Assessment of Magnetic Resonance Imaging Changes and Functional Outcomes Among Adults With Severe Herpes Simplex Encephalitis

Benjamine Sarton; Pierre Jaquet; Djida Belkacemi; Etienne de Montmollin; Fabrice Bonneville; Charline Sazio; Aurelien Frérou; Marie Conrad; Delphine Daubin; Russell Chabanne; Laurent Argaud; Frédéric Dailler; Noëlle Brulé; Nicolas Lerolle; Quentin Maestraggi; Julien Marechal; Pierre Bailly; Keyvan Razazi; Francois Mateos; Bertrand Guidet; Albrice Levrat; Vincent Susset; Alexandre Lautrette; Jean-Paul Mira; Ahmed El Kalioubie; Alexandre Robert; Alexandre Massri; Jean François Albucher; Jean Marc Olivot; Jean Marie Conil; Lila Boudma; Jean-François Timsit; Romain Sonneville; Stein Silva; Pierre Jaquet; Etienne de Montmollin; Claire Dupuis; Mikael Alves; Laurent Argaud; Pierre Bailly; François Barbier; Lila Bouadma; Noelle Brulé; Fabrice Brunel; Russell Chabanne; Marie Conrad; Daniel da Silva; Frederic Dailler; Delphine Daubin; Sophie Demeret; Nicolas Lerolle; Julien Marechal; Bruno Mourvillier; Ahmed El Kalioubi; Benjamine Sarton; Romain Sonneville; Vincent Susset; Jean Marc Tadié; Jean-Françoit Timsit; Michel Wolff; Alexandre Lautrette; Emmanuel Novy; Bertrand Guidet; François Mateos; Clément Brault; Quentin Maestraggi; Keyvan Razazi; Jean-Pierre Quenot; Aurélie Joret; Albrice Levrat; Alexandre Massri; Alexandre Robert; Damien Contou; Jean-Paul Mira; Stephane Gaudry; Guillaume Voiriot; Asael Berger; Vincent Das; Nicolas Engrand; Martin Murgier; Shidasp Siami; Sami Hraiech; Eric Mariotte; Claire Ragot; Annabelle Stoclin; Pierre Trouiller; Mathieu Schmidt; Charline Sazio

doi:10.1001/jamanetworkopen.2021.14328

Journal Articles JAMA Network Open Year : 2021

Assessment of Magnetic Resonance Imaging Changes and Functional Outcomes Among Adults With Severe Herpes Simplex Encephalitis

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Benjamine Sarton

Function : Author
PersonId : 1370145
IdRef : 25827347X

Toulouse NeuroImaging Center

Service de Réanimation polyvalente [CHU Toulouse]

Pierre Jaquet

Function : Author

CIC - CHU Bichat

Djida Belkacemi

Function : Author

Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]

Etienne de Montmollin

Function : Author

CIC - CHU Bichat

Fabrice Bonneville

Function : Author
PersonId : 990236
ORCID : 0000-0003-2950-8759
IdRef : 103796568

Toulouse NeuroImaging Center

Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]

Charline Sazio

Function : Author

CHU de Bordeaux Pellegrin [Bordeaux]

Aurelien Frérou

Function : Author

Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]

Marie Conrad

Function : Author

Centre Hospitalier Universitaire de Nancy

Delphine Daubin

Function : Author

CHU Montpellier = Montpellier University Hospital

Russell Chabanne

Function : Author

CHU Gabriel Montpied [Clermont-Ferrand]

Laurent Argaud

Function : Author

Hôpital Edouard Herriot [CHU - HCL]

Frédéric Dailler

Function : Author

Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]

Noëlle Brulé

Function : Author

Centre Hospitalier Universitaire de Nantes = Nantes University Hospital

Nicolas Lerolle

Function : Author

Centre Hospitalier Universitaire d'Angers

Quentin Maestraggi

Function : Author

Hôpital de Hautepierre [Strasbourg]

Julien Marechal

Function : Author

Centre hospitalier universitaire de Poitiers = Poitiers University Hospital

Pierre Bailly

Function : Author

Hôpital de la Cavale Blanche - CHRU Brest

Keyvan Razazi

Function : Author

CHU Henri Mondor [Créteil]

Francois Mateos

Function : Author

Centre hospitalier de Saint-Brieuc [Hôpital Yves Le Foll]

Bertrand Guidet

Function : Author

CHU Saint-Antoine [AP-HP]

Albrice Levrat

Function : Author

Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]

Vincent Susset

Function : Author

Centre Hospitalier Métropole Savoie [Chambéry]

Alexandre Lautrette

Function : Author
PersonId : 918605
ORCID : 0000-0003-4545-7461
IdRef : 113365063

CHU Clermont-Ferrand

Jean-Paul Mira

Function : Author

Hôpital Cochin [AP-HP]

Ahmed El Kalioubie

Function : Author

Hôpital Roger Salengro [Lille]

Alexandre Robert

Function : Author

Centre Hospitalier Universitaire de Nice

Alexandre Massri

Function : Author

Centre hospitalier de Pau

Jean François Albucher

Function : Author

Jean Marc Olivot

Function : Author

Toulouse NeuroImaging Center

Jean Marie Conil

Function : Author

Lila Boudma

Function : Author

CIC - CHU Bichat

Jean-François Timsit

Function : Author

CIC - CHU Bichat

Romain Sonneville

Function : Author

CIC - CHU Bichat

Stein Silva

Function : Author
PersonId : 1255005
ORCID : 0000-0001-9690-7413
IdRef : 090858832

Toulouse NeuroImaging Center

Service de Réanimation polyvalente [CHU Toulouse]

Pierre Jaquet

Function : Author

Etienne de Montmollin

Function : Author

Claire Dupuis

Function : Author

Mikael Alves

Function : Author

Laurent Argaud

Function : Author

Pierre Bailly

Function : Author

François Barbier

Function : Author

Lila Bouadma

Function : Author

Noelle Brulé

Function : Author

Fabrice Brunel

Function : Author
PersonId : 173575
IdHAL : fabricebrunel
ORCID : 0000-0002-0659-7229

Russell Chabanne

Function : Author

Marie Conrad

Function : Author

Daniel da Silva

Function : Author

Frederic Dailler

Function : Author

Delphine Daubin

Function : Author

Sophie Demeret

Function : Author

Nicolas Lerolle

Function : Author

Julien Marechal

Function : Author

Bruno Mourvillier

Function : Author

Ahmed El Kalioubi

Function : Author

Benjamine Sarton

Function : Author

Romain Sonneville

Function : Author

Vincent Susset

Function : Author

Jean Marc Tadié

Function : Author

Jean-Françoit Timsit

Function : Author

Michel Wolff

Function : Author

Alexandre Lautrette

Function : Author

Emmanuel Novy

Function : Author

Bertrand Guidet

Function : Author

François Mateos

Function : Author

Clément Brault

Function : Author

Quentin Maestraggi

Function : Author

Keyvan Razazi

Function : Author

Jean-Pierre Quenot

Function : Author

Aurélie Joret

Function : Author

Albrice Levrat

Function : Author

Alexandre Massri

Function : Author

Alexandre Robert

Function : Author

Damien Contou

Function : Author

Jean-Paul Mira

Function : Author

Stephane Gaudry

Function : Author

Guillaume Voiriot

Function : Author

Asael Berger

Function : Author

Vincent Das

Function : Author

Nicolas Engrand

Function : Author

Martin Murgier

Function : Author
PersonId : 1149296
ORCID : 0000-0001-8027-2353
IdRef : 19844818X

Shidasp Siami

Function : Author

Sami Hraiech

Function : Author

Eric Mariotte

Function : Author

Claire Ragot

Function : Author

Annabelle Stoclin

Function : Author

Pierre Trouiller

Function : Author

Mathieu Schmidt

Function : Author

Charline Sazio

Function : Author

Abstract

Importance: Current guidelines recommend brain magnetic resonance imaging (MRI) for clinical management of patients with severe herpes simplex encephalitis (HSE). However, the prognostic value of brain imaging has not been demonstrated in this setting. Objective: To investigate the association between early brain MRI data and functional outcomes of patients with HSE at 90 days after intensive care unit (ICU) admission. Design, setting, and participants: This multicenter cohort study was conducted in 34 ICUs in France from 2007 to 2019 and recruited all patients who received a clinical diagnosis of encephalitis and exhibited cerebrospinal fluid positivity for herpes simplex virus DNA in the polymerase chain reaction analysis. Data analysis was performed from January to April 2020. Exposures: All patients underwent a standard brain MRI during the first 30 days after ICU admission. Main outcomes and measures: MRI acquisitions were analyzed by radiologists blinded to patients' outcomes, using a predefined score. Multivariable logistic regression and supervised hierarchical classifiers methods were used to identify factors associated with poor outcome at 90 days, defined by a score of 3 to 6 (indicating moderate-to-severe disability or death) on the Modified Rankin Scale. Results: Overall, 138 patients (median [interquartile range {IQR}] age, 62.6 [54.0-72.0] years; 75 men [54.3%]) with an admission median (IQR) Glasgow Coma Scale score of 9 (6-12) were studied. The median (IQR) delay between ICU admission and MRI was 1 (1-7) days. At 90 days, 95 patients (68.8%) had a poor outcome, including 16 deaths (11.6%). The presence of fluid-attenuated inversion recovery MRI signal abnormalities in more than 3 brain lobes (odds ratio [OR], 25.71; 95% CI, 1.21-554.42), age older than 60 years (OR, 7.62; 95% CI, 2.02-28.91), and the presence of diffusion-weighted MRI signal abnormalities in the left thalamus (OR, 6.90; 95% CI, 1.12-43.00) were independently associated with poor outcome. Machine learning models identified bilateral diffusion abnormalities as an additional factor associated with poor outcome (34 of 39 patients [87.2%] with bilateral abnormalities had poor outcomes) and confirmed the functional burden of left thalamic lesions, particularly in older patients (all 11 patients aged >60 years had left thalamic lesions). Conclusions and relevance: These findings suggest that in adult patients with HSE requiring ICU admission, extensive MRI changes in the brain are independently associated with poor functional outcome at 90 days. Thalamic diffusion signal changes were frequently observed and were associated with poor prognosis, mainly in older patients.

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Human health and pathology

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Submitted on : Wednesday, April 3, 2024-4:49:03 PM

Last modification on : Wednesday, December 4, 2024-11:33:10 AM

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hal-04531154 , version 1 (03-04-2024)

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HAL Id : hal-04531154 , version 1
DOI : 10.1001/jamanetworkopen.2021.14328
PUBMED : 34313743
PUBMEDCENTRAL : PMC8317014

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Benjamine Sarton, Pierre Jaquet, Djida Belkacemi, Etienne de Montmollin, Fabrice Bonneville, et al.. Assessment of Magnetic Resonance Imaging Changes and Functional Outcomes Among Adults With Severe Herpes Simplex Encephalitis. JAMA Network Open, 2021, 4 (7), pp.e2114328. ⟨10.1001/jamanetworkopen.2021.14328⟩. ⟨hal-04531154⟩

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Assessment of Magnetic Resonance Imaging Changes and Functional Outcomes Among Adults With Severe Herpes Simplex Encephalitis

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