Scarpino Maenia, Lanzo Giovanni, Carrai Riccardo, Lolli Francesco, Migliaccio Maria Luisa, Spalletti Maddalena, Peris Adriano, Amantini Aldo, Grippo Antonello
SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; Unità di Riabilitazione Neurologica, Fondazione Don Carlo Gnocchi, IRCCS, Florence, Italy.
SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
Neurophysiol Clin. 2017 Feb;47(1):19-29. doi: 10.1016/j.neucli.2016.11.001. Epub 2016 Dec 16.
To assess whether Somatosensory Evoked Potentials (SEPs), recorded within 24h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury of various aetiologies.
SEPs were classified as absent (A), pathological (P), and normal (N). Considering SEP recordings from both hemispheres, 6 patterns were identified: NN, NP, PP, NA, AP, and AA. The final endpoint was BD.
Of the 203 patients included in the study, 70 (34%) evolved toward BD. The survival analysis indicated that the combination of SEP patterns in a two-graded scale (grade 1: NN-NP-PP-NA, and grade 2: AP-AA), allowed for prediction of BD with the best accuracy. This aggregation predicted BD with a sensitivity of 75.7% (CI: 64-84), a specificity of 76.6% (CI: 68-83), a positive predictive value of 64.2% (CI: 53-74) and a negative predictive value of 84.3% (CI: 77-90) in overall patients, and with a sensitivity of 75.0% (CI: 63-84), a specificity of 84.9% (CI: 75-90), a positive predictive value of 77.5% (CI: 63-88) and a negative predictive value of 84.3% (CI: 74-91) when excluding cardiac arrest.
It is worth including SEPs, in association with other investigations and clinical signs, in prognostic scores of BD. The early identification of patients at high risk of evolving towards BD could help physicians to optimise management.
评估在重症监护病房（ICU）入院后24小时内记录的体感诱发电位（SEP）是否为各种病因所致获得性脑损伤的昏迷患者脑死亡（BD）的可靠预测指标。
SEP分为消失（A）、病理性（P）和正常（N）。考虑双侧半球的SEP记录，确定了6种模式：NN、NP、PP、NA、AP和AA。最终终点为BD。
纳入研究的203例患者中，70例（34%）进展为BD。生存分析表明，SEP模式在两级量表（1级：NN-NP-PP-NA，2级：AP-AA）中的组合对BD的预测准确性最高。这种汇总预测BD的总体敏感度为75.7%（95%置信区间：64%-84%），特异度为76.6%（95%置信区间：68%-83%），阳性预测值为64.2%（95%置信区间：53%-74%），阴性预测值为84.3%（95%置信区间：77%-90%）；排除心脏骤停患者后，敏感度为75.0%（95%置信区间：63%-84%），特异度为84.9%（95%置信区间：75%-90%），阳性预测值为77.5%（95%置信区间：63%-88%），阴性预测值为84.3%（95%置信区间：74%-91%）。
在BD的预后评分中，将SEP与其他检查及临床体征相结合是值得的。早期识别有进展为BD高风险的患者有助于医生优化管理。
