Clinical description and outcome of overall varicella-zoster virus-related organ dysfunctions admitted in intensive care units: the VAZOREA cohort study

• Published in: Annals of intensive care 2024-03, Vol.14 (1), p.44-44, Article 44
• Main Authors: Malherbe, Jolan, Godard, Pierre, Lacherade, Jean-Claude, Coirier, Valentin, Argaud, Laurent, Hyvernat, Hervé, Schneider, Francis, Charpentier, Julien, Wallet, Florent, Pocquet, Juliette, Plantefeve, Gaëtan, Quenot, Jean-Pierre, Bay, Pierre, Delbove, Agathe, Georges, Hugues, Urbina, Tomas, Schnell, David, Le Moal, Charlène, Stanowski, Matthieu, Muris, Corentin, Jonas, Maud, Sauneuf, Bertrand, Lesieur, Olivier, Lhermitte, Amaury, Calvet, Laure, Gueguen, Ines, du Cheyron, Damien
• Format: Article
• Language: English
• Subjects: Alcohol abuse; Anesthesiology; Cohort analysis; Critical Care Medicine; Emergency Medicine; Encephalitis; Human health and pathology; Immunocompromised host; Intensive; Intensive care; Intensive care units; Life Sciences; Medicine; Medicine & Public Health; Mortality; Pneumonia; Varicella-Zoster virus
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-024-01270-w

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