Rossetti A O, Hurwitz S, Logroscino G, Bromfield E B
Department of Neurology, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Neurol Neurosurg Psychiatry. 2006 May;77(5):611-5. doi: 10.1136/jnnp.2005.080887.
Identification of outcome-predictive factors could lower risk of under- or over-treatment in status epilepticus (SE). Older age and acute symptomatic aetiology have been shown to predict mortality, but other variables are controversial and level of consciousness has received relatively little attention. The objective of this study was to assess variables predictive of mortality, particularly those available at presentation.
The discharge database (1997-2004) of two university hospitals was screened for adult patients with EEG confirmed SE, excluding cerebral anoxia. Outcome at discharge (mortality, return to baseline clinical conditions) was analysed in relation to demographics, clinical features, and aetiology. Aetiologies were also classified based on whether or not they were potentially fatal independently of SE.
Mortality was 15.6% among 96 patients with a first SE episode, 10 of whom also experienced recurrent SE during the study period. Eleven other patients had only recurrent SE. Mortality was 4.8% among these 21 patients with recurrent SE. Return to baseline condition was more frequent after recurrent than incident SE (p=0.02). For the first SE episode, death was associated with potentially fatal aetiology (p=0.01), age>or=65 (p=0.02), and stupor or coma at presentation (p=0.04), but not with gender, history of epilepsy, SE type, or time to treatment>or=1 h.
At initial evaluation, older age and marked impairment of consciousness are predictive of death. Surviving a first SE episode could lower the mortality and morbidity of subsequent episodes, suggesting that underlying aetiology, rather than SE per se, is the major determinant of outcome.
识别预后预测因素可降低癫痫持续状态（SE）治疗不足或过度治疗的风险。年龄较大和急性症状性病因已被证明可预测死亡率，但其他变量存在争议，且意识水平受到的关注相对较少。本研究的目的是评估预测死亡率的变量，尤其是那些在就诊时可得的变量。
对两家大学医院的出院数据库（1997 - 2004年）进行筛查，以确定脑电图证实为SE的成年患者，排除脑缺氧患者。分析出院时的预后（死亡率、恢复到基线临床状况）与人口统计学、临床特征和病因的关系。病因还根据其是否独立于SE具有潜在致命性进行分类。
96例首次发生SE的患者中，死亡率为15.6%，其中10例在研究期间还经历了反复SE。另外11例患者仅有反复SE。这21例反复SE患者的死亡率为4.8%。反复SE后恢复到基线状况比首次发作SE更常见（p = 0.02）。对于首次SE发作，死亡与潜在致命病因（p = 0.01）、年龄≥65岁（p = 0.02）以及就诊时昏迷或昏睡（p = 0.04）相关，但与性别、癫痫病史、SE类型或治疗时间≥1小时无关。
在初始评估时，年龄较大和意识明显受损可预测死亡。首次SE发作存活可降低后续发作的死亡率和发病率，这表明潜在病因而非SE本身是预后的主要决定因素。
