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Intensive Care Medicine

, Volume 44, Issue 9, pp 1502–1511 | Cite as

Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study

  • Damien ContouEmail author
  • Romain Sonneville
  • Florence Canoui-Poitrine
  • Gwenhaël Colin
  • Rémi Coudroy
  • Frédéric Pène
  • Jean-Marc Tadié
  • Martin Cour
  • Gaëtan Béduneau
  • Antoine Marchalot
  • Laurent Guérin
  • Sébastien Jochmans
  • Stephan Ehrmann
  • Nicolas Terzi
  • Sébastien Préau
  • François Barbier
  • Guillaume Schnell
  • Damien Roux
  • Olivier Leroy
  • Claire Pichereau
  • Elodie Gélisse
  • Lara Zafrani
  • Richard Layese
  • Christian Brun-Buisson
  • Armand Mekontso Dessap
  • Nicolas de Prost
  • For the Hopeful Study Group
Original

Abstract

Purpose

Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality.

Methods

A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up).

Results

Among the 306 included patients, 126 (41.2%; 95% CI 35.6–46.9) died and 180 (58.8%; 95% CI 53.3–64.3) survived during the follow-up period [13 (3–24) days], including 51/180 patients (28.3%, 95% CI 21.9–35.5) who eventually required limb amputations, with a median number of 3 (1–4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR) = 1.03 (1.02–1.04); p < 0.001], lower leucocytes [HR 0.83 (0.69–0.99); p = 0.034] and platelet counts [HR 0.77 (0.60–0.91); p = 0.007], and arterial blood lactate levels [HR 2.71 (1.68–4.38); p < 0.001] were independently associated with hospital death, while a neck stiffness [HR 0.51 (0.28–0.92); p = 0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06–3.38); p = 0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis.

Conclusion

Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation.

Trials registration

NCT03216577.

Keywords

Purpura fulminans Sepsis Septic shock Limb amputation Streptococcus pneumoniae Neisseria meningitidis 

Notes

Acknowledgements

List of the members of the Hopeful Study Group: Laurent Argaud (Lyon), François Barbier (Orléans), Amélie Bazire (Brest), Gaëtan Béduneau (Rouen), Frédéric Bellec (Montauban), Pascal Beuret (Roanne), Pascal Blanc (Pontoise), Cédric Bruel (Saint-Joseph), Christian Brun-Buisson (Mondor, AP-HP), Gwenhaël Colin (La Roche-sur-Yon), Delphine Colling (Roubaix), Alexandre Conia (Chartres), Rémi Coudroy (Poitiers), Martin Cour (Lyon), Damien Contou (Henri Mondor—AP-HP and Argenteuil), Fabrice Daviaud (Corbeil-Essonnes), Vincent Das (Montreuil), Jean Dellamonica (Nice), Nadège Demars (Antoine Beclère, AP-HP), Stephan Ehrmann (Tours), Arnaud Galbois (Quincy sous Sénart), Elodie Gelisse (Reims), Julien Grouille (Blois), Laurent Guérin (Ambroise Paré—AP-HP), Emmanuel Guérot (HEGP, AP-HP), Samir Jaber (Montpellier), Caroline Jannière-Nartey (Créteil), Sébastien Jochmans (Melun), Mathieu Jozwiak (Kremlin Bicêtre, AP-HP), Pierre Kalfon (Chartres), Antoine Kimmoun (Nancy), Alexandre Lautrette (Clermont Ferrand), Jérémie Lemarié (Nancy), Charlène Le Moal (Le Mans), Christophe Lenclud (Mantes La Jolie), Nicolas Lerolle (Angers), Olivier Leroy (Tourcoing), Antoine Marchalot (Dieppe), Bruno Mégarbane (Lariboisière, AP-HP), Armand Mekontso Dessap (Mondor, AP-HP), Etienne de Montmollin (Saint-Denis), Frédéric Pène (Cochin, AP-HP), Claire Pichereau (Poissy), Gaëtan Plantefève (Argenteuil), Sébastien Préau (Lille), Gabriel Preda (Saint-Antoine, AP-HP), Nicolas de Prost (Henri Mondor, AP-HP), Jean-Pierre Quenot (Dijon), Sylvie Ricome (Aulnay-sous-Bois), Damien Roux (Louis Mourier, AP-HP), Bertrand Sauneuf (Cherbourg), Matthieu Schmidt (Pitié Salpétrière, AP-HP), Guillaume Schnell (Le Havre), Romain Sonneville (Bichat, AP-HP), Jean-Marc Tadié (Rennes), Yacine Tandjaoui (Avicenne, AP-HP), Martial Tchir (Villeneuve Saint Georges), Nicolas Terzi (Grenoble), Xavier Valette (Caen), Lara Zafrani (Saint-Louis, AP-HP), Benjamin Zuber (Versailles).

Compliance with ethical standards

Conflicts of interest

This study received a financial support of the Fondation de France (#0069110). The authors have not disclosed any potential conflicts of interest.

Supplementary material

134_2018_5341_MOESM1_ESM.docx (58 kb)
Supplementary material 1 (DOCX 57 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Damien Contou
    • 1
    • 2
    Email author
  • Romain Sonneville
    • 3
  • Florence Canoui-Poitrine
    • 4
    • 5
  • Gwenhaël Colin
    • 6
  • Rémi Coudroy
    • 7
    • 8
  • Frédéric Pène
    • 9
  • Jean-Marc Tadié
    • 10
  • Martin Cour
    • 11
  • Gaëtan Béduneau
    • 12
  • Antoine Marchalot
    • 13
  • Laurent Guérin
    • 14
  • Sébastien Jochmans
    • 15
  • Stephan Ehrmann
    • 16
  • Nicolas Terzi
    • 17
  • Sébastien Préau
    • 18
  • François Barbier
    • 19
  • Guillaume Schnell
    • 20
  • Damien Roux
    • 21
  • Olivier Leroy
    • 22
  • Claire Pichereau
    • 23
  • Elodie Gélisse
    • 24
  • Lara Zafrani
    • 25
  • Richard Layese
    • 4
  • Christian Brun-Buisson
    • 1
  • Armand Mekontso Dessap
    • 1
  • Nicolas de Prost
    • 1
  • For the Hopeful Study Group
  1. 1.Service de Réanimation Médicale, Groupe de Recherche CARMAS, Assistance Publique-Hôpitaux de ParisCentre Hospitalier Universitaire Henri MondorCréteilFrance
  2. 2.Service de Réanimation PolyvalenteCentre Hospitalier Victor DupouyArgenteuilFrance
  3. 3.Service de Réanimation MédicaleHôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de ParisParisFrance
  4. 4.Service de Santé PubliqueHôpital Henri-Mondor, Assistance Publique-Hôpitaux de ParisCréteilFrance
  5. 5.Clinical Epidemiology and Ageing UnitUniversité Paris-Est, UPEC, DHU A-TVB, IMRB-EA7376 CEpiACréteilFrance
  6. 6.Service de Réanimation Médico-chirurgicaleCentre Hospitalier Départemental de Vendée, Boulevard Stéphane MoreauLa Roche-sur-YonFrance
  7. 7.Service de Réanimation MédicaleCentre Hospitalier Universitaire de PoitiersPoitiersFrance
  8. 8.INSERM CIC1402, ALIVE GroupUniversité de PoitiersPoitiersFrance
  9. 9.Service de Réanimation MédicaleHôpital Cochin, Assistance Publique-Hôpitaux de ParisParisFrance
  10. 10.Service de Réanimation MédicaleCentre Hospitalier Universitaire de RennesRennesFrance
  11. 11.Réanimation MédicaleHospices Civils de Lyon, Groupement Hospitalier Edouard HerriotLyonFrance
  12. 12.Service de Réanimation MédicaleCentre Hospitalier Universitaire de RouenRouenFrance
  13. 13.Service de Réanimation PolyvalenteCentre Hospitalier de MelunMelunFrance
  14. 14.CHRU de Tours, Médecin Intensive Réanimation, CIC 1415, CRICS-TriggerSEP, Centre d’étude des Pathologies Respiratoires, INSERM U1100Université de ToursToursFrance
  15. 15.Service de Réanimation PolyvalenteCentre Hospitalier de MelunMelunFrance
  16. 16.Service de Réanimation MédicaleCentre Hospitalier Régional UniversitaireToursFrance
  17. 17.Service de Réanimation MédicaleCentre Hospitalier Universitaire Grenoble AlpesLa TroncheFrance
  18. 18.Service de Réanimation MédicaleCentre Hospitalier Régional Universitaire de LilleLilleFrance
  19. 19.Service de Réanimation MédicaleCentre Hospitalier Régional d’OrléansOrléansFrance
  20. 20.Service de Réanimation Médico-ChirurgicaleGH Le HavreLe HavreFrance
  21. 21.Service de Réanimation Médico-ChirurgicaleHôpital Louis Mourier, Assistance Publique-Hôpitaux de ParisColombesFrance
  22. 22.Service de Réanimation Médico-ChirurgicaleCentre Hospitalier de TourcoingTourcoingFrance
  23. 23.Service de Réanimation Médico-ChirurgicaleCentre Hospitalier Intercommunal Poissy/Saint-Germain-en-LayePoissyFrance
  24. 24.Service de Réanimation Médico-Chirurgicale, Hôpital Maison BlancheCentre Hospitalier Universitaire de ReimsReimsFrance
  25. 25.Service de Réanimation Médicale, Assistance Publique-Hôpitaux de ParisCentre Hospitalier Universitaire Saint-LouisParisFrance

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