BACKGROUND Varicella-zoster virus (VZV) is one of the main viruses responsible of acute encephalitis. However, data on the prognosis and neurologic outcome of critically ill patients with VZV encephalitis are limited. We aimed to describe the clinical features of VZV encephalitis in the ICU and to identify factors associated with a favorable neurologic outcome. We performed a multicenter cohort study of patients with VZV encephalitis admitted in 18 ICUs in France between 2000 and 2017. Factors associated with a favorable neurologic outcome, defined by a modified Rankin Score (mRS) of 0-2 1 year after ICU admission, were identified by multivariable regression analysis. RESULTS Fifty-five patients (29 (53%) men, median age 53 (interquartile range 36-66)) were included, of whom 43 (78%) were immunocompromised. ICU admission occurred 1 (0-3) day after the onset of neurological symptoms. Median Glasgow Coma Score at ICU admission was 12 (7-14). Cerebrospinal fluid examination displayed a median leukocyte count of 68 (13-129)/mm3, and a median protein level of 1.37 (0.77-3.67) g/L. CT scan and MRI revealed brain lesions in 30% and 66% of the cases, respectively. Invasive mechanical ventilation was implemented in 46 (84%) patients for a median duration of 13 (3-30) days. Fourteen (25%) patients died in the ICU. One year after ICU admission, 20 (36%) patients had a favorable neurologic outcome (mRS 0-2), 12 (22%) had significant disability (mRS 3-5), and 18 (33%) were deceased (lost to follow-up n = 5, 9%). On multivariable analysis, age (OR 0.92 per year, (0.88-0.97), p = 0.01), and invasive mechanical ventilation (OR 0.09 CI 95% (0.01-0.84), p = 0.03) reduced the likelihood of favorable neurologic outcome. CONCLUSION One in every three critically ill patients with VZV encephalitis had a favorable neurologic outcome 1 year after ICU admission. Older age and invasive mechanical ventilation were associated with a higher risk of disability and death.

中文翻译：

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入住 ICU 一年后 VZV 脑炎的神经系统结果：一项多中心队列研究。

背景水痘-带状疱疹病毒(VZV)是引起急性脑炎的主要病毒之一。然而，关于 VZV 脑炎重症患者的预后和神经系统结局的数据有限。我们旨在描述 ICU 中 VZV 脑炎的临床特征，并确定与有利的神经系统结果相关的因素。我们对 2000 年至 2017 年期间在法国 18 个 ICU 收治的 VZV 脑炎患者进行了一项多中心队列研究。与良好的神经系统结果相关的因素是通过多变量回归分析确定。结果 共纳入 55 名患者（29 名（53%）男性，中位年龄 53 岁（四分位距 36-66）），其中 43 名（78%）免疫功能低下。ICU 入院发生在神经系统症状出现后 1 (0-3) 天。入住 ICU 时的中位格拉斯哥昏迷评分为 12 (7-14)。脑脊液检查显示中位白细胞计数为 68 (13-129)/mm3，中位蛋白水平为 1.37 (0.77-3.67) g/L。CT 扫描和 MRI 分别显示 30% 和 66% 的病例有脑部病变。46 名 (84%) 患者实施了有创机械通气，中位持续时间为 13 (3-30) 天。14 名 (25%) 患者在 ICU 中死亡。入住 ICU 一年后，20 名 (36%) 患者的神经系统预后良好 (mRS 0-2)，12 名 (22%) 患者有严重残疾 (mRS 3-5)，18 名 (33%) 患者死亡（失去随访 n = 5, 9%）。在多变量分析中，年龄（OR 0.92/年，（0.88-0.97），p = 0.01）和有创机械通气（OR 0.09 CI 95%（0.01-0.84），p = 0。03) 降低了良好的神经系统结果的可能性。结论 每 3 名 VZV 脑炎重症患者中就有 1 名在 ICU 入院 1 年后神经系统预后良好。年龄较大和有创机械通气与较高的残疾和死亡风险相关。