PDF(Pubmed)
Abstract：
OBJECTIVE: To identify distinct phenotypes of critically ill leptospirosis patients upon ICU admission and their potential associations with outcome.
METHODS: Retrospective observational study including all patients with biologically confirmed leptospirosis admitted to the ICU between January 2014 and December 2022. Subgroups of patients with similar clinical profiles were identified by unsupervised clustering (factor analysis for mixed data and hierarchical clustering on principal components).
METHODS: All patients admitted to the ICU of the University Hospital of Guadeloupe on the study period.
METHODS: One hundred thirty critically ill patients with confirmed leptospirosis were included.
METHODS: None.
RESULTS: At ICU admission, 34% of the patients had acute respiratory failure, and 26% required invasive mechanical ventilation. Shock was observed in 52% of patients, myocarditis in 41%, and neurological involvement in 20%. Unsupervised clustering identified three clusters-\"Weil\'s Disease\" (48%), \"neurological leptospirosis\" (20%), and \"multiple organ failure\" (32%)-with different ICU courses and outcomes. Myocarditis and neurological involvement were key components for cluster identification and were significantly associated with death in ICU. Other factors associated with mortality included shock, acute respiratory failure, and requiring renal replacement therapy.
CONCLUSIONS: Unsupervised analysis of critically ill patients with leptospirosis revealed three patient clusters with distinct phenotypic characteristics and clinical outcomes. These patients should be carefully screened for neurological involvement and myocarditis at ICU admission.
METHODS: Retrospective observational study including all patients with biologically confirmed leptospirosis admitted to the ICU between January 2014 and December 2022. Subgroups of patients with similar clinical profiles were identified by unsupervised clustering (factor analysis for mixed data and hierarchical clustering on principal components).
METHODS: All patients admitted to the ICU of the University Hospital of Guadeloupe on the study period.
METHODS: One hundred thirty critically ill patients with confirmed leptospirosis were included.
METHODS: None.
RESULTS: At ICU admission, 34% of the patients had acute respiratory failure, and 26% required invasive mechanical ventilation. Shock was observed in 52% of patients, myocarditis in 41%, and neurological involvement in 20%. Unsupervised clustering identified three clusters-\"Weil\'s Disease\" (48%), \"neurological leptospirosis\" (20%), and \"multiple organ failure\" (32%)-with different ICU courses and outcomes. Myocarditis and neurological involvement were key components for cluster identification and were significantly associated with death in ICU. Other factors associated with mortality included shock, acute respiratory failure, and requiring renal replacement therapy.
CONCLUSIONS: Unsupervised analysis of critically ill patients with leptospirosis revealed three patient clusters with distinct phenotypic characteristics and clinical outcomes. These patients should be carefully screened for neurological involvement and myocarditis at ICU admission.
摘要：
目的：确定入住ICU的重症钩端螺旋体病患者的不同表型及其与预后的潜在关联。
方法：回顾性观察性研究包括2014年1月至2022年12月入住ICU的所有生物学确诊钩端螺旋体病患者。通过无监督聚类（混合数据的因子分析和主成分的分层聚类）确定具有相似临床特征的患者亚组。
方法：研究期间所有入住瓜德罗普岛大学医院ICU的患者。
方法：纳入130例确诊钩端螺旋体病的危重患者。
方法：无。
结果：入住ICU时，34%的患者出现急性呼吸衰竭,26%需要有创机械通气。在52％的患者中观察到休克，心肌炎占41%，和20%的神经系统受累。无监督聚类识别出三个聚类-“威尔病”(48%)，“神经性钩端螺旋体病”（20%），和“多器官衰竭”（32％）-具有不同的ICU课程和结局。心肌炎和神经系统受累是群集识别的关键组成部分，并且与ICU中的死亡显着相关。与死亡率相关的其他因素包括休克，急性呼吸衰竭,需要肾脏替代疗法.
结论：对钩端螺旋体病危重患者的无监督分析显示，3个患者群具有不同的表型特征和临床结局。这些患者在入住ICU时应仔细筛查神经系统受累和心肌炎。
方法：回顾性观察性研究包括2014年1月至2022年12月入住ICU的所有生物学确诊钩端螺旋体病患者。通过无监督聚类（混合数据的因子分析和主成分的分层聚类）确定具有相似临床特征的患者亚组。
方法：研究期间所有入住瓜德罗普岛大学医院ICU的患者。
方法：纳入130例确诊钩端螺旋体病的危重患者。
方法：无。
结果：入住ICU时，34%的患者出现急性呼吸衰竭,26%需要有创机械通气。在52％的患者中观察到休克，心肌炎占41%，和20%的神经系统受累。无监督聚类识别出三个聚类-“威尔病”(48%)，“神经性钩端螺旋体病”（20%），和“多器官衰竭”（32％）-具有不同的ICU课程和结局。心肌炎和神经系统受累是群集识别的关键组成部分，并且与ICU中的死亡显着相关。与死亡率相关的其他因素包括休克，急性呼吸衰竭,需要肾脏替代疗法.
结论：对钩端螺旋体病危重患者的无监督分析显示，3个患者群具有不同的表型特征和临床结局。这些患者在入住ICU时应仔细筛查神经系统受累和心肌炎。
