Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

A. F. Miailhe (1) , E. Mercier (2) , A. Maamar (3) , J. C. Lacherade (4) , A. Le Thuaut (1) , Alina Gaultier (1) , P. Asfar (5) , L. Argaud (6) , A. Ausseur (7) , A. Ben Salah (8) , V. Botoc (9) , K. Chaoui (10) , J. Charpentier (11) , C. Cracco (12) , N. de Prost (13) , M. L. Eustache (14) , A. Ferre (15) , E. Gauvin (16) , S. Goursaud (17) , M. Grall (18) , P. Guiot (19) , M. Jonas (20) , F. Lambiotte (21) , M. Landais (22) , J. Lemarie (23, 24) , O. Lesieur (25) , C. Lhommet (26) , P. Michel (27) , Y. Monseau (28) , S. Moschietto (29) , S. Nseir (30) , D. Osman (31) , J. Pillot (32) , G. Piton (33) , N. Sedillot (34) , M. Sirodot (35) , D. Thevenin (36) , L. Zafrani (37) , Y. Zerbib (38) , Pascale Bourhy (39) , J. B. Lascarrou (1) , J. Reignier (1)

1 CHU Nantes - Centre Hospitalier Universitaire de Nantes
2 Hôpital Bretonneau
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
5 Service de Réanimation Médicale, CHU d'Angers, France
6 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
7 CH Cholet - Centre Hospitalier de Cholet
8 Hôpitaux de Chartres [Chartres]
9 Service de réanimation (CH Saint-Malo)
10 Centre Hospitalier Cahors
11 Hôpital Cochin [AP-HP]
12 CH Angoulême - Centre Hospitalier d'Angoulême
13 CIC Henri Mondor - Centre d'Investigation Clinique Henri Mondor
14 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
15 CHV - Centre Hospitalier de Versailles André Mignot
16 CH Georges Renon Niort - Centre Hospitalier Georges Renon [Niort]
17 CHU Caen
18 Hôpital Charles Nicolle [Rouen]
19 Centre Hospitalier de Mulhouse, site du Hasenrain (Mulhouse)
20 Centre hospitalier de Saint-Nazaire
21 Centre hospitalier [Valenciennes, Nord]
22 Centre Hospitalier Le Mans (CH Le Mans)
23 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
24 Service de Réanimation Médicale [CHRU Nancy]
25 Centre Hospitalier de La Rochelle (CHR)
26 CHU de Saint-Brieuc
27 Centre Hospitalier René Dubos [Pontoise]
28 CH Périgueux - Hopital de Périgueux
29 Centre Hospitalier Henri Duffaut (Avignon)
30 CIC Lille - Centre d'Investigation Clinique - Innovation Technologique de Lille - CIC 1403 - CIC 9301
31 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
32 CHCB - Centre Hospitalier de la Côte Basque
33 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
34 CHBBF - Centre Hospitalier Fleyriat [Bourg en Bresse]
35 Centre Hospitalier d'Annecy
36 Centre Hospitalier de Lens
37 Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
38 CHU Amiens-Picardie
39 Biologie des Spirochètes / Biology of Spirochetes

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.

Mots clés: *Outcome; *Intensive care unit; *Temperate zone; *Severe leptospirosis; *Mortality

Domaines: Sciences du Vivant [q-bio]

A. F. Miailhe, E. Mercier, A. Maamar, J. C. Lacherade, A. Le Thuaut, et al.. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Medicine, 2019, 45 (12), pp.1763--1773. ⟨10.1007/s00134-019-05808-6⟩. ⟨hal-02465751⟩