Vieille Thibault, Jacq Gwenaëlle, Merceron Sybille, Huriaux Laetitia, Chelly Jonathan, Quenot Jean-Pierre, Legriel Stéphane
Department of Intensive Care, Burgundy University Hospital, Dijon, France; IctalGroup, Le Chesnay, France.
IctalGroup, Le Chesnay, France; Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France; UVSQ, INSERM, University Paris-Saclay, CESP, PsyDev Team, 94800 Villejuif, France.
Epilepsy Behav. 2023 Apr;141:109083. doi: 10.1016/j.yebeh.2023.109083. Epub 2023 Feb 18.
Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired.
We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure.
The 206 women and 293 men had a median age of 59 years [47-70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55-3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71-4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43-3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75-4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37-3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31-1.22, P = 0.17).
Preadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives.
#NCT03457831.
功能状态是与重症监护病房（ICU）收治决策及护理级别相关的标准之一。我们的主要目的是根据成年惊厥性癫痫持续状态（CSE）患者入院前功能状态是否受损，描述其特征及预后。
我们回顾性分析了2005年至2018年间连续入住两家法国ICU的成年CSE患者的数据，并将其回顾性纳入发作期登记研究。入院前存在功能障碍定义为入院前格拉斯哥预后量表（GOS）评分为3分。主要结局指标为1年时GOS评分下降≥1分。采用多因素分析确定与该指标相关的因素。
206名女性和293名男性，中位年龄59岁[47 - 70岁]。入院前GOS评分为3分的患者有56例（11.2%），评分为4分或5分的患者有443例。与GOS - 4/5组相比，GOS - 3组的特点是治疗限制决策频率更高（35.7%对12%，P < 0.0001），ICU死亡率相似（19.6对13.1，P = 0.22），1年死亡率更高（39.3%对25.6%，P < 0.01），1年时GOS评分无恶化的患者比例相似（42.9对44.1，P = 0.89）。多因素分析显示，1年预后不良与年龄超过59岁（比值比[OR]，2.36；95%置信区间[CI]，1.55 - 3.58，P < 0.0001）、入院前存在最终致命的合并症（OR，2.92；95%CI，1.71 - 4.98，P = 0.0001）、难治性CSE（OR，2.19；95%CI，1.43 - 3.36，P = 0.0004）、CSE病因是脑损伤（OR，2.75；95%CI，1.75 - 4.27，P < 0.0001）以及ICU入院时逻辑器官功能障碍评分≥3分（OR，2.08；95%CI，1.37 - 3.15，P = 0.0006）相关。入院前GOS评分为3分与第一年功能下降无关（OR，0.61；95%CI，0.31 - 1.22，P = 0.17）。
成年CSE患者入院前的功能状态与入院后第一年的功能下降无独立相关性。这一发现可能有助于医生做出ICU收治决策，并帮助成年患者制定预立医疗指示。
#NCT03457831
