Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-08-20

AUTHORS

Damien Contou, Romain Sonneville, Florence Canoui-Poitrine, Gwenhaël Colin, Rémi Coudroy, Frédéric Pène, Jean-Marc Tadié, Martin Cour, Gaëtan Béduneau, Antoine Marchalot, Laurent Guérin, Sébastien Jochmans, Stephan Ehrmann, Nicolas Terzi, Sébastien Préau, François Barbier, Guillaume Schnell, Damien Roux, Olivier Leroy, Claire Pichereau, Elodie Gélisse, Lara Zafrani, Richard Layese, Christian Brun-Buisson, Armand Mekontso Dessap, Nicolas de Prost, For the Hopeful Study Group

ABSTRACT

PurposeData on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality.MethodsA 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up).ResultsAmong the 306 included patients, 126 (41.2%; 95% CI 35.6–46.9) died and 180 (58.8%; 95% CI 53.3–64.3) survived during the follow-up period [13 (3–24) days], including 51/180 patients (28.3%, 95% CI 21.9–35.5) who eventually required limb amputations, with a median number of 3 (1–4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR) = 1.03 (1.02–1.04); p < 0.001], lower leucocytes [HR 0.83 (0.69–0.99); p = 0.034] and platelet counts [HR 0.77 (0.60–0.91); p = 0.007], and arterial blood lactate levels [HR 2.71 (1.68–4.38); p < 0.001] were independently associated with hospital death, while a neck stiffness [HR 0.51 (0.28–0.92); p = 0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06–3.38); p = 0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis.ConclusionPurpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation.Trials registrationNCT03216577. More... »

PAGES

1502-1511

Journal

TITLE

Intensive Care Medicine

ISSUE

9

VOLUME

44

Author Affiliations

  • Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69 Rue du Lieutenant-Colonel Prudhon, 95100, Argenteuil, France
  • Service de Réanimation Médicale, Hôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
  • Clinical Epidemiology and Ageing Unit, Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA7376 CEpiA, Créteil, France
  • Service de Réanimation Médico-chirurgicale, Centre Hospitalier Départemental de Vendée, Boulevard Stéphane Moreau, 85925, La Roche-sur-Yon, France
  • INSERM CIC1402, ALIVE Group, Université de Poitiers, Poitiers, France
  • Service de Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033, Rennes, France
  • Réanimation Médicale, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, 3 Quai des Célestins, 69002, Lyon, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, 1 Rue de Germont, 76000, Rouen, France
  • Service de Réanimation Polyvalente, Centre Hospitalier de Melun, 98 Rue Freteau de Peny, 77000, Melun, France
  • CHRU de Tours, Médecin Intensive Réanimation, CIC 1415, CRICS-TriggerSEP, Centre d’étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France
  • Service de Réanimation Polyvalente, Centre Hospitalier de Melun, 98 Avenue du Général Patton, 77000, Melun, France
  • Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire, 2 Boulevard Tonnellé, 37000, Tours, France
  • Service de Réanimation Médicale, Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
  • Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, 59000, Lille, France
  • Service de Réanimation Médicale, Centre Hospitalier Régional d’Orléans, 1 Rue Porte Madeleine, 45000, Orléans, France
  • Service de Réanimation Médico-Chirurgicale, GH Le Havre, 76600, Le Havre, France
  • Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 Rue des Renouillers, 92700, Colombes, France
  • Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Tourcoing, 55 Rue du Président Coty, 59200, Tourcoing, France
  • Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300, Poissy, France
  • Service de Réanimation Médico-Chirurgicale, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, 51092, Reims, France
  • Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
  • Service de Santé Publique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51,Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
  • Service de Réanimation Médicale, Groupe de Recherche CARMAS, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-018-5341-3

    DOI

    http://dx.doi.org/10.1007/s00134-018-5341-3

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1106255020

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30128591


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    463 schema:name Service de Réanimation Médicale, Centre Hospitalier Universitaire Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
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    473 grid-institutes:grid.50550.35 schema:alternateName Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
    474 schema:name Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
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