| Title: |
Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs |
| Authors: |
Miailhe, A. F.; Mercier, E.; Maamar, A.; Lacherade, J. C.; Le Thuaut, A.; Gaultier, Alina; Asfar, P.; Argaud, L.; Ausseur, A.; Ben Salah, A.; Botoc, V.; Chaoui, K.; Charpentier, J.; Cracco, C.; de Prost, N.; Eustache, M. L.; Ferre, A.; Gauvin, E.; Goursaud, S.; Grall, M.; Guiot, P.; Jonas, M.; Lambiotte, F.; Landais, M.; Lemarie, J.; Lesieur, O.; Lhommet, C.; Michel, P.; Monseau, Y.; Moschietto, S.; Nseir, S.; Osman, D.; Pillot, J.; Piton, G.; Sedillot, N.; Sirodot, M.; Thevenin, D.; Zafrani, L.; Zerbib, Y.; Bourhy, Pascale; Lascarrou, J. B.; Reignier, J. |
| Contributors: |
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (CHU Nantes); Centre Hospitalier Régional Universitaire de Tours (CHRU Tours); Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Pontchaillou; Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée); Centre Hospitalier Universitaire d'Angers (CHU Angers); Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN); Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon); Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM); Centre Hospitalier de Cholet (CH Cholet); Hôpitaux de Chartres Chartres; Service de réanimation (CH Saint-Malo); Centre hospitalier de Saint-Malo; Centre Hospitalier Cahors; Hôpital Cochin AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Centre Hospitalier d'Angoulême (CH Angoulême); Centre d'Investigation Clinique Henri Mondor (CIC Henri Mondor); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Henri Mondor Créteil; Groupe Henri Mondor-Albert Chenevier-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Henri Mondor-Albert Chenevier-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12); Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA); Centre Hospitalier de Versailles André Mignot (CHV); Centre Hospitalier Georges Renon Niort (CH Georges Renon Niort); CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie (CHU Caen Normandie); Normandie Université (NU); Hôpital Charles Nicolle Rouen; CHU Rouen; Normandie Université (NU)-Normandie Université (NU); Centre Hospitalier de Mulhouse, site du Hasenrain (Mulhouse); Centre hospitalier de Saint-Nazaire; Centre hospitalier Valenciennes, Nord; Centre Hospitalier Le Mans (CH Le Mans); Défaillance Cardiovasculaire Aiguë et Chronique (DCAC); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL); Service de Réanimation Médicale CHRU Nancy; Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy); Centre Hospitalier de La Rochelle (CHR); Centre hospitalier de Saint-Brieuc Hôpital Yves Le Foll (CH Saint-Brieuc); Groupement Hospitalier Territoire d'Armor (GHT Armor); Centre Hospitalier René Dubos Pontoise; Hopital de Périgueux (CH Périgueux); Hopital de Périgueux; Centre Hospitalier Henri Duffaut Avignon (CH Avignon); Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301 (CIC Lille); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre; Centre Hospitalier de la Côte Basque (CHCB); Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon); Centre Hospitalier Fleyriat Bourg en Bresse (CHBBF); Centre Hospitalier Annecy-Genevois Saint-Julien-en-Genevois; Centre Hospitalier de Lens; Service d'Anesthésie-Réanimation AP-HP Hôpitaux Saint-Louis Lariboisière; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal APHP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité); CHU Amiens-Picardie; Biologie des Spirochètes / Biology of Spirochetes; Institut Pasteur Paris (IP) |
| Source: |
ISSN: 0342-4642. |
| Publisher Information: |
CCSD; Springer Verlag |
| Publication Year: |
2019 |
| Collection: |
HAL Lyon 1 (University Claude Bernard Lyon 1) |
| Subject Terms: |
Mortality; Severe leptospirosis; Temperate zone; Intensive care unit; Outcome; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; 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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/31654079; PUBMED: 31654079 |
| DOI: |
10.1007/s00134-019-05808-6 |
| Availability: |
https://hal.science/hal-02465751; https://doi.org/10.1007/s00134-019-05808-6 |
| Accession Number: |
edsbas.6E575C7F |
| Database: |
BASE |