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Factors related to mortality in critically ill histoplasmosis: a multicenter retrospective study in Guadeloupe and French Guyana.
Camous, Laurent; Surel, Arthur; Kallel, Hatem; Nicolas, Muriel; Martino, Frederic; Valette, Marc; Demoule, Alexandre; Pommier, Jean-David.
Afiliação
  • Camous L; Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France. laurent.camous@chu-guadeloupe.fr.
  • Surel A; Réanimation médicale et chirurgicale-CHU de Guadeloupe, 97139, Les Abyme, France. laurent.camous@chu-guadeloupe.fr.
  • Kallel H; Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France.
  • Nicolas M; Intensive Care Unit, Cayenne Hospital, French Guyana, France.
  • Martino F; Mycology Department, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France.
  • Valette M; Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France.
  • Demoule A; Université de Paris and Université des Antilles, INSERM, BIGR, 75015, Paris, France.
  • Pommier JD; Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France.
Ann Intensive Care ; 13(1): 30, 2023 Apr 21.
Article em En | MEDLINE | ID: mdl-37085583
PURPOSE: To describe clinical and biological features and the outcomes of patients admitted for histoplasmosis in two intensive care units (ICU) in French Guyana and in the French West Indies (Guadeloupe). METHODS: All patients admitted to these two ICUs for culture-proven histoplasmosis between January 2014 to August 2022 were included in the study. Using univariate and multivariate analysis, we assessed risk factors at ICU admission that were associated with death. RESULTS: Forty patients were included (65% men). Median age was 56 years and simplified acute physiologic score (SAPS) II was 65. HIV was found in 58%, another immunodeficiency was identified in 28%, and no underlying immunodeficiency could be identified in 14% of patients. Within the first 24 h of ICU admission, 85% of patients had acute respiratory failure, 78% had shock, 30% had coma, and 48% had hemophagocytic lymphohistiocytosis. Mechanical ventilation was instituted in 78% of patients and renal replacement therapy in 55%. The 30-day mortality was 53%. By multivariate analysis, factors independently associated with 30-day mortality were SOFA score (odds ratio [OR] 1.5, 95% confidence interval [CI] [1.1-2.1]), time between symptom onset and treatment per day (OR 1.1, 95% CI 1.0-1.1), and hemophagocytic lymphohistiocytosis (OR 6.4, 95% CI 1.1-47.5). CONCLUSION: Histoplasmosis requiring ICU admission is a protean disease with multiple and severe organ involvement. Immunodeficiency is found in most patients. The prognosis remains severe despite appropriate treatment and is worsened by late treatment initiation.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies País/Região como assunto: America do sul / Caribe ingles / Guadalupe / Guyana Idioma: En Revista: Ann Intensive Care Ano de publicação: 2023 Tipo de documento: Article País de afiliação: França País de publicação: Alemanha
Texto completo
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies País/Região como assunto: America do sul / Caribe ingles / Guadalupe / Guyana Idioma: En Revista: Ann Intensive Care Ano de publicação: 2023 Tipo de documento: Article País de afiliação: França País de publicação: Alemanha