Clinical features, etiologies, and outcomes of central nervous system infections in intensive care : A multicentric retrospective study in a large Brazilian metropolitan area
Copyright © 2023 Elsevier Inc. All rights reserved..
PURPOSE: The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates.
MATERIALS AND METHODS: We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality.
RESULTS: In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression.
CONCLUSIONS: Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:79 |
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| Enthalten in: |
Journal of critical care - 79(2024) vom: 01. Feb., Seite 154451 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Andrade, Hugo Boechat [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 16.12.2023 Date Revised 18.03.2024 published: Print-Electronic ClinicalTrials.gov: NCT05370573 Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2023.154451 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Andrade, Hugo Boechat |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinical features, etiologies, and outcomes of central nervous system infections in intensive care |b A multicentric retrospective study in a large Brazilian metropolitan area |
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| 500 | |a Date Completed 16.12.2023 | ||
| 500 | |a Date Revised 18.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT05370573 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates | ||
| 520 | |a MATERIALS AND METHODS: We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality | ||
| 520 | |a RESULTS: In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression | ||
| 520 | |a CONCLUSIONS: Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, U.S. Gov't, P.H.S. | |
| 650 | 4 | |a Central nervous system infection | |
| 650 | 4 | |a Critical care | |
| 650 | 4 | |a Encephalitis | |
| 650 | 4 | |a In-hospital mortality | |
| 650 | 4 | |a Meningitis | |
| 650 | 4 | |a Meningoencephalitis | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Surveillance | |
| 700 | 1 | |a da Silva, Ivan Rocha Ferreira |e verfasserin |4 aut | |
| 700 | 1 | |a Espinoza, Rodolfo |e verfasserin |4 aut | |
| 700 | 1 | |a Ferreira, Marcel Treptow |e verfasserin |4 aut | |
| 700 | 1 | |a da Silva, Mayara Secco Torres |e verfasserin |4 aut | |
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| 700 | 1 | |a Detepo, Paula João Tomás |e verfasserin |4 aut | |
| 700 | 1 | |a Varela, Margareth Catoia |e verfasserin |4 aut | |
| 700 | 1 | |a Ramos, Grazielle Viana |e verfasserin |4 aut | |
| 700 | 1 | |a da Silva, Aline Reis |e verfasserin |4 aut | |
| 700 | 1 | |a Soares, Jesus |e verfasserin |4 aut | |
| 700 | 1 | |a Belay, Ermias D |e verfasserin |4 aut | |
| 700 | 1 | |a Sejvar, James J |e verfasserin |4 aut | |
| 700 | 1 | |a Bozza, Fernando Augusto |e verfasserin |4 aut | |
| 700 | 1 | |a Cerbino-Neto, José |e verfasserin |4 aut | |
| 700 | 1 | |a Japiassú, André Miguel |e verfasserin |4 aut | |
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