• Arnaud-Félix Miailhe, Emmanuelle Mercier, Adel Maamar, Jean-Claude Lacherade, Aurélie Le Thuaut, Aurélie Gaultier, Pierre Asfar, Laurent Argaud, Antoine Ausseur, Adel Ben Salah, Vlad Botoc, Karim Chaoui, Julien Charpentier, Christophe Cracco, Nicolas De Prost, Marie-Line Eustache, Alexis Ferré, Elena Gauvin, Suzanne Goursaud, Maximilien Grall, Philippe Guiot, Maud Jonas, Fabien Lambiotte, Mickael Landais, Jérémie Lemarié, Olivier Lesieur, Claire Lhommet, Philippe Michel, Yannick Monseau, Sébastien Moschietto, Saad Nseir, David Osman, Jérome Pillot, Gaël Piton, Nicholas Sedillot, Michel Sirodot, Didier Thevenin, Lara Zafrani, Yoann Zerbib, Pascale Bourhy, Lascarrou Jean-Baptiste JB Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France., Jean Reignier, and LEPTOREA.
• Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.
• Intensive Care Med. 2019 Dec 1; 45 (12): 1763-1773.

PurposeTo report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone.MethodsLEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes.ResultsThe 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations.ConclusionsSevere leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.

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