Abstract
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.
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Acknowledgements
We are indebted to A. Wolfe, M.D., who helped to prepare and review the manuscript.
The members of LEPTOREA are Djillali Annane, Kevin Arandel, Pierre-Marie Bertrand, P. Bouju, Yves Cohen, Jean Dellamonica, Jérôme Devaquet, Michel Djibre, Olivier Ellrodt, Henri Faure, Nicolas Ferrière, Claude Guérin, Florent Joly, Philippe Letocart, Charles-Edouard Luyt, Philippe Mateu, Hamid Merdji, Olivier Michel, Omar Ben Hadj Salem, Laurent Papazian, Olivier Passouant, Walter Picard, Fabienne Plouvier, Jean-Pierre Quenot, Jean-Damien Ricard, Jean-Philippe Rigaud, Frédérique Schortgen, Bertrand Souweine, Benjamin Sztrymf, Nicolas Terzi, Toufik Kamel, Kada Klouche, Thierry Vanderlinden, Philippe Vignon, Christophe Vinsonneau, Roland De Varax, Jérôme Roustan, Fabrice Zeni, Guy Le Gall, Jean-Luc Diehl, Bertrand Guidet, Vincent Das, Jacques Durand Gasselin.
Funding
The study was supported by the Nantes University Hospital.
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Authors and Affiliations
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Contributions
A-FM, ALT, AG, PB, J-BL, and JR designed the study, analyzed the data and wrote the original manuscript. EM, AM, J-CL, PA, LA, AA, ABS, VB, KC, JC, CC, NP, M-LE, AF, EG, SG, MG, PG, MJ, FL, ML, JL, OL, CL, PM, YM, SM, SN, DO, JP, GP, NS, MS, DT, LZ, YZ, participated in acquiring the data and writing the manuscript. All authors approved the final version of the manuscript and have agreed to be accountable for the work it reports.
Djillali Annane, service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré (APHP), Faculté Simone Veil des science de la santé, Université de Versailles Saint-Quentin en Yvelines, Université Paris Saclay, Garches, France. Kevin Arandel, Service de Réanimation polyvalente, Centre Hospitalier de Cahors, Cahors, France. Pierre-Marie Bertrand, Service de Médecine Intensive Réanimation, CH de Cannes, Cannes, France. Bouju P, Service de Réanimation Polyvalente, CH Bretagne Sud, Lorient, France. Yves Cohen, Service de Réanimation Médico-Chirurgicale, CHU Avicenne, Hôpitaux Universitaires Paris Seine Saint Denis, APHP, Bobigny, France. Jean Dellamonica, service de Médecine Intensive-Réanimation, Archet 1, CHU de Nice, Nice, France; Université Côte d’Azur UCA, Nice, Franc. Jérôme Devaquet, service de Réanimation polyvalente, hôpital Foch, Suresnes, France. Michel Djibre, Service de Réanimation, medico-chirurgicale, CHU Tenon, APHP, Paris, France. Olivier Ellrodt, CH Melun, Service de Médecine Intensive Réanimation, Melun, France. Henri Faure, service de Réanimation, CH d’Aulnay, Aulnay, France. Nicolas Ferrière, Service de Réanimation médicale, CHU Brest, Brest, France. Claude Guérin, Service de Réanimation médicale, CHU Lyon 2, Lyon, France. Florent Joly, Université de Poitiers; service de Médecine Intensive Réanimation, CHU Poitiers, Poitiers, France. Philippe Letocart, Service de Réanimation polyvalente, Hopital Jacques Puel, Rodez, France. Charles-Edouard Luyt, service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de la Sorbonne, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France. Philippe Mateu. Service de Médecine Intensive Réanimation, CH Charleville-Mézière, Charlesville-Mézière, France. Hamid Merdji, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, service de réanimation, Nouvel Hôpital Civil, Strasbourg, France. Olivier Michel, Service de Réanimation, Centre Hospitalier Jacques Coeur, Bourges, France. Omar Ben Hadj Salem, MD; Réanimation Médico-chirurgicale, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France. Laurent Papazian, Centre d’Etudes et de Recherches sur les Services de Santé et qualité de vie EA3279, APHM, Hôpital Nord, Médecine Intensive-Réanimation, Aix-Marseille Université, 13015, Marseille, France. Olivier Passouant, Service de Réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, Reims, France. Walter Picard, Service de Réanimation, CH de Pau, Pau, France. Fabienne Plouvier, Service de Réanimation polyvalente, CH Agen, France. Jean-Pierre Quenot, Service de Médecine Intensive Réanimation, CHU François Mitterrand, Dijon, France; Lipness Team, INSERM LNC-UMR1231, LabExLipSTIC, INSERM CIC 1432, Epidémiologie Clinique, Université de Bourgogne, Dijon, France. Jean-Damien Ricard. INSERM, IAME, UMR 1137, F-75018 Paris, France; AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France. Jean-Philippe Rigaud, Service de Médecine Intensive Réanimation, CH Dieppe, Dieppe, France. Frédérique Schortgen, Service de réanimation et de surveillance continue, Centre Hospital Intercommunal, Créteil, France. Bertrand Souweine, CHU Clermont-Ferrand, Service de Médecine Intensive Réanimation, Clermont-Ferrand, France. Benjamin Sztrymf, service de Médecine Intensive–Réanimation, Hôpital Antoine Béclère, APHP, Clamart, France; INSERM U999 “HTAP: Physiopathologie et innovation thérapeutique”. Nicolas Terzi, service de Médecine Intensive–Réanimation, CHU de Grenoble, Grenoble, France; Inserm U 1032, Université de Grenoble, Grenoble, FranceToufik Kamel, CHR Orléans, Service de Médecine Intensive Réanimation, Orléans, France. Kada Klouche, Service de Médecine Intensive Réanimation, Hopital Lapeyronnie, CHU de Montpellier, Montpellier, France. Thierry Vanderlinden, Service de Médecine Intensive Réanimation, GH ICL, Lomme, France. Philippe Vignon, Service de reanimation, CHU de Limoges, Limoges, France. Christophe Vinsonneau, Service de Réanimation et Surveillance continue, Centre Hospitalier de Béthune, Béthune, France. Roland De Varax, CH de Macon, Service de Médecine Intensive Réanimation, Macon, France. Jérôme Roustan, Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France. Fabrice Zeni, CHU de Saint Etienne, Service de Médecine Intensive Réanimation, Saint Etienne, France. Guy Le Gall, CH Morlaix, Service de Médecine Intensive Réanimation, Morlaix, France. Jean-Luc Diehl, Hopital Européen Georges-Pompidou, AP-HP, Service de Médecine Intensive Réanimation, Paris, France. Bertrand Guidet, CHU Saint-Antoine, APHP, Service de Médecine Intensive Réanimation, Paris, France. Vincent Das, Centre Hospitalier Intercommunal André Grégoire, Réanimation polyvalente, Montreuil, France. Jacques Durand Gasselin, Service de réanimation polyvalente, Centre Hospitalier Sainte-Musse, Toulon, France.
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Miailhe, AF., Mercier, E., Maamar, A. et al. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Med 45, 1763–1773 (2019). https://doi.org/10.1007/s00134-019-05808-6
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DOI: https://doi.org/10.1007/s00134-019-05808-6