From the Neuroepidemiology Research Unit (T.C.A., J.G.B.), Department of Clinical Neurological Sciences, Western University; ICES Western (B.N.A., L.R., S.Z.S., J.G.B.), London, Canada; and Department of Medicine (G.S.), Division of Neurology, University of Toronto, Canada.
Neurology. 2020 Oct 20;95(16):e2271-e2279. doi: 10.1212/WNL.0000000000010609. Epub 2020 Sep 4.
To determine whether survivors of intensive care unit (ICU) hospitalizations with sepsis experience higher epilepsy risk than survivors of ICU hospitalizations without sepsis, and to identify sepsis survivors at highest risk.
We used linked, administrative health care databases to conduct a population-based, retrospective matched cohort study of adult Ontario residents discharged from an ICU between January 1, 2010, and December 31, 2015, identified using the Discharge Abstract Database. We used propensity scores to match patients who experienced sepsis during their index ICU hospitalization with up to 4 patients who did not experience sepsis. We applied marginal Cox proportional hazards regression to estimate the risk of epilepsy within 2 years following the index ICU hospitalization. Among sepsis survivors, Cox proportional hazards regression was used to identify factors associated with epilepsy.
A total of 143,892 patients were included, 32,252 (22.4%) of whom were exposed. Sepsis survivors were at significantly higher epilepsy risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.15-1.80). The risk of epilepsy marginally decreased with increasing age (HR 0.97, 95% CI 0.96-0.99); patients with chronic kidney disease (HR 2.25, 95% CI 1.48-3.43) were at highest risk.
In this real-world analysis, sepsis survivors, particularly those who are younger and have chronic kidney disease, are at significantly higher epilepsy risk. These findings indicate that sepsis may be an unrecognized epilepsy risk factor.
确定 ICU 败血症住院幸存者是否比非败血症 ICU 住院幸存者经历更高的癫痫风险，并确定处于最高风险的败血症幸存者。
我们使用链接的行政医疗保健数据库，对 2010 年 1 月 1 日至 2015 年 12 月 31 日期间从 ICU 出院的安大略省成年居民进行了一项基于人群的回顾性匹配队列研究，该研究使用出院摘要数据库确定。我们使用倾向评分匹配在指数 ICU 住院期间发生败血症的患者与多达 4 名未发生败血症的患者。我们应用边际 Cox 比例风险回归估计指数 ICU 住院后 2 年内癫痫的风险。在败血症幸存者中，我们应用 Cox 比例风险回归确定与癫痫相关的因素。
共纳入 143892 名患者，其中 32252 名（22.4%）患者暴露。败血症幸存者癫痫风险显著增加（风险比 [HR] 1.44，95%置信区间 [CI] 1.15-1.80）。癫痫风险随年龄增加而略有下降（HR 0.97，95%CI 0.96-0.99）；慢性肾脏病患者（HR 2.25，95%CI 1.48-3.43）风险最高。
在这项真实世界分析中，败血症幸存者，尤其是年龄较小和患有慢性肾脏病的患者，癫痫风险显著增加。这些发现表明败血症可能是一个未被识别的癫痫危险因素。
