Critical West Nile Neuroinvasive Disease
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Data to guide neurointensivists seeing patients with West Nile Neuroinvasive disease (WNND) are lacking. We present a comparatively large series of patients with WNND admitted to the intensive care unit (ICU) and provide data on their early diagnosis, triage to the ICU and predictors of short-term outcomes.
We retrospectively identified patients aged ≥ 18 years old with WNND from January 1999 to November 2016. Demographic and clinical data, the modified Rankin Scale at discharge and disposition were collected. Univariate analysis was performed to find predictors of ICU admission and to assess the impact of ICU admission on the short-term outcomes. P values < 0.05 were considered significant.
Among 26 patients, 16 were admitted to the ICU. Age < 60 years and the presentation with encephalitis and acute flaccid paralysis predicted ICU admission (P = 0.044 and 0.0007). Among patients requiring ICU admission, four died and no one was discharged home. ICU admission predicted longer hospital stay (P = 0.021), inhospital death (P = 0.034), survival with inability to walk independently (P = 0.0094), and discharge disposition other than home (P = 0.007). In the ICU group, older age was associated with longer hospital stay (P = 0.0001) and inhospital death (P = 0.035).
WNND requiring ICU care has a high morbidity and mortality, especially among older patients. Survivors are highly disabled at discharge, but many improve over time. Therefore, more data on the long-term prognosis of survivors are needed to guide the goals of care in the acute setting.
KeywordsWest Nile virus Critical care Encephalitis Acute flaccid paralysis
MAH was involved in study conception, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision. IDC contributed to acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision. EFMW helped in analysis and interpretation of data, drafting of manuscript and critical revision. AAR was involved in study conception, analysis and interpretation of data, drafting of manuscript and critical revision.
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 2.Prevention CfDCa. West Nile virus disease cases and deaths reported to CDC by year and clinical presentation 1999–2015. https://www.cdc.gov/westnile/statsmaps/cumMapsData.html#three.