Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

A Correction to this article was published on 25 July 2019

This article has been updated

Abstract

Purpose

We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission.

Methods

We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3–6 (indicating moderate-to-severe disability or death) on the modified Rankin scale.

Results

Overall, 259 patients with a score on the Glasgow coma scale of 9 (6–12) and a body temperature of 38.7 (38.1–39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18–4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21–4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35–6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28–0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results.

Conclusions

In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

  • 25 July 2019

    The original article unfortunately contained a mistake. Due to technical problems the study group was not tagged correctly. Please find the correct tagging down below. We apologize for the mistake.

References

  1. Granerod J, Ambrose HE, Davies NW et al (2010) Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 10:835–844

    Article  PubMed  Google Scholar 

  2. Mailles A, De Broucker T, Costanzo P et al (2012) Long-term outcome of patients presenting with acute infectious encephalitis of various causes in France. Clin Infect Dis 54:1455–1464

    Article  PubMed  Google Scholar 

  3. Whitley RJ, Soong SJ, Dolin R et al (1977) Adenine arabinoside therapy of biopsy-proved herpes simplex encephalitis. National Institute of Allergy and Infectious Diseases collaborative antiviral study. N Engl J Med 297:289–294

    Article  CAS  PubMed  Google Scholar 

  4. Modi S, Mahajan A, Dharaiya D et al (2017) Burden of herpes simplex virus encephalitis in the United States. J Neurol 264(6):1204–1208

    Article  CAS  PubMed  Google Scholar 

  5. Raschilas F, Wolff M, Delatour F et al (2002) Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis 35:254–260

    Article  PubMed  Google Scholar 

  6. Singh TD, Fugate JE, Hocker S et al (2016) Predictors of outcome in HSV encephalitis. J Neurol 263:277–289

    Article  CAS  PubMed  Google Scholar 

  7. Wijdicks EFM, Menon DK, Smith M (2015) Ten things you need to know to practice neurological critical care. Intensive Care Med 41:318–321

    Article  PubMed  Google Scholar 

  8. Saxena M, Young P, Pilcher D et al (2015) Early temperature and mortality in critically ill patients with acute neurological diseases: trauma and stroke differ from infection. Intensive Care Med 41:823–832

    Article  PubMed  PubMed Central  Google Scholar 

  9. Poissy J, Wolff M, Dewilde A et al (2009) Factors associated with delay to acyclovir administration in 184 patients with herpes simplex virus encephalitis. Clin Microbiol Infect 15:560–564

    Article  CAS  PubMed  Google Scholar 

  10. Poissy J, Champenois K, Dewilde A et al (2012) Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome. BMC Infect Dis 12:356

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jouan Y, Grammatico-Guillon L, Espitalier F et al (2015) Long-term outcome of severe herpes simplex encephalitis: a population-based observational study. Crit Care 19:345

    Article  PubMed  PubMed Central  Google Scholar 

  12. Venkatesan A, Tunkel AR, Bloch KC et al (2013) Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 57:1114–1128

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Knaus WA, Zimmerman JE, Wagner DP et al (1981) APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597

    Article  CAS  PubMed  Google Scholar 

  14. Van Swieten JC, Koudstaal PJ, Visser MC et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    Article  PubMed  Google Scholar 

  15. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  Google Scholar 

  16. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710

    Article  CAS  Google Scholar 

  17. van de Beek D, de Gans J, Spanjaard L et al (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351:1849–1859

    Article  PubMed  Google Scholar 

  18. O’Grady NP, Barie PS, Bartlett JG et al (2008) Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 36:1330–1349

    Article  PubMed  Google Scholar 

  19. Bruno A, Shah N, Lin C et al (2010) Improving modified Rankin Scale assessment with a simplified questionnaire. Stroke 41:1048–1050

    Article  PubMed  Google Scholar 

  20. Bruno A, Akinwuntan AE, Lin C et al (2011) Simplified modified rankin scale questionnaire: reproducibility over the telephone and validation with quality of life. Stroke 42:2276–2279

    Article  Google Scholar 

  21. Stahl JP, Mailles A, De Broucker T, Steering Committee and Investigators Group (2012) Herpes simplex encephalitis and management of acyclovir in encephalitis patients in France. Epidemiol Infect 140:372–381

    Article  CAS  Google Scholar 

  22. Riancho J, Delgado-Alvarado M, Sedano MJ et al (2013) Herpes simplex encephalitis: clinical presentation, neurological sequelae and new prognostic factors. Ten years of experience. Neurol Sci 34:1879–1881

    Article  PubMed  Google Scholar 

  23. Cag Y, Erdem H, Leib S et al (2016) Managing atypical and typical herpetic central nervous system infections: results of a multinational study. Clin Microbiol Infect 22:568.e9–568.e17

    Article  CAS  Google Scholar 

  24. Chow FC, Glaser CA, Sheriff H et al (2015) Use of clinical and neuroimaging characteristics to distinguish temporal lobe herpes simplex encephalitis from its mimics. Clin Infect Dis 60:1377–1383

    PubMed  PubMed Central  Google Scholar 

  25. Stahl JP, Azouvi P, Bruneel F et al (2017) Guidelines on the management of infectious encephalitis in adults. Med Mal Infect 47:179–194

    Article  CAS  PubMed  Google Scholar 

  26. Sonneville R, Gault N, de Montmollin E et al (2015) Clinical spectrum and outcomes of patients with encephalitis requiring intensive care. Eur J Neurol 22(1):6–16

    Article  CAS  PubMed  Google Scholar 

  27. Thakur KT, Motta M, Asemota AO et al (2013) Predictors of outcome in acute encephalitis. Neurology 81:793–800

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sonneville R, Mariotte E, Neuville M et al (2016) Early-onset status epilepticus in patients with acute encephalitis. Medicine (Baltimore) 95:e4092

    Article  Google Scholar 

  29. Sili U, Kaya A, Mert A, HSV Encephalitis Study Group (2014) Herpes simplex virus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients. J Clin Virol 60:112–118

    Article  Google Scholar 

  30. Tan IL, McArthur JC, Venkatesan A, Nath A (2012) Atypical manifestations and poor outcome of herpes simplex encephalitis in the immunocompromised. Neurology 79:2125–2132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

ENCEPHALITICA study group: Julien Marechal, M.D. (Medical Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France). Bruno Mourvillier, M.D., (Medical Intensive Care Unit, CHU de Reims, Reims, France). Frederic Dailler, M.D., (Department of Anesthesiology and Intensive Care Medicine, Hôpital Pierre Wertheimer, Lyon, France). Fabrice Bruneel, M.D. (Medical Intensive Care Unit, André Mignot Hospital, Versailles, France). Alexandre Lautrette, M.D., Ph.D. (Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France). Emmanuel Novy, M.D. (Polyvalent Intensive Care Unit, Mercy Hospital CHR Metz-Thionville, Ars-Laquenexy, France). Bertrand Guidet, M.D. PhD. (Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France). François Mateos, M.D. (Intensive care Unit, Centre hospitalier Saint-Brieuc, Saint-Brieuc, France). Clément Brault, M.D. (Department of Intensive Care Medicine, Amiens-Picardie University Hospital, Amiens, France). Quentin Maestraggi, M.D. (Medical Intensive Care Unit and UMR 1121, Hautepierre Hospital Strasbourg, France). Keyvan Razazi, M.D. (Medical Intensive Care Unit, hopitaux Universitaires Henri Mondor, Créteil, France). Jean-Pierre Quenot, M.D. (Medical Intensive Care Unit, Centre Hospitalo-Universitaire de Dijon, Dijon, France). Aurélie Joret, M.D. (Medical Intensive Care Unit, CHU de Caen, Caen, France). Albrice Levrat, M.D. (Intensive care unit, Centre Hospitalier Annecy-Genevois, Annecy, France). Alexandre Massri, M.D. (Intensive Care Unit, Centre Hospitalier Francois Mitterand Pau, France). Alexandre Robert, M.D. (Medical Intensive Care Unit, Hôpital de l’Archet 1, CHU de Nice, Nice, France). Damien Contou, M.D. (Polyvalent Intensive Care Unit, Centre Hospitalier Victor Dupouy, Argenteuil, France). Jean-Paul Mira, M.D. Ph.D. (Medical Intensive Care Unit, Cochin University Hospital, Paris, France). Gaudry Stephane, M.D., Ph.D. (Polyvalent Intensive Care Unit, Louis Mourier University Hospital, Colombes, France). Guillaume Voiriot, M.D., Ph.D. (Polyvalent Intensive Care Unit, Centre Hospitalier Universitaire Tenon, Paris, France). Asael Berger, M.D. (Intensive Care Unit, Centre Hospitalier de Haguenau, Haguenau, France). Vincent Das, M.D., Ph.D. (Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France). Nicolas Engrand, M.D. (Neurosurgical Intensive Care Unit, Fondation ophtalmologique Adolphe Rotschild, Paris, France. Martin Murgier, M.D. (Intensive care unit, Saint-Etienne University Hospital, Saint-Etienne, France). Shidasp Siami, M.D. (Polyvalent ICU, Centre Hospitalier Sud Essone Dourdan-Etampes-Siège, Etampes, France). Sami Hraiech, M.D., Ph.D. (Medical Intensive Care Unit, Aix-Marseille Universite, Hopital Nord, Marseille, France). Eric Mariotte, M.D. (Medical ICU, Saint-Louis Hospital, Paris, France). Claire Ragot, M.D. (Medical-Surgical ICU, Robert Boulin Hospital, Libourne, France). Annabelle Stoclin, M.D. (Intensive Care Unit, Institut Gustave Roussy, Villejuif, France). Pierre Trouiller, M.D. (Intensive Care Unit, Antoine Béclère Hospital, Clarmart, France). Mathieu Schmidt, M.D., Ph.D. (Medical Intensive Care Unit, Hôpital Pitié–Salpêtrière, AP-HP, Paris, France).

Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex, France

    P. Jaquet, E. de Montmollin, C. Dupuis, M. Wolff, L. Bouadma, J. F. Timsit & R. Sonneville

  2. UMR 1137, IAME, Paris Diderot University, Paris, France

    E. de Montmollin, C. Dupuis, L. Bouadma & J. F. Timsit

  3. Medical Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France

    C. Sazio

  4. Medical Intensive Care Unit, Central Hospital, Nancy University Hospitals, Nancy, France

    M. Conrad

  5. Polyvalent Intensive Care Unit, Chambery Hospital, Chambery, France

    V. Susset

  6. Neurologic Intensive Care Unit, Pitié–Salpêtrière University Hospital, AP-HP, Paris, France

    S. Demeret

  7. Medical Intensive Care Unit, Pontchaillou University Hospital, Rennes, France

    J. M. Tadie

  8. Medical Intensive Care Unit, Edouard Herriot University Hospital, Lyon, France

    L. Argaud

  9. Medical Intensive Care Unit, La Source Hospital, Orléans, France

    F. Barbier

  10. Intensive Care Unit, Purpan University Hospital, Toulouse, France

    B. Sarton & S. Silva

  11. Department of Perioperative Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France

    R. Chabane

  12. Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France

    D. Daubin

  13. Medical Intensive Care Unit, Nantes University Hospital, Nantes, France

    N. Brulé

  14. Medical Intensive Care Unit, CHU Angers, Angers University Hospital, Angers, France

    N. Lerolle

  15. Polyvalent Intensive Care Unit, Poissy–Saint-Germain-en-Laye Hospital, Poissy, France

    M. Alves

  16. Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France

    D. Da Silva

  17. Medical Intensive Care Unit, Roger Salengro University Hospital, Lille, France

    A. El Kalioubi

  18. Medical Intensive Care Unit, La Cavale Blanche University Hospital, Brest, France

    P. Bailly

  19. UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France

    R. Sonneville

Authors
  1. P. Jaquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. de Montmollin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Dupuis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Sazio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Conrad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Susset
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Demeret
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. M. Tadie
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Argaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. Barbier
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. B. Sarton
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. R. Chabane
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. D. Daubin
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. N. Brulé
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. N. Lerolle
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. M. Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. D. Da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. A. El Kalioubi
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. S. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. P. Bailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. M. Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. L. Bouadma
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. J. F. Timsit
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. R. Sonneville
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

ENCEPHALITICA study group

Corresponding author

Correspondence to R. Sonneville.

Ethics declarations

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

ENCEPHALITICA study group members are listed in “Acknowledgements”.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 617 kb)

Supplementary material 2 (DOCX 32 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jaquet, P., de Montmollin, E., Dupuis, C. et al. Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study. Intensive Care Med 45, 1103–1111 (2019). https://doi.org/10.1007/s00134-019-05684-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-019-05684-0

Keywords

Search

Navigation