Sutter Raoul, Kaplan Peter W
Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland
Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Clin EEG Neurosci. 2016 Jan;47(1):61-8. doi: 10.1177/1550059415579768. Epub 2015 Mar 30.
Marked impairment of consciousness, brain lesion on neuroimaging, and nonreactive electroencephalographic (EEG) background activity are established outcome predictors in patients with hypoxic encephalopathy. In this observational cohort study, we aimed to assess the predictive value of clinical, neuroimaging and EEG characteristics for outcome in different types of acute nonhypoxic encephalopathic patients. All adult intensive care unit patients from a tertiary academic medical care center with clinical and EEG evidence of acute nonhypoxic encephalopathy were included from 2004 to 2012. Clinical data, neuroimaging studies, EEG characteristics, and outcome were assessed. In-hospital death was the main outcome. Median age of 262 patients was 65 years (range 18-98 years). Mortality was 12.6%. In Poisson regression analyses, older age (P=.02), intracranial hemorrhage (P=.008), coma (P=.012), and nonreactive EEG background activity (P<.0001) were independently associated with death with nonreactive EEG being the strongest predictor (relative risk 3.74; 95% confidence interval 2.02-6.91). Subgroup analysis revealed no significant effect modification for the predictive value of nonreactive EEG by the presence or absence of coma and different types of acute brain lesions. In conclusion, this study identifies and quantifies the independent predictive value of older age, intracranial hemorrhage, coma, and nonreactive EEG for death, in patients with different types of acute nonhypoxic encephalopathy. These results add further credence to the limited body of evidence that EEG provides important prognostic information in different types of acute encephalopathy not related to hypoxic brain injury. Further studies are warranted to analyze the robustness of this predictor in larger subpopulations with specific etiologies of acute nonhypoxic encephalopathies.
意识严重受损、神经影像学检查发现脑损伤以及脑电图（EEG）背景活动无反应是缺氧性脑病患者已确定的预后预测指标。在这项观察性队列研究中，我们旨在评估临床、神经影像学和EEG特征对不同类型急性非缺氧性脑病患者预后的预测价值。纳入了2004年至2012年来自三级学术医疗中心的所有成年重症监护病房患者，这些患者有急性非缺氧性脑病的临床和EEG证据。评估了临床数据、神经影像学研究、EEG特征和预后。院内死亡是主要结局。262例患者的中位年龄为65岁（范围18 - 98岁）。死亡率为12.6%。在泊松回归分析中，年龄较大（P = 0.02）、颅内出血（P = 0.008）、昏迷（P = 0.012）和EEG背景活动无反应（P < 0.0001）与死亡独立相关，EEG无反应是最强的预测指标（相对风险3.74；95%置信区间2.02 - 6.91）。亚组分析显示，昏迷的存在与否以及不同类型的急性脑损伤对EEG无反应预测价值无显著效应修正。总之，本研究确定并量化了年龄较大、颅内出血、昏迷和EEG无反应对不同类型急性非缺氧性脑病患者死亡的独立预测价值。这些结果进一步证明了有限的证据，即EEG在不同类型与缺氧性脑损伤无关的急性脑病中提供重要的预后信息。有必要进一步研究分析该预测指标在具有急性非缺氧性脑病特定病因的更大亚组人群中的稳健性。
