Dani Raunak, Sodani Ajoy, Telang Kapil, Nigam Richa
Department of Neurology, Sri Aurobindo Medical College and P.G. Institute, Indore, Madhya Pradesh, India.
Ann Indian Acad Neurol. 2019 Jan-Mar;22(1):84-90. doi: 10.4103/aian.AIAN_466_17.
The determinants of the outcome in adult convulsive status epilepticus(CSE), also the implication of the value of mean arterial blood pressure (MAP), and random blood sugar at admission on the outcome are not clear.
The objective of this study is to look for the determinants of unfavorable outcome in CSE.
Ambispectively gathered data from 55 patients, treated consecutively with identical protocol during January 2010-December 2016, were analyzed. The demographic and clinical variables were identified and correlated with outcome in each individual.
There were 65.45% males and 34.55% females. Favorable outcome (conscious and discharged) was seen in 63.6%, unfavorable (death 14.5%, absent cortical functions 10.9%, and inability to wean-off anesthetic agents 10.9%). The parameters associated with unfavorable outcome were female gender (odds ratio [OR]: 1.45), MAP ≤80 mmHg (OR: 2.57), time to first medical attention >5 h (OR: 127.8), and time to control clinical seizures >3.5 h (OR: 7.87). Almost 44.2% of patients with SE severity score >2 had unfavorable outcome (sensitivity 75% and specificity 45.7%). New scoring system, the CSE outcome score (CSEOS, developed by combining the predictors associated with higher odds of poor outcome), predicted the poor outcome with the sensitivity and specificity of 90% and 54.29%, respectively.
Low MAP and delay of >3.5 h in treatment initiation or seizure control are the key determinants of poor outcome in CSE. With the incorporation of CSEOS, we believe that our findings can be helpful in the process of clinical decision-making and prognostication of patients with CSE.
成人惊厥性癫痫持续状态（CSE）预后的决定因素，以及入院时平均动脉压（MAP）和随机血糖值对预后的影响尚不清楚。
本研究旨在寻找CSE不良预后的决定因素。
对2010年1月至2016年12月期间连续采用相同方案治疗的55例患者进行回顾性收集数据并分析。确定人口统计学和临床变量，并将其与每个个体的预后进行关联分析。
男性占65.45%，女性占34.55%。63.6%的患者预后良好（意识清醒并出院），不良预后（死亡14.5%，无皮质功能10.9%，无法停用麻醉剂10.9%）。与不良预后相关的参数为女性性别（比值比[OR]：1.45）、MAP≤80 mmHg（OR：2.57）、首次就医时间>5小时（OR：127.8）以及控制临床癫痫发作时间>3.5小时（OR：7.87）。几乎44.2%的SE严重程度评分>2的患者预后不良（敏感性75%，特异性45.7%）。新的评分系统，即CSE预后评分（CSEOS，通过结合与不良预后较高几率相关的预测因素开发），预测不良预后的敏感性和特异性分别为90%和54.29%。
低MAP以及治疗开始或癫痫发作控制延迟>3.5小时是CSE不良预后的关键决定因素。通过纳入CSEOS，我们相信我们的研究结果有助于CSE患者的临床决策和预后评估过程。
