TY - JOUR
T1 - Clinical features, etiologies, and outcomes in adult patients with meningoencephalitis requiring intensive care (EURECA)
T2 - an international prospective multicenter cohort study
AU - Sonneville, Romain
AU - de Montmollin, Etienne
AU - Contou, Damien
AU - Ferrer, Ricard
AU - Gurjar, Mohan
AU - Klouche, Kada
AU - Sarton, Benjamine
AU - Demeret, Sophie
AU - Bailly, Pierre
AU - da Silva, Daniel
AU - Escudier, Etienne
AU - le Guennec, Loic
AU - Chabanne, Russel
AU - Argaud, Laurent
AU - Ben Hadj Salem, Omar
AU - Thyrault, Martial
AU - Frerou, Aurélien
AU - Louis, Guillaume
AU - de Pascale, Gennaro
AU - Horn, Janneke
AU - Helbok, Raimund
AU - Geri, Guillaume
AU - Bruneel, Fabrice
AU - Martin-Loeches, Ignacio
AU - Taccone, Fabio Silvio
AU - de Waele, Jan J.
AU - Ruckly, Stéphane
AU - Staiquly, Quentin
AU - Citerio, Giuseppe
AU - Timsit, Jean-François
AU - on behalf of the EURECA Investigator Study Group
AU - Santafe, Manuel
AU - Smonig, Roland
AU - Roux, Damien
AU - Voiriot, Guillaume
AU - Souweine, Bertrand
AU - Razazi, Keyvan
AU - Ducrocq, Thibault
AU - Boronat, Patricia
AU - Aissaoui, Nadia
AU - Reuter, Danielle
AU - Cariou, Alain
AU - Mateu, Philippe
AU - Moreno, Barabara Balandin
AU - Vera, Paula
AU - Jordan, Estela Val
AU - Barbier, François
AU - Landais, Mickael
AU - Bourenne, Jeremy
AU - Marchalot, Antoine
AU - Perrin, Mathilde
N1 - Funding Information: RS reports a grant from the European Society of Intensive Care Medicine (ESICM) for the current work and grants from the French Ministry of Health, outside the submitted work. Other authors report no competing interest. Funding Information: European Society of Intensive Care Medicine. GC was supported by the Italian MUR Dipartimenti di Eccellenza 2023-2027 (l. 232/2016, art. 1, commi 314 - 337). Publisher Copyright: © 2023, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/5
Y1 - 2023/5
N2 - Purpose: We aimed to characterize the outcomes of patients with severe meningoencephalitis requiring intensive care. Methods: 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 ≤ 13), a cerebrospinal fluid pleocytosis ≥ 5 cells/mm3, 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. Results: 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 ≤ 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. Conclusion: 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.
AB - Purpose: We aimed to characterize the outcomes of patients with severe meningoencephalitis requiring intensive care. Methods: 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 ≤ 13), a cerebrospinal fluid pleocytosis ≥ 5 cells/mm3, 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. Results: 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 ≤ 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. Conclusion: 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.
KW - Encephalitis
KW - Intensive care unit
KW - Meningitis
KW - Meningoencephalitis
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85152054548&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00134-023-07032-9
DO - https://doi.org/10.1007/s00134-023-07032-9
M3 - Article
C2 - 37022378
SN - 0342-4642
VL - 49
SP - 517
EP - 529
JO - Intensive care medicine
JF - Intensive care medicine
IS - 5
ER -