Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, Rochester, MN.
Department of Neurology, Mayo Clinic, Rochester, MN.
Crit Care Med. 2019 Sep;47(9):1226-1231. doi: 10.1097/CCM.0000000000003869.
To determine the causes of death in patients with status epilepticus. To analyze the relative contributions of seizure etiology, seizure refractoriness, use of mechanical ventilation, anesthetic drugs for seizure control, and medical complications to in-hospital and 90-day mortality, hospital length of stay, and discharge disposition.
Retrospective cohort.
Single-center neuroscience ICU.
Patients with status epilepticus were identified by retrospective search of electronic database from January 1, 2011, to December 31, 2016.
Review of electronic medical records.
Demographics, clinical characteristics, treatments, and outcomes were collected. Univariable and multivariable logistic regression analysis were used to determine whether the use of anesthetic drugs, mechanical ventilation, Status Epilepticus Severity Score, refractoriness of seizures, etiology of seizures, or medical complications were associated with in-hospital, 90-day mortality or discharge disposition. Among 244 patients with status epilepticus (mean age was 64 yr [interquartile range, 42-76], 55% male, median Status Epilepticus Severity Score 3 [interquartile range, 2-4]), 24 received anesthetic drug infusions for seizure control. In-hospital and 90-day mortality rates were 9.2% and 19.2%, respectively. Death was preceded by withdrawal of life-sustaining treatment in 19 patients (86.3%) and cardiac arrest in three (13.7%). Only Status Epilepticus Severity Score was associated with in-hospital and 90-day mortality, whereas the use of anesthetic drugs for seizure control, mechanical ventilation, medical complications, etiology, and refractoriness of seizures were not. Hospital length of stay was longer in patients with medical complications (p = 0.0091), refractory seizures (p = 0.0077), and in those who required anesthetic drugs for seizure control (p = 0.0035). Patients who had refractory seizures were less likely to be discharged home (odds ratio, 0.295; CI, 0.143-0.608; p = 0.0009).
In this cohort, death primarily resulted from the underlying neurologic disease and withdrawal of life-sustaining treatment and not from our treatment choices. Use of anesthetic drugs, medical complications, and mechanical ventilation were not associated with in-hospital and 90-day mortality.
确定癫痫持续状态患者的死亡原因。分析癫痫病因、癫痫发作难治性、机械通气、控制癫痫发作的麻醉药物使用以及医疗并发症对住院和 90 天死亡率、住院时间和出院去向的相对贡献。
回顾性队列研究。
单中心神经科学 ICU。
通过对 2011 年 1 月 1 日至 2016 年 12 月 31 日电子数据库的回顾性搜索，确定癫痫持续状态患者。
回顾电子病历。
收集人口统计学、临床特征、治疗和结局数据。采用单变量和多变量逻辑回归分析，确定麻醉药物、机械通气、癫痫持续状态严重程度评分、癫痫发作难治性、癫痫病因或医疗并发症是否与住院、90 天死亡率或出院去向有关。在 244 例癫痫持续状态患者中（平均年龄为 64 岁[四分位间距，42-76]，55%为男性，中位癫痫持续状态严重程度评分 3[四分位间距，2-4]），24 例患者接受了麻醉药物输注以控制癫痫发作。住院和 90 天死亡率分别为 9.2%和 19.2%。19 例患者（86.3%）在死亡前停止了维持生命的治疗，3 例患者（13.7%）发生了心脏骤停。只有癫痫持续状态严重程度评分与住院和 90 天死亡率相关，而控制癫痫发作的麻醉药物使用、机械通气、医疗并发症、病因和癫痫发作难治性与住院和 90 天死亡率无关。有医疗并发症（p=0.0091）、难治性癫痫（p=0.0077）和需要麻醉药物控制癫痫发作的患者（p=0.0035）住院时间更长。难治性癫痫患者更不可能出院回家（优势比，0.295；CI，0.143-0.608；p=0.0009）。
在本队列中，死亡主要是由基础神经疾病和停止维持生命的治疗引起的，而不是由我们的治疗选择引起的。麻醉药物使用、医疗并发症和机械通气与住院和 90 天死亡率无关。
