Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study

Jaquet, Pierre; É, de Montmollin; Dupuis, Claire; Sazio, Charline; Conrad, Marie; Susset,; Demeret, Sophie; Jm, Tadie; Argaud, Laurent; Barbier, François; Sarton, Benjamine; R, Chabane; Daubin, Delphine; Brulé, Noëlle; Lerolle, Nicolas; Alves, Maria Lúcia D’Arbo; D, Da Silva; Ae, Kalioubi; Silva, S; Bailly, Pierre; Wolff, Michel; Bouadma, Lila; Jf, Timsit; Sonneville, Romain

doi:10.1007/s00134-019-05684-0

Cited by 34 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 1 Early identification of patients with poor prognosis remains to be a major concern in clinical practice. 2 , 3 Some predictive factors, such as delayed treatment, 4 – 6 intensive care unit (ICU) admission, 7 – 9 and abnormal CSF inflammation, 3 , 10 might be considered useful in the early identification of patients with poor prognosis. The anti-NMDAR Encephalitis One-Year Functional Status (NEOS) score, including not only the aforementioned factors, has been developed and assisted in predicting the risk of 1-year poor functional status, which in turn is useful in deciding whether early second-line immunotherapy or other novel salvage therapies should be offered to those patients with anti-NMDAR encephalitis.…”

mentioning

confidence: 99%

Validation of the NEOS score in Chinese patients with anti-NMDAR encephalitis

Peng

Dai

Liu

et al. 2020

Neurol Neuroimmunol Neuroinflamm

View full text Add to dashboard Cite

ObjectiveThe performance of anti-NMDAR Encephalitis One-Year Functional Status (NEOS) in predicting the 1-year functional status in Chinese patients with anti-NMDAR encephalitis is unknown.MethodsWe recruited patients with anti-NMDAR encephalitis from the Multicenter and Prospective Clinical Registry Study of Anti-NMDAR Encephalitis in Beijing Area. Patients were followed up for 1 year. We defined the poor functional status as a modified Rankin Scale score of more than 2 and good functional status as a modified Rankin Scale score of no more than 2. We performed a receiver-operator characteristic analysis to assess the discriminatory power of the NEOS score in predicting the 1-year functional status by using the area under the curve (AUC). Calibration was assessed by Pearson correlation coefficient and Hosmer-Lemeshow tests.ResultsAmong the 111 patients with anti-NMDAR encephalitis recruited from 364 potentially eligible participants, 87 (78.4%) had good functional status at 1 year, whereas the remaining 24 (21.6%) had poor functional status. The AUC of the NEOS score for 1-year poor functional status was 0.86 (95% CI 0.78–0.93, p < 0.001). The increased NEOS was associated with higher risk of 1-year poor functional status in patients with anti-NMDAR encephalitis.ConclusionsThe NEOS score is considered a reliable predictor of the risk of 1-year poor functional status in Chinese patients with anti-NMDAR encephalitis. This score could help to estimate the velocity of clinical improvement in advance.Clinicaltrial.gov identifierNCT02443350.Classification of evidenceThis study provides Class III evidence that in patients with anti-NMDAR encephalitis, the NEOS score predicts 1-year functional status.

show abstract

mentioning

confidence: 99%

Validation of the NEOS score in Chinese patients with anti-NMDAR encephalitis

Peng

Dai

Liu

et al. 2020

Neurol Neuroimmunol Neuroinflamm

View full text Add to dashboard Cite

show abstract

“…However, the rarity of HSVE and the multiple alternative explanations for patients’ presentation make it challenging to change practice patterns. Finally, delayed admission to the ICU (that is, initial admission to a general ward, followed by latter transfer to ICU) was associated with poor functional outcomes among patients with HSVE, and those with delayed ICU admission had more commonly aspiration pneumonia and need for mechanical ventilation [9]. It is likely that the latter complications and, possibly, associated delays in start of acyclovir therapy have contributed to worse patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been only few studies that specifically examined critically ill patients with HSVE that require ICU admission. In two recent multicenter studies from France, ICU admission was reported in 32.8% [8], and mortality among ICU admissions ranged from 11.9% at the end of hospitalization [8] to 17% at 90 days [9]. However, the patterns of demand for critical care services among patients with HSVE and longitudinal trends of hospital outcomes among the critically ill have not been reported, to our knowledge.…”

Section: Introductionmentioning

confidence: 99%

Herpes Simplex Virus Encephalitis: Patterns of Epidemiology and Outcomes of Patients Admitted to the Intensive Care Unit in Texas, 2008 - 2016

Oud

2019

J Clin Med Res

View full text Add to dashboard Cite

BackgroundPatients with herpes simplex virus encephalitis (HSVE) often require admission to the intensive care unit (ICU) and have considerably worse outcomes than those not critically ill. The short-term outcomes of critically ill patients in the general population have markedly improved over the past decades. However, the population-level patterns of demand for critical care services among patients with HSVE have not been examined, and it is unknown whether there were corresponding outcome gains among those admitted to the ICU.MethodsThe Texas Inpatient Public Use Data File was used to identify hospitalizations with HSVE aged ≥ 18 years during 2008 - 2016. ICU admissions were identified using unit-specific revenue codes. The patterns of ICU utilization and those of short-term outcomes (with short-term mortality defined as in-hospital death or discharge to hospice) were examined across demographic strata and over time.ResultsAmong 1,964 hospitalizations with HSVE, 1,176 (59.9%) were admitted to ICU (45.8% aged ≥ 65 years; 53.1% female, among ICU admissions). ICU utilization increased with age (from 47.9% (age 18 - 44 years) through 61.2% (older adults (age ≥ 65 years)); P = 0.0003 for trend), and increased over time only among older adults (odds ratio: 1.06/year (95% confidence interval (CI): 1.01 - 1.12)). Among ICU admissions, routine home discharge, transfer to a post-acute care facility, and short-term mortality occurred in 26.8%, 39.5%, and 18.7%, respectively; the corresponding outcomes for older adults were 10.6%, 51.4%, and 26.2%, respectively. The outcomes for the whole cohort of ICU admissions remained unchanged over time.ConclusionsAdults with HSVE had high demand for critical care services, and those admitted to ICU had high short-term mortality and substantial residual morbidity among survivors, which remained unchanged over time. These findings can inform clinicians’ decision-making and discussions about goals of care with affected patients and their surrogates.

show abstract

“…Varicella-zoster virus (VZV) is the first etiology identified in immunocompromised patients [16]. HSV encephalitis in these patients may present atypically and is associated with poorer outcomes [18,19]. Other viruses in immunocompromised population include cytomegalovirus (CMV), human herpesvirus (HHV)-6 and -7 as well as John Cunningham-virus (JCV) [20].…”

Section: Acute Meningoencephalitismentioning

confidence: 99%