Choi Jun Young, Hong Ji Man, Kim Tae Joon, Kim Byung Gon, Huh Kyoon
Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
Clin Neurol Neurosurg. 2019 Sep;184:105454. doi: 10.1016/j.clineuro.2019.105454. Epub 2019 Jul 24.
Early recognition of refractory status epilepticus (RSE) is essential to select an appropriate treatment strategy and is closely associated with the outcome. Only few studies of RSE biomarkers exist; hence, we investigated the serum levels of uric acid (UA), albumin, and C-reactive protein (CRP) as potential serologic biomarkers for RSE.
Consecutive status epilepticus (SE) patients who had serial conventional blood tests in a referral hospital over a period of 10 years were retrospectively analyzed. Patients with anoxic encephalopathy, renal failure, acute stroke, and myocardial infarction were excluded. RSE was defined as seizure continuing after the first- and second-line treatments. We also assessed SE severity in all included patients using the Status Epilepticus Severity Score (STESS). General demographics and blood test findings were compared between responsive SE and RSE patients.
A total of 141 patients (99 responsive and 42 refractory) were recruited from our SE registry. Compared to responsive patients, patients with RSE showed a higher STESS, lower initial albumin levels, lower initial UA levels, lower follow-up UA levels, and greater reduction of UA levels. The RSE group more frequently had acute symptomatic etiology, showed longer hospitalization, and had poorer functional outcomes compared to the responsive-SE group. All evaluated UA level parameters exhibited significant areas under the curve in receiver operating characteristic analyses, predictive of RSE. Initial UA levels, as well as changes therein, were significantly associated with RSE in multivariate logistic regression analysis.
UA levels at initial and follow-up evaluations, and changes therein differentiated responsive SE and RSE, demonstrating the feasibility of UA serum levels as a biomarker for RSE.
早期识别难治性癫痫持续状态（RSE）对于选择合适的治疗策略至关重要，且与预后密切相关。目前关于RSE生物标志物的研究较少；因此，我们研究了血清尿酸（UA）、白蛋白和C反应蛋白（CRP）水平，作为RSE潜在的血清学生物标志物。
回顾性分析了一家转诊医院在10年期间连续进行常规血液检查的癫痫持续状态（SE）患者。排除患有缺氧性脑病、肾衰竭、急性中风和心肌梗死的患者。RSE定义为一线和二线治疗后仍持续发作的癫痫。我们还使用癫痫持续状态严重程度评分（STESS）评估了所有纳入患者的SE严重程度。比较了反应性SE患者和RSE患者的一般人口统计学特征和血液检查结果。
我们的SE登记系统共纳入了141例患者（99例反应性患者和42例难治性患者）。与反应性患者相比，RSE患者的STESS更高，初始白蛋白水平更低，初始UA水平更低，随访UA水平更低，UA水平下降幅度更大。与反应性SE组相比，RSE组急性症状性病因更为常见，住院时间更长，功能预后更差。在接受者操作特征分析中，所有评估的UA水平参数均显示出显著的曲线下面积，可预测RSE。在多因素逻辑回归分析中，初始UA水平及其变化与RSE显著相关。
初始和随访评估时的UA水平及其变化可区分反应性SE和RSE，表明UA血清水平作为RSE生物标志物的可行性。
