ABSTRACT
BACKGROUND:
Due to
aging population and increasing part of
immunocompromised patients, a raise in
life-threatening organ damage related to VZV can be expected. Two
retrospective studies were already conducted on VZV in ICU but focused on specific organ
injury.
Patients with high-
risk of VZV
disease still must be identified. The objective of this study was to
report the clinical features and outcome of all
life-threatening VZV manifestations requiring
intensive care unit (ICU) admission. This retrospective
cohort study was conducted in 26 French ICUs and included all
adult patients with any
life-threatening VZV-related event requiring ICU admission or occurring in ICU between 2010 and 2019.
RESULTS:
One-hundred nineteen
patients were included with a median SOFA score of 6. One hundred eight
patients (90.8%) were admitted in ICU for VZV
disease, leaving 11 (9.2%) with VZV
disease occurring in ICU. Sixty-one
patients (51.3%) were immunocompromised.
Encephalitis was the most prominent organ involvement (55.5%), followed by
pneumonia (44.5%) and
hepatitis (9.2%). Fifty-four
patients (45.4%) received
norepinephrine, 72 (60.5% of the total cohort) needed invasive
mechanical ventilation, and 31 (26.3%) received renal-replacement
therapy.
In-hospital mortality was 36.1% and was significantly associated with three independent
risk factors by multivariable
logistic regression immunosuppression, VZV
disease occurring in ICU and
alcohol abuse. Hierarchical
clustering on principal components revealed five phenotypically distinct clusters of
patients VZV-related
pneumonia, mild
encephalitis, severe
encephalitis in solid
organ transplant recipients,
encephalitis in other
immunocompromised hosts and VZV
disease occurring in ICU.
In-hospital mortality was highly different across
phenotypes, ranging from zero to 75% (p < 0.001).
CONCLUSION:
Overall, severe VZV manifestations are associated with high
mortality in the ICU, which appears to be driven by
immunosuppression status rather than any specific organ involvement. Deciphering the clinical
phenotypes may help clinicians identify high-
risk patients and assess
prognosis.
