Freund Yonathan, Bloom Benjamin, Bokobza Jerome, Baarir Nacera, Laribi Said, Harris Tim, Navarro Vincent, Bernard Maguy, Pearse Rupert, Riou Bruno, Hausfater Pierre
Sorbonne universités, UPMC Univ Paris 06, UMRS INSERM 1166, IHU ICAN, Paris, France; Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
Emergency Department, Royal London Hospital, London, United Kingdom; Queen Mary University of London, London, United Kingdom.
PLoS One. 2015 Apr 7;10(4):e0122405. doi: 10.1371/journal.pone.0122405. eCollection 2015.
To evaluate the performance of S100-B protein and copeptin, in addition to clinical variables, in predicting outcomes of patients attending the emergency department (ED) following a seizure.
We prospectively included adult patients presented with an acute seizure, in four EDs in France and the United Kingdom. Participants were followed up for 28 days. The primary endpoint was a composite of seizure recurrence, all-cause mortality, hospitalization or rehospitalisation, or return visit in the ED within seven days.
Among the 389 participants included in the analysis, 156 (40%) experienced the primary endpoint within seven days and 195 (54%) at 28 days. Mean levels of both S100-B (0.11 μg/l [95% CI 0.07-0.20] vs 0.09 μg/l [0.07-0.14]) and copeptin (23 pmol/l [9-104] vs 17 pmol/l [8-43]) were higher in participants meeting the primary endpoint. However, both biomarkers were poorly predictive of the primary outcome with a respective area under the receiving operator characteristic curve of 0.57 [0.51-0.64] and 0.59 [0.54-0.64]. Multivariable logistic regression analysis identified higher age (odds ratio [OR] 1.3 per decade [1.1-1.5]), provoked seizure (OR 4.93 [2.5-9.8]), complex partial seizure (OR 4.09 [1.8-9.1]) and first seizure (OR 1.83 [1.1-3.0]) as independent predictors of the primary outcome. A second regression analysis including the biomarkers showed no additional predictive benefit (S100-B OR 3.89 [0.80-18.9] copeptin OR 1 [1.00-1.00]).
The plasma biomarkers S100-B and copeptin did not improve prediction of poor outcome following seizure. Higher age, a first seizure, a provoked seizure and a partial complex seizure are independently associated with adverse outcomes.
评估S100 - B蛋白和 copeptin以及临床变量在预测癫痫发作后前往急诊科（ED）就诊患者的预后方面的表现。
我们前瞻性纳入了法国和英国四个急诊科中出现急性癫痫发作的成年患者。对参与者进行了28天的随访。主要终点是癫痫复发、全因死亡率、住院或再次住院，或在7天内返回急诊科的综合情况。
在纳入分析的389名参与者中，156名（40%）在7天内经历了主要终点，195名（54%）在28天内经历了主要终点。达到主要终点的参与者中，S100 - B（0.11μg/l [95% CI 0.07 - 0.20] 对比 0.09μg/l [0.07 - 0.14]）和copeptin（23 pmol/l [9 - 104] 对比 17 pmol/l [8 - 43]）的平均水平均较高。然而，这两种生物标志物对主要结局的预测能力较差，其各自的受试者工作特征曲线下面积分别为0.57 [0.51 - 0.64] 和0.59 [0.54 - 0.64]。多变量逻辑回归分析确定年龄较大（每十年优势比[OR] 1.3 [1.1 - 1.5]）、诱发性癫痫发作（OR 4.93 [2.5 - 9.8]）、复杂部分性癫痫发作（OR 4.09 [1.8 - 9.1]）和首次癫痫发作（OR 1.83 [1.1 - 3.0]）是主要结局的独立预测因素。包含生物标志物的第二次回归分析未显示出额外的预测益处（S100 - B OR 3.89 [0.80 - 18.9]，copeptin OR 1 [1.00 - 1.00]）。
血浆生物标志物S100 - B和copeptin并不能改善癫痫发作后不良结局的预测。年龄较大、首次癫痫发作、诱发性癫痫发作和部分复杂性癫痫发作与不良结局独立相关。
