Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study
Abstract Background We aimed to investigate the association of intracranial complications diagnosed on neuroimaging with neurological outcomes of adults with severe pneumococcal meningitis. Methods We performed a retrospective multicenter study on consecutive adults diagnosed with pneumococcal menin...
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2024-12-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-024-01405-z |
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| author | Camille Legouy Renaud Cornic Keyvan Razazi Damien Contou Stéphane Legriel Eve Garrigues Pauline Buiche Maxens Decavèle Sarah Benghanem Thomas Rambaud Jérôme Aboab Marina Esposito-Farèse Jean-François Timsit Camille Couffignal Romain Sonneville |
| author_facet | Camille Legouy Renaud Cornic Keyvan Razazi Damien Contou Stéphane Legriel Eve Garrigues Pauline Buiche Maxens Decavèle Sarah Benghanem Thomas Rambaud Jérôme Aboab Marina Esposito-Farèse Jean-François Timsit Camille Couffignal Romain Sonneville |
| author_sort | Camille Legouy |
| collection | DOAJ |
| description | Abstract Background We aimed to investigate the association of intracranial complications diagnosed on neuroimaging with neurological outcomes of adults with severe pneumococcal meningitis. Methods We performed a retrospective multicenter study on consecutive adults diagnosed with pneumococcal meningitis requiring at least 48 h of stay in the intensive care unit (ICU) and undergoing neuroimaging, between 2005 and 2021. All neuroimaging were reanalyzed to look for intracranial complications which were categorized as (1) ischemic lesion, (2) intracranial hemorrhage (3) abscess/empyema, (4) ventriculitis, (5) cerebral venous thrombosis, (6) hydrocephalus, (7) diffuse cerebral oedema. The primary outcome was unfavorable outcome at 90 days after ICU admission, defined by a modified Rankin Scale (mRS) score > 2. Results Among the 237 patients included, intracranial complications were diagnosed in 68/220 patients (31%, 95%CI 0.25–0.37) who underwent neuroimaging at ICU admission and in 75/110 patients (68%, 95%CI 0.59–0.77) who underwent neuroimaging during ICU stay. At 90 days, 103 patients (44%, 95%CI 37–50) had unfavorable outcome, including 71 (30%) deaths. The most frequent intracranial complications were ischemic lesion (69/237 patients, 29%), diffuse cerebral oedema (43/237, 18%) and ventriculitis (36/237, 15%). Through multivariable analysis, we found that intracranial complications (adjusted odds ratio (aOR) 2.88, 95%CI 1.37–6.21) were associated with unfavorable outcome, along with chronic alcohol consumption (aOR 3.10, 95%CI 1.27–7.90), chronic vascular disease (aOR 4.41, 95%CI 1.58–13.63), focal neurological sign(s) (aOR 2.38, 95%CI 1.11–5.23), and cerebrospinal fluid leukocyte count < 1000 cell/microL (aOR 4.24, 95%CI 2.11–8.83). Competing risk analysis, with persistent disability (mRS score 3–5) as the primary risk and ICU-death as the competing risk, revealed that chronic alcohol consumption was the sole significant variable associated with persistent disability at 90 days (cause-specific hazard ratio 4.26, 95%CI 1.83–9.91), whereas the remaining variables were associated with mortality. Conclusions In adults with severe pneumococcal meninigitis, intracranial complications were independently associated with a higher risk of poor functional outcome, in the form of persistent disability or death. This study highlights the value of neuroimaging studies in this population, and provides relevant information for prognostication. |
| format | Article |
| id | doaj-art-d99d82c0474444c38c11daf8c6d1684e |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
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| series | Annals of Intensive Care |
| spelling | doaj-art-d99d82c0474444c38c11daf8c6d1684e2025-02-02T12:42:28ZengSpringerOpenAnnals of Intensive Care2110-58202024-12-0114111210.1186/s13613-024-01405-zIntracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort studyCamille Legouy0Renaud Cornic1Keyvan Razazi2Damien Contou3Stéphane Legriel4Eve Garrigues5Pauline Buiche6Maxens Decavèle7Sarah Benghanem8Thomas Rambaud9Jérôme Aboab10Marina Esposito-Farèse11Jean-François Timsit12Camille Couffignal13Romain Sonneville14Service d’anesthésie-réanimation, GHU Paris Psychiatrie & NeurosciencesCentre d’Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital BichatMédecine intensive réanimation, Hôpital Henri MondorMédecine intensive réanimation, Centre hospitalier d’ArgenteuilMédecine intensive réanimation, Centre hospitalier de VersaillesMédecine intensive réanimation, Hôpital Ambroise ParéMédecine intensive réanimation, Hôpital de Saint AntoineGroupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S)Médecine intensive réanimation, Hôpital CochinMédecine intensive réanimation, Hôpital AvicenneMédecine intensive réanimation, Hôpital DelafontaineCentre d’Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital BichatUniversité Paris Cité, INSERM U1137Centre d’Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital BichatUniversité Paris Cité, INSERM U1137Abstract Background We aimed to investigate the association of intracranial complications diagnosed on neuroimaging with neurological outcomes of adults with severe pneumococcal meningitis. Methods We performed a retrospective multicenter study on consecutive adults diagnosed with pneumococcal meningitis requiring at least 48 h of stay in the intensive care unit (ICU) and undergoing neuroimaging, between 2005 and 2021. All neuroimaging were reanalyzed to look for intracranial complications which were categorized as (1) ischemic lesion, (2) intracranial hemorrhage (3) abscess/empyema, (4) ventriculitis, (5) cerebral venous thrombosis, (6) hydrocephalus, (7) diffuse cerebral oedema. The primary outcome was unfavorable outcome at 90 days after ICU admission, defined by a modified Rankin Scale (mRS) score > 2. Results Among the 237 patients included, intracranial complications were diagnosed in 68/220 patients (31%, 95%CI 0.25–0.37) who underwent neuroimaging at ICU admission and in 75/110 patients (68%, 95%CI 0.59–0.77) who underwent neuroimaging during ICU stay. At 90 days, 103 patients (44%, 95%CI 37–50) had unfavorable outcome, including 71 (30%) deaths. The most frequent intracranial complications were ischemic lesion (69/237 patients, 29%), diffuse cerebral oedema (43/237, 18%) and ventriculitis (36/237, 15%). Through multivariable analysis, we found that intracranial complications (adjusted odds ratio (aOR) 2.88, 95%CI 1.37–6.21) were associated with unfavorable outcome, along with chronic alcohol consumption (aOR 3.10, 95%CI 1.27–7.90), chronic vascular disease (aOR 4.41, 95%CI 1.58–13.63), focal neurological sign(s) (aOR 2.38, 95%CI 1.11–5.23), and cerebrospinal fluid leukocyte count < 1000 cell/microL (aOR 4.24, 95%CI 2.11–8.83). Competing risk analysis, with persistent disability (mRS score 3–5) as the primary risk and ICU-death as the competing risk, revealed that chronic alcohol consumption was the sole significant variable associated with persistent disability at 90 days (cause-specific hazard ratio 4.26, 95%CI 1.83–9.91), whereas the remaining variables were associated with mortality. Conclusions In adults with severe pneumococcal meninigitis, intracranial complications were independently associated with a higher risk of poor functional outcome, in the form of persistent disability or death. This study highlights the value of neuroimaging studies in this population, and provides relevant information for prognostication.https://doi.org/10.1186/s13613-024-01405-zPneumococcal meningitisIntracranial complicationsNeurologyIntensive care unitNeuropronostication |
| spellingShingle | Camille Legouy Renaud Cornic Keyvan Razazi Damien Contou Stéphane Legriel Eve Garrigues Pauline Buiche Maxens Decavèle Sarah Benghanem Thomas Rambaud Jérôme Aboab Marina Esposito-Farèse Jean-François Timsit Camille Couffignal Romain Sonneville Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study Annals of Intensive Care Pneumococcal meningitis Intracranial complications Neurology Intensive care unit Neuropronostication |
| title | Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study |
| title_full | Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study |
| title_fullStr | Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study |
| title_full_unstemmed | Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study |
| title_short | Intracranial complications in adult patients with severe pneumococcal meningitis: a retrospective multicenter cohort study |
| title_sort | intracranial complications in adult patients with severe pneumococcal meningitis a retrospective multicenter cohort study |
| topic | Pneumococcal meningitis Intracranial complications Neurology Intensive care unit Neuropronostication |
| url | https://doi.org/10.1186/s13613-024-01405-z |
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