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Purpose <p>Invasive meningococcal disease (IMD) is a rare but potentially fatal infection caused by <i>Neisseria meningitidis.</i> In adults requiring admission to intensive care unit (ICU), IMD typically presents with two distinct clinical presentations: neurological (meningitis) and hemodynamic (sepsis). These presentations are often conflated, despite the differences in pathophysiology and outcome.</p> Methods <p>RETRO-MENINGO is a nationwide, multicentre, retrospective cohort study conducted in 102 French ICUs between January 1, 2016, and December 31, 2024. Adults (≥ 18&#xa0;years) admitted to the ICU with a microbiologically confirmed IMD were categorised as having either a neurological or a hemodynamic presentation according to the main reason for ICU admission. The primary outcome was day-60 mortality in each presentation.</p> Results <p>Of 654 patients (median age 33&#xa0;years [IQR 21–56]; 63.5% without comorbidities), 407 (62%) had a neurological and 247 (38%) a hemodynamic presentation at ICU admission. Hemodynamic presentation was associated with older age (39.0 vs. 30.0&#xa0;years; <i>p</i> = 0.001), immunosuppression (17.0% vs. 7.1%; <i>p</i> &lt; 0.001), purpuric rash (55.9% vs. 43.7%; <i>p</i> = 0.003), earlier ICU admission (1 vs. 2&#xa0;days; <i>p</i> = 0.001) and more frequent bacteremia (83.8% vs. 35.6%; <i>p</i> &lt; 0.001). Serogroup B was predominant in neurological presentation, whereas serogroup W135 was more common in hemodynamic presentation. Compared to neurological presentation, hemodynamic presentation required more organ support (vasopressors, invasive mechanical ventilation, transfusions, renal replacement therapy) and had a significantly higher day-60 mortality (25.5% vs. 4.7%; <i>p</i> &lt; 0.001). Hemodynamic presentation (aOR 4.33, 95% CI 2.26–8.62;<i> p</i> &lt; 0.001), absence of comorbidities (aOR 2.21, 95% CI 1.19–4.23;<i> p</i> = 0.014), age &gt; 35&#xa0;years (aOR 3.65, 95% CI 1.73–6.07; <i>p</i> &lt; 0.001), arterial lactate level &gt; 5&#xa0;mmol/L (aOR 2.60, 95% CI 1.43–4.77; <i>p</i> = 0.002) and symptom onset &lt; 24&#xa0;h (aOR 1.90, 95% CI 1.00–3.55; <i>p</i> = 0.040) were independently associated with day-60 mortality, while early administration of a parenteral third-generation cephalosporin prior to ICU admission was strongly protective (aOR 0.31, 95% CI 0.18–0.55; <i>p</i> &lt; 0.001).</p> Conclusion <p>Neurological and hemodynamic presentation of IMD are clinically and prognostically distinct. Recognition of these phenotypes is critical for appropriate management and prediction of outcome.</p>

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Hemodynamic and neurological presentations of invasive meningococcal disease in adults: a nationwide study across 100+ French ICUs

  • 期刊论文

  • 发表日期：

    2025年8月12日

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  • Damien Contou,
  • Benoit Painvin,
  • Delphine Daubin,
  • Arthur Orieux,
  • Hugo Pirollet,
  • Martin Cour,
  • Benjamine Sarton,
  • Marie Gauvrit,
  • Mathilde Taillantou-Candau,
  • Paola Lepoutre,
  • Guillaume Louis,
  • Fabrice Bruneel,
  • Christelle Teiten,
  • Maud Vincendeau,
  • Marion Giry,
  • François Legay,
  • Rémi Coudroy,
  • Olivier Puig,
  • Pierre Bay,
  • Guillaume Schnell,
  • Geoffrey Ledoux,
  • Romain Sonneville,
  • Danielle Reuter,
  • Xavier Valette,
  • Piotr Szychowiak,
  • Nicolas Dufour,
  • Tomas Urbina,
  • Gaëtan Plantefève,
  • Nicolas de Prost,
  • Julien Maizel,
  • David Schnell,
  • Noémie Zucman,
  • Adrien Joseph,
  • Stéphane Gaudry,
  • Cindy Lage,
  • Hakim Slimani,
  • Marion Monnin,
  • Julien Grouille,
  • Nicholas Sédillot,
  • Anna Bourreau,
  • Nicolas Pichon,
  • Juliette Audibert,
  • Frédérique Schortgen,
  • Jérémy Rosman,
  • Julien Dupeyrat,
  • Sophie Périnel-Ragey,
  • Antoine Marchalot,
  • Florent Bavozet,
  • Caroline Varillon,
  • Rhioui Kawtar,
  • Jean-Baptiste Michot,
  • Benjamin Zuber,
  • Arnaud Galbois,
  • Nicholas Heming,
  • Vincent Elsensohn,
  • Nicolas Bréchot,
  • Tài Pham,
  • Olivier Lesieur,
  • Antonin Courtais,
  • Lucie Lefèvre,
  • Béatrice Combe,
  • Gwenhaël Colin,
  • Emmanuel Vivier,
  • Pierre-Nicolas Bris,
  • Jérémy Bourenne,
  • Olivier Ellrodt,
  • Sylvie Vimeux,
  • Regaieg Kais,
  • Vincent Das,
  • Valentin Pointurier,
  • Alan Mourougayen,
  • Mathieu Jozwiak,
  • Michaël Mervant,
  • Emmanuelle Kuperminc,
  • Marion Ducos,
  • Marie Lecronier,
  • Claire Pichereau,
  • Marc Pineton de Chambrun,
  • Pierre Kergoat,
  • Pascal Beuret,
  • Serge Carreira,
  • Cédric Bruel,
  • Victor Roubin,
  • Romain Persichini,
  • Maxime Leclerc,
  • Swann Bredin,
  • Lara Zafrani,
  • Thomas Volpe,
  • Charlotte Quentin,
  • Aude Gibelin,
  • Jonathan Chelly,
  • Hugues Georges,
  • Matthieu Jamme,
  • Florian Reizine,
  • Bérengère Vivet,
  • Bertrand Canoville,
  • Xavier Souloy,
  • Jean-Marc Tadié,
  • Guillaume Dumas,
  • Yvan Caspar,
  • Stephan Ehrmann,
  • François Beloncle,
  • Jean-Baptiste Lascarrou,
  • Stein Silva,
  • Gaëtan Béduneau,
  • Sarah Benghanem,
  • Sébastien Préau,
  • Côme Bureau,
  • Frederic Wallet,
  • Francois Barbier,
  • Toufik Kamel,
  • Kada Klouche,
  • Guillaume Géri,
  • Clémence Marois,
  • Camille Legouy,
  • Philippe Vignon,
  • Alexandre Lautrette,
  • Damien Roux,
  • Julien Demiselle,
  • Rayane Lakehal,
  • Annabelle Stoclin

摘要

Purpose

Invasive meningococcal disease (IMD) is a rare but potentially fatal infection caused by Neisseria meningitidis. In adults requiring admission to intensive care unit (ICU), IMD typically presents with two distinct clinical presentations: neurological (meningitis) and hemodynamic (sepsis). These presentations are often conflated, despite the differences in pathophysiology and outcome.

Methods

RETRO-MENINGO is a nationwide, multicentre, retrospective cohort study conducted in 102 French ICUs between January 1, 2016, and December 31, 2024. Adults (≥ 18 years) admitted to the ICU with a microbiologically confirmed IMD were categorised as having either a neurological or a hemodynamic presentation according to the main reason for ICU admission. The primary outcome was day-60 mortality in each presentation.

Results

Of 654 patients (median age 33 years [IQR 21–56]; 63.5% without comorbidities), 407 (62%) had a neurological and 247 (38%) a hemodynamic presentation at ICU admission. Hemodynamic presentation was associated with older age (39.0 vs. 30.0 years; p = 0.001), immunosuppression (17.0% vs. 7.1%; p < 0.001), purpuric rash (55.9% vs. 43.7%; p = 0.003), earlier ICU admission (1 vs. 2 days; p = 0.001) and more frequent bacteremia (83.8% vs. 35.6%; p < 0.001). Serogroup B was predominant in neurological presentation, whereas serogroup W135 was more common in hemodynamic presentation. Compared to neurological presentation, hemodynamic presentation required more organ support (vasopressors, invasive mechanical ventilation, transfusions, renal replacement therapy) and had a significantly higher day-60 mortality (25.5% vs. 4.7%; p < 0.001). Hemodynamic presentation (aOR 4.33, 95% CI 2.26–8.62; p < 0.001), absence of comorbidities (aOR 2.21, 95% CI 1.19–4.23; p = 0.014), age > 35 years (aOR 3.65, 95% CI 1.73–6.07; p < 0.001), arterial lactate level > 5 mmol/L (aOR 2.60, 95% CI 1.43–4.77; p = 0.002) and symptom onset < 24 h (aOR 1.90, 95% CI 1.00–3.55; p = 0.040) were independently associated with day-60 mortality, while early administration of a parenteral third-generation cephalosporin prior to ICU admission was strongly protective (aOR 0.31, 95% CI 0.18–0.55; p < 0.001).

Conclusion

Neurological and hemodynamic presentation of IMD are clinically and prognostically distinct. Recognition of these phenotypes is critical for appropriate management and prediction of outcome.