aut | |
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| 700 | 1 | |a Lhommet, Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Michel, Philippe |e verfasserin |4 aut | |
| 700 | 1 | |a Monseau, Yannick |e verfasserin |4 aut | |
| 700 | 1 | |a Moschietto, Sébastien |e verfasserin |4 aut | |
| 700 | 1 | |a Nseir, Saad |e verfasserin |4 aut | |
| 700 | 1 | |a Osman, David |e verfasserin |4 aut | |
| 700 | 1 | |a Pillot, Jérome |e verfasserin |4 aut | |
| 700 | 1 | |a Piton, Gaël |e verfasserin |4 aut | |
| 700 | 1 | |a Sedillot, Nicholas |e verfasserin |4 aut | |
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| 700 | 1 | |a Dellamonica, Jean |e investigator |4 oth | |
| 700 | 1 | |a Devaquet, Jérôme |e investigator |4 oth | |
| 700 | 1 | |a Djibre, Michel |e investigator |4 oth | |
| 700 | 1 | |a Ellrodt, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Faure, Henri |e investigator |4 oth | |
| 700 | 1 | |a Ferrière, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Guérin, Claude |e investigator |4 oth | |
| 700 | 1 | |a Joly, Florent |e investigator |4 oth | |
| 700 | 1 | |a Letocart, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Luyt, Charles-Edouard |e investigator |4 oth | |
| 700 | 1 | |a Mateu, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Merdji, Hamid |e investigator |4 oth | |
| 700 | 1 | |a Michel, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Salem, Omar Ben Hadj |e investigator |4 oth | |
| 700 | 1 | |a Papazian, Laurent |e investigator |4 oth | |
| 700 | 1 | |a Passouant, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Picard, Walter |e investigator |4 oth | |
| 700 | 1 | |a Plouvier, Fabienne |e investigator |4 oth | |
| 700 | 1 | |a Quenot, Jean-Pierre |e investigator |4 oth | |
| 700 | 1 | |a Ricard, Jean-Damien |e investigator |4 oth | |
| 700 | 1 | |a Rigaud, Jean-Philippe |e investigator |4 oth | |
| 700 | 1 | |a Schortgen, Frédérique |e investigator |4 oth | |
| 700 | 1 | |a Souweine, Bertrand |e investigator |4 oth | |
| 700 | 1 | |a Sztrymf, Benjamin |e investigator |4 oth | |
| 700 | 1 | |a Terzi, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Kamel, Toufik |e investigator |4 oth | |
| 700 | 1 | |a Klouche, Kada |e investigator |4 oth | |
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