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Damien C, Yuan F, Legros B, Gaspard N. Complications during and after ICU stay are associated with increased mortality after status epilepticus. Clin Neurol Neurosurg 2024; 246:108554. [PMID: 39278005 DOI: 10.1016/j.clineuro.2024.108554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Status Epilepticus (SE) is a neurological emergency with high mortality rate that often requires admission in Intensive Care Units (ICU). Several factors of worse outcome have been identified in prior studies. The aim of our study was to determine the mortality in ICU and in the ward in patients with SE admitted to an ICU and to identify risk factors of mortality. METHODS Retrospective cohort study of patients admitted with SE treated in the ICU of a tertiary medical center between 2015 and 2020. The primary outcome measure was mortality in the ICU (ICU death) or in the ward after ICU discharge (post-ICU death). RESULTS 252 patients were included, with a mean age of 63 (±16) years and 127 males (50 %). 58 died in the ICU, 27 died in the ward. Overall mortality was associated with a higher burden of comorbidities (OR:1.28, p < 0.001), the use of vasopressors (OR: 5.65, p < 0.001) and a higher burden of ICU complications (OR: 1.32, p = 0.002). Mortality rate was higher in more severe SE episodes (nonconvulsive, acute symptomatic and refractoriness. In-ICU mortality was associated with the use of vasopressors (OR: 7.92, p<0.001) and mechanical ventilation (OR: 3.13, p = 0.031), the length of in-ICU stay (OR: 0.91, p = 0.005) and a higher burden of ICU complications (OR: 1.37, p = 0.001). Compared to post-ICU deaths, ICU deaths also had higher Sequential Organ Failure Assessment (SOFA) score on ICU admission (p<0.001). Post-ICU mortality was associated with a higher burden of comorbidities (OR: 1.34, p<0.001), a higher burden of complications after ICU-discharge (OR: 1.33, p = 0.01), and more often refractory SE episode (OR: 2.63, p = 0.01). Compared to survivors, post-ICU deaths experienced mostly infectious and respiratory complications, after ICU-discharge. CONCLUSION Death was more frequent in more severe SE episodes: non convulsive semiology, acute etiology, and refractoriness. In-ICU, post-ICU and all-cause mortality in patients with SE admitted to an ICU are all associated with a higher burden of comorbidities, which are non-modifiable prognostic factors, but also with a higher burden of complications, some of which are preventable, such as respiratory infections.
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Affiliation(s)
- Charlotte Damien
- Service de Neurologie, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 808 Route de Lennik, Bruxelles 1070, Belgium
| | - Fang Yuan
- Service de Neurologie, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 808 Route de Lennik, Bruxelles 1070, Belgium; Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 250 East Changgang Road, Guangzhou 510260, China
| | - Benjamin Legros
- Service de Neurologie, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 808 Route de Lennik, Bruxelles 1070, Belgium
| | - Nicolas Gaspard
- Service de Neurologie, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 808 Route de Lennik, Bruxelles 1070, Belgium; Neurology Department, Yale University School of Medicine, 800 Howard Ave, New Haven, CT 06519, United States.
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Park J, Kim MH, Lee HW. Clinical Outcomes and Systemic Complications Related to the Severity and Etiology of Status Epilepticus Using a Common Data Model. Neurocrit Care 2024; 40:1117-1126. [PMID: 38062300 DOI: 10.1007/s12028-023-01889-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 10/31/2023] [Indexed: 06/05/2024]
Abstract
BACKGROUND Status epilepticus (SE) is a critical neurological emergency in patients with neurological and nonneurological diseases. Mortality rises with SE severity. However, whether brain injury or systemic organ dysfunction causes death after SE remains unclear. We studied clinical outcomes and systemic dysfunctions associated with SE using standardized data from the common data model. This model includes clinical evaluations and treatments that provide real-world evidence for standard practice. METHODS This retrospective cohort study used the common data model database of a single tertiary academic medical center. Patients diagnosed with SE (corresponding to G41 of the International Classification of Diseases 10 and administration of antiseizure medication) between January 1, 2001, and January 1, 2018, were enrolled. Demographics, classifications of SE severity, and outcomes were collected as operational definitions by using a common data model format. Systemic complications were defined based on the Sequential Organ Failure Assessment criteria. RESULTS The electronic medical records of 1,825,196 patients were transformed into a common data model, and 410 patients were enrolled. The proportion of patients classified as having nonrefractory SE was 65.4% (268/410), followed by refractory (28.5%, 117/410) and super-refractory SE (6.1%, 25/410). Patients with more severe SE had longer intensive care unit and hospital stays. Renal dysfunction and thrombocytopenia were higher in the in-hospital death group (P = 0.002 and 0.003, respectively). In multivariable analysis, the Acute Physiology and Chronic Health Evaluation II score and platelet count were significantly different in the in-hospital death group (odds ratio, 1.169, P = 0.004; and 0.989, P = 0.043). CONCLUSIONS Systemic complications after SE, especially low platelet counts, were linked to worse outcomes and increased mortality in a common data model. The common data model offers expandability and comprehensive analysis, making it a potentially valuable tool for SE research.
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Affiliation(s)
- Jin Park
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
- Department of Neurology and Critical Care Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Min-Ho Kim
- Informatization Department, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Hyang Woon Lee
- Departments of Neurology and Medical Science, Ewha Womans University College of Medicine, Computational Medicine, System Health Science and Engineering, and Artificial Intelligence Convergence Graduate Programs, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
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Jacq G, Crepon B, Resche-Rigon M, Schenck M, Geeraerts T, Meziani F, Megarbane B, Chaffaut C, Cariou A, Legriel S. Clinician-Reported Physical and Cognitive Impairments After Convulsive Status Epilepticus: Post Hoc Study of a Randomized Controlled Trial. Neurocrit Care 2024; 40:495-505. [PMID: 37286846 DOI: 10.1007/s12028-023-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Clinician-reported outcome (ClinRO) measures are emerging as useful contributors to assessments of treatment benefits. The objective of this study was to collect ClinRO measures of physical and cognitive impairments after convulsive status epilepticus (CSE) requiring intensive care unit admission. METHODS We conducted a post hoc analysis of the data from HYBERNATUS, a multicenter open-label controlled trial that randomized 270 critically ill patients with CSE requiring mechanical ventilation in 11 French intensive care units to therapeutic hypothermia (32-34 °C for 24 h) plus standard care or standard care alone. We included all patients who attended a day 90 in-person neurologist visit with measurement of the functional independence measure (FIM) score (range from 18 [total assistance] to 126 [total independence]), Mini-Mental State Examination (MMSE) score (range 0-30), and Glasgow outcome scale (GOS) score (1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; and 5, mild or no disability). These three scores were compared across groups defined by several patient and CSE characteristics. RESULTS Of 229 patients with GOS scores ≥ 3 on day 90 (male sex, 58.2%; median age, 56 years [47-67]), 67 (29%) attended an in-person neurologist visit. Twenty-nine (43%) patients had a previous history of epilepsy, and 16 (24%) patients had a primary brain insult. CSE was refractory in 22 (33%) patients. On day 90 after CSE onset, median FIM and MMSE scores were 121 (112-125) and 26.0 (24.0-28.8), respectively. The GOS score was 3 in 16 (33.8%) patients, 4 in 9 (13.4%) patients, and 5 in 42 (62.7%) patients. Worse GOS score values were significantly associated with worse FIM and MMSE scores. CONCLUSIONS In patients attending the in-person neurologist visit on day 90 after CSE onset, ClinRO measures indicated that the main impairments were cognitive. FIM and MMSE scores were associated with GOS scores. Further studies are needed to evaluate the possible impact of neuroprotective and rehabilitation strategies on disability and cognitive impairments in survivors of CSE. Clinical trial registration NCT01359332.
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Affiliation(s)
- Gwenaëlle Jacq
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France.
- IctalGroup, Le Chesnay, France.
- CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Benoit Crepon
- Neurology Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Matthieu Resche-Rigon
- SBIM Biostatistics and Medical Information, Assistance Publique-Hôpitaux de Paris, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, Paris, France
- Université Paris Diderot, Paris, France
- ECSTRA Team (Epidémiologie Clinique et Statistiques Pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Maleka Schenck
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Department, Toulouse University Hospital, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Ferhat Meziani
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Bruno Megarbane
- Medical Intensive Care Unit, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM Biostatistics and Medical Information, Assistance Publique-Hôpitaux de Paris, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, Paris, France
- Université Paris Diderot, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, Hôpitaux Universitaires-Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
- INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Stephane Legriel
- Intensive Care Department, Centre Hospitalier de Versailles - Site André Mignot, 177 Rue de Versailles, 78150, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
- CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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Shahi S, Paneru H, Ojha R, Karn R, Rajbhandari R, Gajurel BP. SOFA and APACHE II scoring systems for predicting outcome of neurological patients admitted in a tertiary hospital intensive care unit. Ann Med Surg (Lond) 2024; 86:1895-1900. [PMID: 38576938 PMCID: PMC10990338 DOI: 10.1097/ms9.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/08/2024] [Indexed: 04/06/2024] Open
Abstract
Background The field of neurology encompasses the study and treatment of disorders that affect the nervous system, and patients with neurological conditions often require specialized care, particularly in the ICU. Predictive scoring systems are measures of disease severity used to predict patient outcomes. The aim of this study was to compare the discriminative power of commonly used scoring systems, namely the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) in the ICU of a tertiary care hospital. Methods This retrospective study included patients with neurological disorders in the ICUs of Tribhuvan University Teaching Hospital from 1 January 2022 to 31 December 2022. Results A total of 153 patients were included. The mean age of the patients was 54.76 ± 17.32 years with higher male predominance (60.78%). Ischaemic stroke was the most common neurological disorder. There were 58 patients (37.9%) who required mechanical ventilation and all-cause mortality was 20.9%. The mean SOFA score was significantly higher (P=0.002) in survivors, whereas the mean APACHE II did not show a significant difference (P=0.238). Receiver operating characteristic (ROC) analysis showed the area of curve (AUC) of SOFA score was 0.765 and of APACHE II was 0.722. Conclusions SOFA score had comparatively higher discriminative power than APACHE II. Assessment of the performance of scoring systems in a specific ICU setting improves the sensitivity and applicability of the model to these settings.
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Affiliation(s)
| | - Hem Paneru
- Critical Care Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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Krejzar Z, Sila D, Waldauf P, Kuriscak E, Mokrejs P, Spatenkova V. Impact of frailty, biomarkers and basic biochemical parameters on outcomes of comatose patients in status epilepticus: a single-center prospective pilot study. BMC Neurol 2024; 24:46. [PMID: 38279084 PMCID: PMC10811840 DOI: 10.1186/s12883-024-03537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/14/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Status epilepticus (SE) is a severe acute condition in neurocritical care with high mortality. Searching for risk factors affecting the prognosis in SE remains a significant issue. The primary study's aim was to test the predictive values of the Clinical Frailty Scale (CFS) and the Modified 11-item Frailty Index (mFI-11), the biomarkers and basic biochemical parameters collected at ICU on the Glasgow Outcome Scale (GOS) assessed at hospital discharge (hosp), and three months later (3 M), in comatose patients with SE. The secondary aim was to focus on the association between the patient's state at admission and the duration of mechanical ventilation, the ICU, and hospital stay. METHODS In two years single-centre prospective pilot study enrolling 30 adult neurocritical care patients with SE classified as Convulsive SE, A.1 category according to the International League Against Epilepsy (ILAE) Task Force without an-/hypoxic encephalopathy, we evaluated predictive powers of CFS, mFI-11, admission Status Epilepticus Severity Score (STESS), serum protein S100, serum Troponin T and basic biochemical parameters on prognosticating GOS using univariate linear regression, logistic regression and Receiver Operating Characteristic (ROC) analysis. RESULTS Our study included 60% males, with a mean age of 57 ± 16 years (44-68) and a mean BMI of 27 ± 5.6. We found CFS, mFI-11, STESS, and age statistically associated with GOS at hospital discharge and three months later. Among the biomarkers, serum troponin T level affected GOS hosp (p = 0.027). Serum C-reactive protein significance in prognosticating GOS was found by logistic regression (hosp p = 0.008; 3 M p = 0.004), and serum calcium by linear regression (hosp p = 0.028; 3 M p = 0.015). In relation to secondary outcomes, we found associations between the length of hospital stay and each of the following: age (p = 0.03), STESS (p = 0.009), and serum troponin T (p = 0.029) parameters. CONCLUSIONS This pilot study found promising predictive powers of two frailty scores, namely CFS and mFI-11, which were comparable to age and STESS predictors regarding the GOS at hospital discharge and three months later in ICU patients with SE. Among biomarkers and biochemical parameters, only serum troponin T level affected GOS at hospital discharge.
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Affiliation(s)
- Zdenek Krejzar
- Department of Neurology, First Faculty of Medicine, Charles University in Prague, Katerinska 1660/32, Prague 2, 121 08, Czech Republic
- Centrum of Anaesthesiology, Resuscitation and Intensive Care, Regional Hospital, Husova 357/10, Liberec, 46001, Czech Republic
| | - David Sila
- Centrum of Anaesthesiology, Resuscitation and Intensive Care, Regional Hospital, Husova 357/10, Liberec, 46001, Czech Republic
- Emergency Medical Services, Klasterni 954/5, Liberec, 460 01, Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Studentska 1402/2, 461 17, Liberec 1, Czech Republic
| | - Petr Waldauf
- Department of Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University in Prague, Ruska 10, Prague, 100 00, Czechia
- University Hospital Kralovske Vinohrady, 110 34 Prague 10, Srobarova, 1050, Czech Republic
| | - Eduard Kuriscak
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague, 128 00, Czech Republic
| | - Petr Mokrejs
- Department of Neurology, First Faculty of Medicine, Charles University in Prague, Katerinska 1660/32, Prague 2, 121 08, Czech Republic
- Emergency Medical Services, Klasterni 954/5, Liberec, 460 01, Czech Republic
| | - Vera Spatenkova
- Faculty of Health Studies, Technical University in Liberec, Studentska 1402/2, 461 17, Liberec 1, Czech Republic.
- Department of Anaesthesiology and Resuscitation, Third Faculty of Medicine, Charles University in Prague, Ruska 10, Prague, 100 00, Czechia.
- University Hospital Kralovske Vinohrady, 110 34 Prague 10, Srobarova, 1050, Czech Republic.
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague, 128 00, Czech Republic.
- Neurocenter, Neurointensive Care Unit, Regional Hospital, Husova 357/10, Liberec, 46001, Czech Republic.
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Mikdashi J, Krumholz A. Long-term outcome of status epilepticus-related to systemic lupus erythematosus: An observational study and a systematic review. Semin Arthritis Rheum 2023; 63:152250. [PMID: 37595509 DOI: 10.1016/j.semarthrit.2023.152250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Status epilepticus-related to systemic lupus erythematosus (SE-SLE) is in general attributed to fulminate neuropsychiatric lupus disease activity, yet the long-term outcome of SE-SLE is not well recognized. This is an observational study of 40 SE-SLE patients pooled from 8 cases at a single tertiary care hospital, and 32 SE-SLE patients identified on a systematic review, with focus on electro-clinical characteristics, imaging studies and the underlying etiology of SE-SLE in correlation with long-term outcome. RESULTS Clinical phenotypes of SE-SLE were heterogeneous, ranging from patients with aura continua to patients in coma. Convulsive SE-SLE occurred among patients with heightened global lupus disease activity and increased cortical and subcortical brain lesion burden localized mostly in the frontal and temporal regions. There were no specific neuroimaging or laboratory abnormalities that allowed early SE-SLE diagnosis where a cluster of cases were of unclear etiology (17.5%). Most SE-SLE cases evolved to refractory SE-SLE with resistance to multiple anti-seizure medications and intravenous anesthetics requiring aggressive immune therapy that led to resolution of SE-SLE active phase. Seizure freedom occurred in 60.0% of patients and the median time to cessation of SE-SLE seizure activity after aggressive therapy was 14 days. Poor long-term outcomes were apparent in SE-SLE patients with one-year mortality (12.5%), recurrent SE-SLE (25.0%), subsequent epilepsy (37.5.1%), poor functional outcome (55.0%) and cognitive impairment (47.5%). A prolonged time to cessation of SE-SLE seizure activity was associated with unfavorable long-term outcome. CONCLUSIONS Diagnostic accuracy of SE-SLE requires better understanding of the etio-pathogenesis and the spectrum of clinical presentations of SE-SLE. Prompt initiation of immune therapy improve SE-SLE outcome, yet optimal therapeutic strategies remain to be determined. Identifying novel biomarkers that distinguish between different forms of SE-SLE and target cellular inflammatory response will help with specific SE-SLE treatment guidelines and prevent poor outcome.
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Affiliation(s)
- Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Allan Krumholz
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Xiao H, Song W, Ai H, Zhang J, Lu J, Zhang D, Zhou Z, Xu P. Correlation between mortality and blood transfusion in patients with major surgery initially admitted to intensive care unit: a retrospective analysis. BMC Anesthesiol 2023; 23:298. [PMID: 37667179 PMCID: PMC10476360 DOI: 10.1186/s12871-023-02261-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE Transfusing red blood cells promptly corrects anemia and improves tissue oxygenation in around 40% of patients hospitalized in the intensive care unit (ICU) after major surgical operations. This study's goal is to investigate how blood transfusions affect the mortality rates of patients after major surgery who are hospitalized in the ICU. METHODS Retrospective research was done on recently hospitalized patients who had major procedures in the ICU between October 2020 and February 2022 at the Huanggang Central Hospital of Yangtze University, China. The patients' prognoses at three months were used to classify them as either survivors or deceased. Patient demographic information, laboratory results, and blood transfusion histories were acquired, and the outcomes of the two groups were compared based on the differences. Univariate and multivariate logistic regression analyses were used to examine the prognosis of surgical disease patients first admitted to the ICU. The receiver operating characteristic (ROC) curve was used to evaluate the predictive power of each risk factor. The relationship between transfusion frequency, transfusion modality, and patient outcome was examined using Spearman's correlation analysis. RESULTS Data from 384 patients was included in the research; of them, 214 (or 55.7%) died within three months of their first stay in the ICU. The death group had higher scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) than the survival group did (all P < 0.05); the death group also had lower scores on the Glasgow Coma Scale, systolic blood pressure, hemoglobin, platelet distribution width, and blood transfusion ratio. Multivariate logistic regression analysis revealed an odds ratio (OR) of 1.654 (1.281-1.989), a 95% confidence interval (CI) of 1.440 (1.207-1.701), and a P value of 0.05 for death in patients undergoing major surgery who were hospitalized to the intensive care unit (ICU). Areas under the ROC curve (AUC) of 0.836, 0.799, and 0.871, respectively, and 95% CIs of 0.796-0.875, 0.755-0.842, and 0.837-0.904, respectively, all P0.05, had significant predictive value for patients initially admitted to the ICU and for APACHE II score > = 12 points, SOFA score > = 6, and blood transfusion. When all three indicators were used jointly to predict a patient's prognosis after major surgery, the accuracy increased to 86.4% (sensitivity) and 100% (specificity). There was a negative correlation between the number of blood transfusions a patient had and their outcome (r = 0.605, P < 0.001) and death (r = 0.698, P < 0.001). CONCLUSION A higher initial ICU APACHE II score, SOFA score, and a number of blood transfusions were associated with improved survival for patients undergoing major surgical operations. Patients' death rates have increased with the increase in the frequency and variety of blood transfusions.
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Affiliation(s)
- Hua Xiao
- Department of Blood Transfusion, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, China
| | - Wei Song
- Department of Blood Transfusion, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, China
| | - Hongmei Ai
- Department of Blood Transfusion, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434000, China
| | - Jingpeng Zhang
- Department of Critical Care Medicine, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, China
| | - Jing Lu
- Department of Blood Transfusion, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, China
| | - Danping Zhang
- Department of Blood Transfusion, Huanggang Central Hospital of Yangtze University, Huanggang, 438000, China
| | - Zaiwen Zhou
- Department of Blood Transfusion, The People's Hospital of Tuanfeng, Tuanfeng, 438800, China.
| | - Pu Xu
- Department of Blood Transfusion, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Bögli SY, Schmidt T, Imbach LL, Nellessen F, Brandi G. Nonconvulsive status epilepticus in neurocritical care: A critical reappraisal of outcome prediction scores. Epilepsia 2023; 64:2409-2420. [PMID: 37392404 DOI: 10.1111/epi.17708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Nonconvulsive status epilepticus (NCSE) is a frequent condition in the neurocritical care unit (NCCU) patient population, with high morbidity and mortality. We aimed to assess the validity of available outcome prediction scores for prognostication in an NCCU patient population in relation to their admission reason (NCSE vs. non-NCSE related). METHODS All 196 consecutive patients diagnosed with NCSE during the NCCU stay between January 2010 and December 2020 were included. Demographics, Simplified Acute Physiology Score II (SAPS II), NCSE characteristics, and in-hospital and 3-month outcome were extracted from the electronic charts. Status Epilepticus Severity Score (STESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE), and encephalitis, NCSE, diazepam resistance, imaging features, and tracheal intubation score (END-IT) were evaluated as previously described. Univariable and multivariable analysis and comparison of sensitivity/specificity/positive and negative predictive values/accuracy were performed. RESULTS A total of 30.1% died during the hospital stay, and 63.5% of survivors did not achieve favorable outcome at 3 months after onset of NCSE. Patients admitted primarily due to NCSE had longer NCSE duration and were more likely to be intubated at diagnosis. The receiver operating characteristic (ROC) for SAPS II, EMSE, and STESS when predicting mortality was between .683 and .762. The ROC for SAPS II, EMSE, STESS, and END-IT when predicting 3-month outcome was between .649 and .710. The accuracy in predicting mortality/outcome was low, when considering both proposed cutoffs and optimized cutoffs (estimated using the Youden Index) as well as when adjusting for admission reason. SIGNIFICANCE The scores EMSE, STESS, and END-IT perform poorly when predicting outcome of patients with NCSE in an NCCU environment. They should be interpreted cautiously and only in conjunction with other clinical data in this particular patient group.
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Affiliation(s)
- Stefan Y Bögli
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tanja Schmidt
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas L Imbach
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland
| | - Friederike Nellessen
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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De Stefano P, Baumann SM, Grzonka P, Sarbu OE, De Marchis GM, Hunziker S, Rüegg S, Kleinschmidt A, Quintard H, Marsch S, Seeck M, Sutter R. Early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study. Epilepsia 2023; 64:1493-1506. [PMID: 37032415 DOI: 10.1111/epi.17614] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE This study was undertaken to investigate the efficacy, tolerability, and outcome of different timing of anesthesia in adult patients with status epilepticus (SE). METHODS Patients with anesthesia for SE from 2015 to 2021 at two Swiss academic medical centers were categorized as anesthetized as recommended third-line treatment, earlier (as first- or second-line treatment), and delayed (later as third-line treatment). Associations between timing of anesthesia and in-hospital outcomes were estimated by logistic regression. RESULTS Of 762 patients, 246 received anesthesia; 21% were anesthetized as recommended, 55% earlier, and 24% delayed. Propofol was preferably used for earlier (86% vs. 55.5% for recommended/delayed anesthesia) and midazolam for later anesthesia (17.2% vs. 15.9% for earlier anesthesia). Earlier anesthesia was statistically significantly associated with fewer infections (17% vs. 32.7%), shorter median SE duration (.5 vs. 1.5 days), and more returns to premorbid neurologic function (52.9% vs. 35.5%). Multivariable analyses revealed decreasing odds for return to premorbid function with every additional nonanesthetic antiseizure medication given prior to anesthesia (odds ratio [OR] = .71, 95% confidence interval [CI] = .53-.94) independent of confounders. Subgroup analyses revealed decreased odds for return to premorbid function with increasing delay of anesthesia independent of the Status Epilepticus Severity Score (STESS; STESS = 1-2: OR = .45, 95% CI = .27-.74; STESS > 2: OR = .53, 95% CI = .34-.85), especially in patients without potentially fatal etiology (OR = .5, 95% CI = .35-.73) and in patients experiencing motor symptoms (OR = .67, 95% CI = .48-.93). SIGNIFICANCE In this SE cohort, anesthetics were administered as recommended third-line therapy in only every fifth patient and earlier in every second. Increasing delay of anesthesia was associated with decreased odds for return to premorbid function, especially in patients with motor symptoms and no potentially fatal etiology.
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Affiliation(s)
- Pia De Stefano
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Sira M Baumann
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Oana E Sarbu
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical faculty of the University of Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
| | - Andreas Kleinschmidt
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical faculty of the University of Geneva, Geneva, Switzerland
| | - Hervé Quintard
- Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland
- Medical faculty of the University of Geneva, Geneva, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
- Medical faculty of the University of Geneva, Geneva, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical faculty of the University of Basel, Basel, Switzerland
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10
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Wagner AS, Baumann SM, Semmlack S, Frei AI, Rüegg S, Hunziker S, Marsch S, Sutter R. Comparing Patients With Isolated Seizures and Status Epilepticus in Intensive Care Units: An Observational Cohort Study. Neurology 2023; 100:e1763-e1775. [PMID: 36878696 PMCID: PMC10136011 DOI: 10.1212/wnl.0000000000206838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/06/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the frequency of status epilepticus (SE) among seizing critically ill adult patients and to determine clinical differences between patients with isolated seizures and patients with SE in the intensive care unit (ICU). METHODS From 2015 to 2020, all consecutive adult ICU patients at a Swiss tertiary care center with isolated seizures or SE as reported by intensivists and/or consulting neurologists were identified by screening of all digital medical, ICU, and EEG records. Patients aged <18 years and patients with myoclonus due to hypoxic-ischemic encephalopathy but without seizures on EEG were excluded. The frequency of isolated seizures, SE, and clinical characteristics at seizure onset associated with SE were the primary outcomes. Uni- and multivariable logistic regression was performed to identify associations with the emergence of SE. RESULTS Among 404 patients with seizures, 51% had SE. Compared with patients with isolated seizures, patients with SE had a lower median Charlson Comorbidity Index (CCI) (3 vs 5, p < 0.001), fewer fatal etiologies (43.6% vs 80.5%, p < 0.001), higher median Glasgow coma scores (7 vs 5, p < 0.001), fever more frequently (27.5% vs 7.5%, p < 0.001), shorter median ICU and hospital stay (ICU: 4 vs 5 days, p = 0.039; hospital stay: 13 vs 15 days, p = 0.045), and recovered to premorbid function more often (36.8% vs 17%, p < 0.001). Multivariable analyses revealed decreased odds ratios (ORs) for SE with increasing CCI (OR 0.91, 95% CI 0.83-0.99), fatal etiology (OR 0.15, 95% CI 0.08-0.29), and epilepsy (OR 0.32, 95% CI 0.16-0.63). Systemic inflammation was an additional association with SE after excluding patients with seizures as the reason for ICU admission (ORfor CRP 1.01, 95% CI 1.00-1.01; ORfor fever 7.35, 95% CI 2.84-19.0). Although fatal etiologies and increasing CCI remained associated with low odds for SE after excluding anesthetized patients and hypoxic-ischemic encephalopathy, inflammation remained associated in all subgroups except patients with epilepsy. DISCUSSION Among all ICU patients with seizures, SE emerged frequently and seen in every second patient. Besides the unexpected low odds for SE with higher CCI, fatal etiology, and epilepsy, the association of inflammation with SE in the critically ill without epilepsy represents a potential treatment target and deserves further attention.
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Affiliation(s)
- Anna S Wagner
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Sira M Baumann
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Saskia Semmlack
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Anja I Frei
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Stephan Rüegg
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Sabina Hunziker
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Stephan Marsch
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland
| | - Raoul Sutter
- From the Department of Neurology (A.S.W., S.M.B., S.R., R.S.), Department of Anesthesiology (S.S.), and Department of Intensive Care (A.I.F., S.M., R.S.), University Hospital Basel; Medical Faculty (S.R., S.H., S.M., R.S.), University of Basel; and Department of Psychosomatic Medicine (S.H.), University Hospital Basel, Switzerland.
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11
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Yuan F, Damien C, Gaspard N. Severity scores for status epilepticus in the ICU: systemic illness also matters. Crit Care 2023; 27:19. [PMID: 36647138 PMCID: PMC9841666 DOI: 10.1186/s13054-022-04276-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/09/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Current prognostic scores for status epilepticus (SE) may not be adequate for patients in ICU who usually have more severe systemic conditions or more refractory episodes of SE. We aimed to compare the prognostic performance of two SE scores, Status Epilepticus Severity Score (STESS) and Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) score, with four systemic severity scores, Acute Physiology and Chronic Health Evaluation 2 (APACHE-2), Simplified Acute Physiology Score 2 (SAPS-2), Sequential Organ Failure Assessment (SOFA) score, and Inflammation, Nutrition, Consciousness, Neurologic function and Systemic condition (INCNS) score in critically ill patients with SE. METHODS This retrospective observational study of a prospectively identified SE cohort was conducted in the ICU at a tertiary-care center. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and associations with outcomes of STESS, EMSE, INCNS, APACHE-2, SAPS-2, and SOFA score for the prediction of in-hospital mortality and no return to baseline condition were assessed. RESULTS Between January 2015 and December 2020, 166 patients with SE in ICU were included in the study. In predicting in-hospital death, APACHE-2 (0.72), SAPS-2 (0.73), and SOFA score (0.71) had higher AUCs than STESS (0.58) and EMSE (0.69). In predicting no return to baseline condition, the AUC of APACHE-2 (0.75) was the highest, and the AUC of INCNS (0.55) was the lowest. When the specificity approached 90%, the sensitivity values of these scores were not quite acceptable (< 40%). Neither SE scores nor systemic severity scores had desirable prognostic power. In the multivariate logistic regression analyses, the best combinations of scores always included at least one or more systemic severity scores. CONCLUSIONS STESS and EMSE were insufficient in outcome prediction for SE patients in ICU, and EMSE was marginally better than STESS. Systemic illness matters in ICU patients with SE, and SE scores should be modified to achieve better accuracy in this severely ill population. This study mostly refers to severely ill patients in the ICU.
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Affiliation(s)
- Fang Yuan
- grid.411866.c0000 0000 8848 7685Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China ,grid.4989.c0000 0001 2348 0746Service de Neurologie, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Charlotte Damien
- grid.4989.c0000 0001 2348 0746Service de Neurologie, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Nicolas Gaspard
- grid.4989.c0000 0001 2348 0746Service de Neurologie, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium ,grid.47100.320000000419368710Neurology Department, Yale University School of Medicine, New Haven, CT USA
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12
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Baumann SM, Semmlack S, Rybitschka A, Kliem PSC, De Marchis GM, Rüegg S, Hunziker S, Marsch S, Sutter R. Prolonged mechanical ventilation in patients with terminated status epilepticus and outcome: An observational cohort study. Epilepsia 2021; 62:3042-3057. [PMID: 34661284 DOI: 10.1111/epi.17100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Classical clinical characteristics associated with successful or unsuccessful extubation are unreliable in neurocritically ill patients, and attempts to predict successful extubation in this context have failed. We aimed to investigate the frequency of mechanical ventilation (MV) in adult patients in status epilepticus (SE) and its clinical associations, to identify predictors at SE onset of prolonged postictal MV, and to determine the associated outcomes with prolonged MV. METHODS From 2012 to 2018, SE patients treated in intensive care units at a Swiss academic care center were included. Multivariable Poisson regression adjusting for potential confounders, such as continuously administered anesthetics, was performed to identify risks for postictal MV for >24 h after SE and its association with no return to neurologic function and death. Linear regression was performed to identify correlations between the durations of administered specific anesthetics and postictal MV. RESULTS Of 262 patients, 42% were ventilated, with 24% being on ventilators for >24 h after SE. Patients with prolonged postictal MV were extubated at a median of 7 days, with 56% not being extubated on the day of successful weaning from MV because of altered consciousness and/or lack of airway-protective reflexes. After extubation, noninvasive ventilation and reintubation were rarely needed. Prolonged postictal MV was associated with increased risk for death independent of potential confounders, including fatal etiology of SE, age, SE severity, and use of anesthetics (relative risk for every additional day = 2.7, p = .024). At SE onset, decreased consciousness and presumed fatal etiology predicted prolonged postictal MV. Anesthetics were associated with prolonged MV, but linear regression could not identify significant correlations. SIGNIFICANCE Our data reveal that prolonged postictal MV is frequent and an independent risk factor for death. Extubation is often delayed for days despite sufficient weaning from the ventilator and altered airway-protective reflexes in only few patients. Studies need to investigate whether more rigorous extubation strategies improve outcome.
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Affiliation(s)
- Sira M Baumann
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Saskia Semmlack
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Anja Rybitschka
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Paulina S C Kliem
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland.,Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
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13
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Prediction of Postictal Delirium Following Status Epilepticus in the ICU: First Insights of an Observational Cohort Study. Crit Care Med 2021; 49:e1241-e1251. [PMID: 34259657 DOI: 10.1097/ccm.0000000000005212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify early predictors of postictal delirium in adult patients after termination of status epilepticus. DESIGN Retrospective study. SETTING ICUs at a Swiss tertiary academic medical center. PATIENTS Status epilepticus patients treated on the ICUs for longer than 24 hours from 2012 to 2018. INTERVENTIONS None. METHODS Primary outcome was postictal delirium during post-status epilepticus treatment defined as an Intensive Care Delirium Screening Checklist greater than or equal to 4. Associations with postictal delirium were secondary outcomes. A time-dependent multivariable Cox proportional hazards model was used to identify risks of postictal delirium. It included variables that differed between patients with and without delirium and established risk factors for delirium (age, sex, number of inserted catheters, illness severity [quantified by the Sequential Organ Failure Assessment and Status Epilepticus Severity Score], neurodegenerative disease, dementia, alcohol/drug consumption, infections, coma during status epilepticus, dose of benzodiazepines, anesthetics, and mechanical ventilation). MEASUREMENTS AND MAIN RESULTS Among 224 patients, post-status epilepticus Intensive Care Delirium Screening Checklist was increased in 83% with delirium emerging in 55% with a median duration of 2 days (interquartile range 1-3 d). Among all variables, only the history of alcohol and/or drug consumption was associated with increased hazards for delirium in multivariable analyses (hazard ratio = 3.35; 95% CI, 1.53-7.33). CONCLUSIONS Our study provides first exploratory insights into the risks of postictal delirium in adult status epilepticus patients treated in the ICU. Delirium following status epilepticus is frequent, lasting mostly 2-3 days. Our findings that with the exception of a history of alcohol and/or drug consumption, other risk factors of delirium were not found to be associated with a risk of postictal delirium may be related to the limited sample size and the exploratory nature of our study. Further investigations are needed to investigate the role of established risk factors in other status epilepticus cohorts. In the meantime, our results indicate that the risk of delirium should be especially considered in patients with a history of alcohol and/or drug consumption.
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14
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Lattanzi S, Giovannini G, Brigo F, Orlandi N, Trinka E, Meletti S. Clinical phenotypes within nonconvulsive status epilepticus. Epilepsia 2021; 62:e129-e134. [PMID: 34244997 PMCID: PMC8456934 DOI: 10.1111/epi.16999] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/03/2023]
Abstract
The study aimed to identify distinct phenotypes within nonconvulsive status epilepticus (NCSE). Consecutive episodes of NCSE in patients at least 14 years old were included. The level of consciousness was assessed through the Glasgow Coma Scale (GCS). Etiology of NCSE was defined as symptomatic (acute, remote, progressive) or unknown. Electroencephalographic (EEG) recordings were searched for lateralized periodic discharges (LPDs), generalized sharply and/or triphasic periodic potentials (GPDs), and spontaneous burst suppression (BS). According to treatment response, NCSE was classified as responsive, refractory, or superrefractory. Average linkage hierarchical cluster analysis was performed with Pearson correlation as similarity measure. Two hundred twenty‐nine episodes of NCSE were included. Three clusters were identified. The first cluster linked GCS score 3–8, presence of spontaneous BS on EEG, acute symptomatic etiology, and treatment superrefractoriness. The second cluster gathered GCS score 9–12, presence of LPDs or GPDs on EEG, unknown etiology, and treatment refractoriness. The third cluster associated GCS score 13–15, absence of LPDs, GPDs, and spontaneous BS on EEG, and progressive and remote symptomatic etiology with treatment responsiveness. Phenotyping the heterogeneity of NCSE into electroclinical clusters can contribute to understanding correlations between pathologic and clinical domains, assessing the intrinsic severity of NCSE episodes, and estimating the likelihood of treatment responsiveness.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Giada Giovannini
- Neurology Unit, Baggiovara Civil Hospital, AOU Modena, Modena, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine, and Movement Science, University of Verona, Verona, Italy.,Division of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Niccolò Orlandi
- Neurology Unit, Baggiovara Civil Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.,Center for Cognitive Neuroscience, Salzburg, Austria.,Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Stefano Meletti
- Neurology Unit, Baggiovara Civil Hospital, AOU Modena, Modena, Italy.,Department of Biomedical, Metabolic, and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
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15
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Zhong Y, Yu Z, Wang L, Yang X. Combined detection of procalcitonin, heparin-binding protein, and interleukin-6 is a promising assay to diagnose and predict acute pancreatitis. J Clin Lab Anal 2021; 35:e23869. [PMID: 34151489 PMCID: PMC8373338 DOI: 10.1002/jcla.23869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background Acute pancreatitis (AP), one of the most common clinical emergencies, is characterized by variable clinical features and inadequate diagnostic methods. At present, the commonly used indicators do not have high specificity and do not necessarily reflect disease severity. We therefore aimed to investigate diagnostic and prognostic value of plasma procalcitonin, heparin‐binding protein, and interleukin‐6 for acute pancreatitis by separate detection and joint detection. Methods The study involved 451 participants, including 343 AP patients and 108 healthy controls. We analyzed the association of the three biomarkers with the severity and prognosis of AP. Results A statistically significant increase in the mean plasma analyte levels was detected in the study group compared to the control group. Multivariate comparison showed that plasma levels of PCT, HBP, and IL‐6 were all significantly different among the three groups at different sampling times (1st, 3rd, 7th, and 10th day of admission) (p < 0.01). The combination of the three indicators had significantly higher diagnostic value than either the individual markers or pairwise combinations (p < 0.001). The levels of the three were all significantly higher in severe acute pancreatitis (SAP) patients than in non‐SAP patients (p < 0.001); meanwhile, patients with high levels had a worse prognosis than those with low levels (p < 0.05). In multivariate analysis adjusted for age and sex, high levels of PCT, HBP, and IL‐6 were found to be independently associated with the development of AP. Conclusions It dramatically improved the diagnostic power of AP when PCT, HBP, and IL‐6 were combined; high PCT, HBP, and IL‐6 levels within 3 days of admission may be the potentially useful indicators for predicting SAP.
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Affiliation(s)
- Yuhong Zhong
- Department of Clinical Laboratory, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongqi Yu
- School of Medical Laboratory, Hangzhou Medical College, Hangzhou, China
| | - Lin Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xufeng Yang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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16
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De Stefano P, Baumann SM, Semmlack S, Rüegg S, Marsch S, Seeck M, Sutter R. Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus: A 2-Center Study. Neurology 2021; 97:e564-e576. [PMID: 34045273 DOI: 10.1212/wnl.0000000000012292] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs. METHODS Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss academic medical care centers from Basel and Geneva were retrospectively assessed. Primary outcomes were return to premorbid neurologic function and in-hospital death. Secondary outcomes were the emergence of complications during SE, duration of SE, and intensive care unit (ICU) and hospital stays. RESULTS Of 230 patients, 205 received treatment escalation after first-line medication. Of those, 27.3% were directly treated with artificial coma and 72.7% with second-line nonanesthetic antiseizure drugs. Of the latter, 16.6% were subsequently put on artificial coma after failure of second-line treatment. Multivariable analyses revealed increasing odds for coma induction after first-line treatment with younger age, the presence of convulsions, and an increased SE severity as quantified by the Status Epilepticus Severity Score (STESS). While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration and ICU and hospital stays. CONCLUSIONS Early induction of artificial coma is performed in more than every fourth patient and especially in younger patients presenting with convulsions and more severe SE. Our data demonstrate that this aggressive treatment escalation was not associated with an increase in complications but with shorter duration of SE and ICU and hospital stays. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that early induction of artificial coma after unsuccessful first-line treatment for SE is associated with shorter duration of SE and ICU and hospital stays compared to the use of a second-line nonanesthetic antiseizure drug instead of or before anesthetics, without an associated increase in complications.
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Affiliation(s)
- Pia De Stefano
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland.
| | - Sira Maria Baumann
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland
| | - Saskia Semmlack
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland
| | - Stephan Rüegg
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland
| | - Stephan Marsch
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland
| | - Margitta Seeck
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland
| | - Raoul Sutter
- From the EEG and Epilepsy Unit (P.D.S., M.S.), Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva; Medical Faculty (S.M.B., S.M., R.S.) and Department of Clinical Research (R.S.), University of Basel; and Department of Intensive Care (S.S., S.R., S.M., R.S.) and Division of Neurophysiology (S.R., R.S.), Department of Neurology, University Hospital Basel, Switzerland
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Frequency and Implications of Complications in the ICU After Status Epilepticus: No Calm After the Storm. Crit Care Med 2020; 48:1779-1789. [PMID: 33205920 DOI: 10.1097/ccm.0000000000004642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the frequency, types, and implications of complications during intensive care in patients after status epilepticus has been successfully terminated. DESIGN Retrospective study. SETTING ICUs at a Swiss tertiary academic medical care center. PATIENTS Data were collected from the digital patient records of all adult patients with status epilepticus from 2012 to 2018. INTERVENTIONS None. METHODS Primary outcomes were defined as frequency of complications following status epilepticus termination and return to premorbid functional baseline. Univariable analyses regarding the relative risks of complications occurring after status epilepticus termination for no return to premorbid neurologic function were estimated by Poisson regression with robust error variance. RESULTS Of 311 patients with status epilepticus, 224 patients (72%) were treated on the ICU for more than 24 hours following status epilepticus termination. Ninety-six percent of patients remained in a prolonged state of altered consciousness for a median of 2 days (interquartile range, 1-3 d) and 80% had complications during their ICU treatment. Fifty-five percent had new-onset delirium with a median duration of 2 days (interquartile range, 1-3 d). Forty-two percent had mechanical ventilation for a median of 4 days (interquartile range, 2-11 d) and 21% had nosocomial infections diagnosed after status epilepticus. Multivariable analyses revealed that mechanical ventilation for more than 24 hours after status epilepticus, and arterial hypotension requiring vasopressors were independently associated with increased risk of no return to premorbid function (RRfor each additional day = 1.01; 95% CI, 1.02-1.03 and RRfor each additional day = 1.03; 95% CI, 1.01-1.05) and death (RRfor each additional day = 1.11; 95% CI, 1.04-1.19 and RRfor each additional day = 1.15; 95% CI, 1.03-1.28). Delirium was independently associated with a decreased relative risk of death (RRfor each additional day = 0.55; 95% CI, 0.37-0.80), but prolonged ICU- and hospital stays. CONCLUSIONS Complications after status epilepticus termination are frequent and associated with no return to premorbid function, death, and prolonged ICU- and hospital stays. These results call for heightened awareness and further studies mainly regarding prediction and preventive strategies in this context.
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Fisch U, Baumann SM, Semmlack S, Marsch S, Rüegg S, Sutter R. Accuracy of Calculated Free Valproate Levels in Adult Patients With Status Epilepticus. Neurology 2020; 96:e102-e110. [PMID: 33055270 DOI: 10.1212/wnl.0000000000011000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/20/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the accuracy of an equation in adult patients with status epilepticus that calculates the free concentration of serum valproic acid (fVPA) from the total concentration of serum valproic acid (tVPA) and serum albumin. METHODS All adult patients with status epilepticus who were treated at a Swiss academic medical center between 2005 and 2018 with concurrent measurements of tVPA, fVPA, and serum albumin were included. fVPA was categorized as subtherapeutic, therapeutic (5-10 mg/L), or supratherapeutic. Agreement was defined as the proportion of measured and calculated fVPA falling within the same category. RESULTS Of 676 patients with status epilepticus, 104 had 506 measurements, with a median of 3 (interquartile range [IQR] 1.5-6.5) per patient. The median tVPA was 43.5 mg/L (27.4-63.6), with measured fVPA 9.1 mg/L (4.5-14.7) and calculated fVPA 10.1 mg/L (7.0-13.0), respectively. The median deviation of calculated from measured fVPA was -0.8 mg/L (-3.2 to 2.5) with 336 measurements >1 mg/L. While the association between measured and calculated fVPA was linear (regression coefficient 1.1, 95% confidence interval 0.9-1.2, p < 0.0001), the agreement on effective drug levels did not match in 39.8% of measurements regardless of serum albumin levels, with calculated fVPA overestimating measured fVPA in 30.4%. tVPA and serum albumin independently influenced the accuracy of the calculated fVPA in the multivariable model. CONCLUSIONS Calculated fVPA is inaccurate when using the proposed equation in adult patients with status epilepticus, calling for drug monitoring based on measured fVPA in this context.
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Affiliation(s)
- Urs Fisch
- From the Department of Neurology (U.F., S.R.) and Clinic for Intensive Care Medicine (S.M.B., S.S., S.M., R.S.), University Hospital Basel; and Medical Faculty of the University of Basel (S.M., S.R., R.S.), Switzerland.
| | - Sira M Baumann
- From the Department of Neurology (U.F., S.R.) and Clinic for Intensive Care Medicine (S.M.B., S.S., S.M., R.S.), University Hospital Basel; and Medical Faculty of the University of Basel (S.M., S.R., R.S.), Switzerland
| | - Saskia Semmlack
- From the Department of Neurology (U.F., S.R.) and Clinic for Intensive Care Medicine (S.M.B., S.S., S.M., R.S.), University Hospital Basel; and Medical Faculty of the University of Basel (S.M., S.R., R.S.), Switzerland
| | - Stephan Marsch
- From the Department of Neurology (U.F., S.R.) and Clinic for Intensive Care Medicine (S.M.B., S.S., S.M., R.S.), University Hospital Basel; and Medical Faculty of the University of Basel (S.M., S.R., R.S.), Switzerland
| | - Stephan Rüegg
- From the Department of Neurology (U.F., S.R.) and Clinic for Intensive Care Medicine (S.M.B., S.S., S.M., R.S.), University Hospital Basel; and Medical Faculty of the University of Basel (S.M., S.R., R.S.), Switzerland
| | - Raoul Sutter
- From the Department of Neurology (U.F., S.R.) and Clinic for Intensive Care Medicine (S.M.B., S.S., S.M., R.S.), University Hospital Basel; and Medical Faculty of the University of Basel (S.M., S.R., R.S.), Switzerland
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19
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Fontaine C, Lemiale V, Resche-Rigon M, Schenck M, Chelly J, Geeraerts T, Hamdi A, Guitton C, Meziani F, Lefrant JY, Megarbane B, Mentec H, Chaffaut C, Cariou A, Legriel S. Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus: A post hoc study of a randomized controlled trial. Neurology 2020; 95:e2529-e2541. [PMID: 32913029 DOI: 10.1212/wnl.0000000000010726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/04/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus. METHODS This was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C-34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus. RESULTS The 172 men and 93 women had a median age of 57 years (45-68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35-120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20-3.85; p = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04-3.85; p = 0.04), primary brain insult (OR 2.00, 95% CI 1.02-4.00; p = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05-5.59; p = 0.04). CONCLUSIONS In our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus. CLINICALTRIALSGOV IDENTIFIER NCT01359332.
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Affiliation(s)
- Candice Fontaine
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Virginie Lemiale
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Matthieu Resche-Rigon
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Maleka Schenck
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Jonathan Chelly
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Thomas Geeraerts
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Aicha Hamdi
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Christophe Guitton
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Ferhat Meziani
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Jean-Yves Lefrant
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Bruno Megarbane
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Hervé Mentec
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Cendrine Chaffaut
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Alain Cariou
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Stephane Legriel
- From the Medical-Surgical Intensive Care Unit (C.F.), Hopital Paris Saint Joseph, Paris; IctalGroup (C.F., J.C., S.L.), Le Chesnay; Medical Intensive Care Unit (V.L.) and SBIM Biostatistics and Medical Information (M.R.-R., C.C.), Saint Louis University Hospital; Université Paris Diderot (M.R.-R., C.C.); ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé) (M.R.-R.), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité; Medical Intensive Care Unit (M.S.), Hôpital de Hautepierre, and Medical Intensive Care Unit (F.M.), Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg; Medical-Surgical Intensive Care Unit (J.C.), Centre Hospitalier de Melun; Anesthesiology and Critical Care Department (T.G.), Toulouse University Hospital, University Toulouse 3 Paul Sabatier; Medical-Surgical Intensive Care Unit (A.H.), Centre Hospitalier de Montreuil; Medical-Surgical Intensive Care Unit (C.G.), Centre Hospitalier du Mans, Le Mans; EA 7293 (F.M.), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg; Intensive Care Units (J.-Y.L.), Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes; Medical Intensive Care Unit (B.M.), Lariboisiere University Hospital, APHP, Paris; Medical-Surgical Intensive Care Unit (H.M.), Centre Hospitalier Victor Dupouy, Argenteuil; Medical Intensive Care Unit (A.C.), Cochin University Hospital, Hopitaux Universitaires-Paris Centre, AP-HP; Paris Descartes University (A.C.), Sorbonne Paris Cité-Medical School; INSERM U970 (A.C.), Paris Cardiovascular Research Center; Intensive Care Department (S.L.), Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay; and Université Paris-Saclay (S.L.), UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.
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Assessing the Risk/Benefit at Status Epilepticus Onset: The Prognostic Scores. J Clin Neurophysiol 2020; 37:381-384. [DOI: 10.1097/wnp.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Legriel S. Hypothermia as a treatment in status epilepticus: A narrative review. Epilepsy Behav 2019; 101:106298. [PMID: 31133509 DOI: 10.1016/j.yebeh.2019.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/19/2022]
Abstract
Status epilepticus (SE) is associated with high mortality and morbidity rates, notably in its refractory and super-refractory forms. This narrative review discusses recent data on the potential benefits of targeted temperature management. In studies of patients with cerebral injury due to various factors, therapeutic hypothermia had variable effects on survival and functional outcomes. Sources of this variability may include the underlying etiology, whether hypothermia was used for prophylaxis or treatment, the degree and duration of hypothermia, and the hypothermia application modalities. Data from animal studies strongly suggest benefits from therapeutic hypothermia in SE. In humans, beneficial effects have been described in anecdotal case reports and small case series, but the level of evidence is low. A randomized controlled trial found no evidence that moderate hypothermia (32-34 °C) was neuroprotective in critically ill patients with convulsive SE. Nevertheless, some promising effects were noted, suggesting that therapeutic hypothermia might have a role as an adjuvant to anticonvulsant drug therapy in patients with refractory or super-refractory SE. This article is part of a Special Issue entitled "Status Epilepticus". This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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Affiliation(s)
- Stéphane Legriel
- Medico-Surgical Intensive Care Department, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150 Le Chesnay Cedex, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; IctalGroup, France.
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Ulvin LB, Taubøll E, Olsen KB, Heuser K. Predictive performances of STESS and EMSE in a Norwegian adult status epilepticus cohort. Seizure 2019; 70:6-11. [PMID: 31229856 DOI: 10.1016/j.seizure.2019.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/29/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE "Status Epilepticus Severity Score" (STESS) and "Epidemiology-based Mortality Score in Status Epilepticus" (EMSE) are two clinical scoring systems aiming to predict mortality in status epilepticus (SE). The objective of this study was to compare their predictive performances in a cohort of 151 SE-patients from Oslo University Hospital in the period 2001-2017. METHOD Variables used to calculate STESS (age, previous seizures, worst SE-semiology, level of consciousness) and two different versions of EMSE, EMSE-EAC (etiology, age, comorbidities) and EMSE-EACE (etiology, age, comorbidities, EEG-pattern), as well as outcome were collected retrospectively. Receiver Operating Characteristic (ROC)-analyses, determination of best cut-off values, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were performed. In addition, Precision-Recall curves (PRC) were produced, plotting PPV as a function of Se. RESULTS Thirteen patients (9%) died during their hospital stay. STESS did not accurately predict mortality, with a ROC-curve showing an area under the curve (AUC) of 0.625(95%CI = 0.472-0.783), p = 0.15. EMSE-EAC performed better with an AUC of 0.714(95%CI = 0.552-0.873), p = 0.01 and a best cut-off value of 37. Se was 69.2%, Sp 72.1%, PPV 19% and NPV 96.2%. EMSE-EACE performed best with an AUC of 0.855(95%CI = 0.736-0.976), p < 0.0005 and a best cut-off value of 79. Se was 77.8%, Sp 87.8%, PPV 36.8% and NPV 97.7%. The PRC showed areas under the PRC of 0.23 for EMSE-EAC and 0.46 for EMSE-EACE. CONCLUSIONS EMSE-EAC and EMSE-EACE performed better than STESS and may be useful in identifying the patients at risk of death in SE. PRC may give a more relevant visual representation of predictive utility than ROC-curves in situations of imbalanced datasets.
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Affiliation(s)
- Line Bédos Ulvin
- Department of Neurology, Oslo University Hospital, Oslo, Norway; ERGO - Epilepsy Research Group of Oslo, Oslo University Hospital, Oslo, Norway.
| | - Erik Taubøll
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; ERGO - Epilepsy Research Group of Oslo, Oslo University Hospital, Oslo, Norway.
| | - Ketil Berg Olsen
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Department of Neurology, Østfold Hospital Trust, Norway; ERGO - Epilepsy Research Group of Oslo, Oslo University Hospital, Oslo, Norway.
| | - Kjell Heuser
- Department of Neurology, Oslo University Hospital, Oslo, Norway; ERGO - Epilepsy Research Group of Oslo, Oslo University Hospital, Oslo, Norway.
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Wang H, Bai ZH, Lv JH, Sun JL, Shi Y, Zhang ZL, Pei HH. The relationship and threshold of serum phosphate with regard to the 28-day mortality risk in sepsis patients undergoing continuous renal replacement therapy. J Int Med Res 2019; 48:300060519831896. [PMID: 30819019 PMCID: PMC7140203 DOI: 10.1177/0300060519831896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the association between serum phosphate levels and the risk of
28-day mortality in critically-ill patients with septic acute kidney injury
(AKI) undergoing continuous renal replacement therapy (CRRT). Methods This retrospective cohort study analysed data from critically-ill patients
with septic AKI who underwent CRRT between January 2009 and September 2016.
Demographic, clinical and routine biochemical data were retrieved from a
database and analysed to identify risk factors for 28-day mortality. Results A total of 796 patients were included in the analyses. Multivariate
regression analyses showed that phosphate (0 h), phosphate (24 h) and delta
phosphate were associated with the 28-day mortality in patients with septic
AKI undergoing CRRT. The adjusted odds ratios (95% confidence interval) were
1.12 (1.03, 1.22), 1.22 (1.14, 1.30) and 1.12 (1.04, 1.20) for phosphate
(0 h), phosphate (24 h) and delta phosphate, respectively. Curve fitting and
threshold analyses showed that when phosphate (0 h) was between 5.6 mg/dl
and 8.7 mg/dl, phosphate (24 h) was >3.8 mg/dl and delta phosphate was
>–1, the 28-day mortality risk increased significantly. Conclusion In patients with septic AKI undergoing CRRT, serum phosphate level was
associated with the prognosis of patients in terms of 28-day mortality.
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Affiliation(s)
- Hai Wang
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zheng-Hai Bai
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jun-Hua Lv
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jiang-Li Sun
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yu Shi
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zheng-Liang Zhang
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Hong-Hong Pei
- Emergency Department & Emergency Intensive Care Unit, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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