Functional outcome after infectious encephalitis: a longitudinal multicenter prospective cohort study.

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2024-11-08 DOI:10.1016/j.cmi.2024.11.001

Pierre Fillâtre, Alexandra Mailles, Jean Paul Stahl, Ronan Garlantezec, Marion Le Marechal, Pierre Tattevin, Sophie Abgrall, Guillaume Baille, Aurélie Baldolli, Kevin Bertrand, Julien Biberon, Charlotte Biron, Geneviève Blanchet-Fourcade, Mathieu Blot, Anne Bonnetain, Elisabeth Botelho-Nevers, David Boutoille, Hélène Brasme, Cédric Bruel, Rodolphe Buzele, Etienne Canouï, Bernard Castan, Charles Cazanave, Céline Cazorla, Thibault Challan-Belval, Pascal Chavanet, Catherine Chirouze, Tomasz Chroboczek, Johan Courjon, Thomas De Broucker, Arnaud De La Blanchardière, Etienne de Montmollin, Eric Denes, Aurélien Dinh, Olivier Epaulard, Pierre Fillatre, Emmanuel Forestier, Amandine Gagneux-Brunon, Nicolas Gaillard, Julien Gautier, François Goehringer, Simon Gravier, Isabelle Gueit, Thomas Guimard, Carole Henry, Jean-Etienne Herbrecht, Fanny Jomier, Snejana Jurici, Solene Kerneis, Jessica Krause, Manuela Le Cam, Marion Le Maréchal, Gwenael Le Moal, Paul Le Turnier, Raphael Lecomte, Anne-Sophie Lecompte, Romain Lefaucheur, Olivier Lesieur, Philippe Lesprit, Guillaume Louis, Rafael Mahieu, Alain Makinson, Guillaune Marc, Alexandre Maria, Nathalie Marin, Guillaume Martin-Blondel, Martin Martinot, Alexandre Mas, Philippe Mateu, Laurence Maulin, Frédéric Mechai, Eugénie Mutez, Jérémie Orain, Anne Schieber-Pachart, Nathalie Pansu, Solene Patrat-Delon, Patricia Pavese, Hélène Pelerin, Véronique Pelonde-Erimée, Diane Ponscarme, Mathilde Puges, Vincent Roubeau, Yvon Ruch, Isabelle Runge, Romain Sonneville, Pierre Tattevin, Saber Touati, Jean-Marie Turmel, Isabelle Tyvaert, Marc-Olivier Vareil, Virginie Vitrat, Heidi Wille, Mathieu Zuber, Emmanuel Canet, Jean Reignier, Adrien Wang

{"title":"Functional outcome after infectious encephalitis: a longitudinal multicenter prospective cohort study.","authors":"Pierre Fillâtre, Alexandra Mailles, Jean Paul Stahl, Ronan Garlantezec, Marion Le Marechal, Pierre Tattevin, Sophie Abgrall, Guillaume Baille, Aurélie Baldolli, Kevin Bertrand, Julien Biberon, Charlotte Biron, Geneviève Blanchet-Fourcade, Mathieu Blot, Anne Bonnetain, Elisabeth Botelho-Nevers, David Boutoille, Hélène Brasme, Cédric Bruel, Rodolphe Buzele, Etienne Canouï, Bernard Castan, Charles Cazanave, Céline Cazorla, Thibault Challan-Belval, Pascal Chavanet, Catherine Chirouze, Tomasz Chroboczek, Johan Courjon, Thomas De Broucker, Arnaud De La Blanchardière, Etienne de Montmollin, Eric Denes, Aurélien Dinh, Olivier Epaulard, Pierre Fillatre, Emmanuel Forestier, Amandine Gagneux-Brunon, Nicolas Gaillard, Julien Gautier, François Goehringer, Simon Gravier, Isabelle Gueit, Thomas Guimard, Carole Henry, Jean-Etienne Herbrecht, Fanny Jomier, Snejana Jurici, Solene Kerneis, Jessica Krause, Manuela Le Cam, Marion Le Maréchal, Gwenael Le Moal, Paul Le Turnier, Raphael Lecomte, Anne-Sophie Lecompte, Romain Lefaucheur, Olivier Lesieur, Philippe Lesprit, Guillaume Louis, Rafael Mahieu, Alain Makinson, Guillaune Marc, Alexandre Maria, Nathalie Marin, Guillaume Martin-Blondel, Martin Martinot, Alexandre Mas, Philippe Mateu, Laurence Maulin, Frédéric Mechai, Eugénie Mutez, Jérémie Orain, Anne Schieber-Pachart, Nathalie Pansu, Solene Patrat-Delon, Patricia Pavese, Hélène Pelerin, Véronique Pelonde-Erimée, Diane Ponscarme, Mathilde Puges, Vincent Roubeau, Yvon Ruch, Isabelle Runge, Romain Sonneville, Pierre Tattevin, Saber Touati, Jean-Marie Turmel, Isabelle Tyvaert, Marc-Olivier Vareil, Virginie Vitrat, Heidi Wille, Mathieu Zuber, Emmanuel Canet, Jean Reignier, Adrien Wang","doi":"10.1016/j.cmi.2024.11.001","DOIUrl":null,"url":null,"abstract":"Objectives: We aimed to describe longitudinal functional outcome among survivors after an infectious encephalitis (IE) and to analyze risk factors for poor functional outcome.Methods: Patients included in the prospective ENCEIF cohort (France, 2016-2019) were followed-up at 6 months and one year after hospital discharge for assessment of i) functional outcome using modified Rankin scale (mRS); ii) cognitive function and abilities to perform activities of daily living. Risk factors for poor outcome on the full distribution of mRS were estimated using multivariable mixed ordinal regression analysis with time between hospital discharge and follow-up as a covariate.Results: Our follow-up study included 322 patients with 896 mRS evaluations. Median age was 66 [50-74] years, 197/322 were male (61%) and 35/322 were immunocompromised (11%). Causative agents were herpes simplex virus 1 (HSV-1) in 95/322 cases (30%), varicella zoster virus (VZV) in 46/322 cases (14%), others documented IE in 90/322 cases (28%) and unknown in 91/322 cases (28%). Intensive care unit (ICU) admission was necessary for 117/322 patients (36%). Brain imaging was abnormal in 180/311 (58%) of patients. At 6 months, 95/287 (33%) had fully recovered and 181/287 (63%) had persisting symptoms. At 12 months, 124/253 (49%) had fully recovered and 108/253 (43%) had persisting symptoms. The proportion of patients who improved was 41% (117/287) during the first 6 months, and 24% (52/218) between 6 and 12 months. Factors significantly associated with poor functional outcome were age, immunosuppression, ICU admission, abnormal brain imaging and causative agents, notably HSV-1. Follow-up visit during the first 120 days did not detect significant change in functional outcome, but was strongly associated with better outcome at the subsequent evaluation.Conclusions: After IE, improvement may take several months. Functional outcome is associated with baseline health status (age, immunosuppression), abnormal brain imaging, ICU admission, and causative agent.","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cmi.2024.11.001","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: We aimed to describe longitudinal functional outcome among survivors after an infectious encephalitis (IE) and to analyze risk factors for poor functional outcome.

Methods: Patients included in the prospective ENCEIF cohort (France, 2016-2019) were followed-up at 6 months and one year after hospital discharge for assessment of i) functional outcome using modified Rankin scale (mRS); ii) cognitive function and abilities to perform activities of daily living. Risk factors for poor outcome on the full distribution of mRS were estimated using multivariable mixed ordinal regression analysis with time between hospital discharge and follow-up as a covariate.

Results: Our follow-up study included 322 patients with 896 mRS evaluations. Median age was 66 [50-74] years, 197/322 were male (61%) and 35/322 were immunocompromised (11%). Causative agents were herpes simplex virus 1 (HSV-1) in 95/322 cases (30%), varicella zoster virus (VZV) in 46/322 cases (14%), others documented IE in 90/322 cases (28%) and unknown in 91/322 cases (28%). Intensive care unit (ICU) admission was necessary for 117/322 patients (36%). Brain imaging was abnormal in 180/311 (58%) of patients. At 6 months, 95/287 (33%) had fully recovered and 181/287 (63%) had persisting symptoms. At 12 months, 124/253 (49%) had fully recovered and 108/253 (43%) had persisting symptoms. The proportion of patients who improved was 41% (117/287) during the first 6 months, and 24% (52/218) between 6 and 12 months. Factors significantly associated with poor functional outcome were age, immunosuppression, ICU admission, abnormal brain imaging and causative agents, notably HSV-1. Follow-up visit during the first 120 days did not detect significant change in functional outcome, but was strongly associated with better outcome at the subsequent evaluation.

Conclusions: After IE, improvement may take several months. Functional outcome is associated with baseline health status (age, immunosuppression), abnormal brain imaging, ICU admission, and causative agent.

查看原文本刊更多论文

传染性脑炎后的功能预后：一项纵向多中心前瞻性队列研究。

目的我们旨在描述感染性脑炎（IE）幸存者的纵向功能预后，并分析不良功能预后的风险因素：前瞻性ENCEIF队列（法国，2016-2019年）中的患者在出院后6个月和1年接受随访，评估i）使用改良Rankin量表（mRS）的功能预后；ii）认知功能和日常生活活动能力。采用多变量混合序数回归分析法，以出院和随访之间的时间作为协变量，估算了mRS全部分布情况下不良预后的风险因素：我们的随访研究包括322名患者，共进行了896次mRS评估。中位年龄为 66 [50-74] 岁，197/322 为男性（61%），35/322 为免疫功能低下者（11%）。95/322例（30%）的病原体为单纯疱疹病毒1（HSV-1），46/322例（14%）的病原体为水痘带状疱疹病毒（VZV），90/322例（28%）的病原体为其他有记录的IE，91/322例（28%）的病原体未知。117/322例患者（36%）需要入住重症监护室（ICU）。180/311（58%）名患者的脑成像出现异常。6个月后，95/287（33%）名患者完全康复，181/287（63%）名患者症状持续存在。12个月时，124/253（49%）人完全康复，108/253（43%）人症状持续存在。在最初的 6 个月中，病情好转的患者比例为 41%（117/287），在 6 至 12 个月期间，病情好转的患者比例为 24%（52/218）。年龄、免疫抑制、入住重症监护室、脑成像异常和致病因子（尤其是 HSV-1）是导致功能转归不佳的重要因素。最初 120 天的随访并未发现功能预后的明显变化，但与随后评估的较好预后密切相关：结论：IE 后，病情的改善可能需要几个月的时间。功能预后与基线健康状况（年龄、免疫抑制）、异常脑成像、入住重症监护室和致病因素有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.