脑电图用于预测成人重症单纯疱疹病毒性脑炎的预后
Electroencephalography for prognostication of outcome in adults with severe herpes simplex encephalitis.
作者信息
Jeantin Lina, Dupuis Claire, Vellieux Geoffroy, Jaquet Pierre, de Montmollin Etienne, Timsit Jean-François, Sonneville Romain
机构信息
Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France.
Department of Intensive Care Medicine, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France.
出版信息
Ann Intensive Care. 2023 Feb 23;13(1):10. doi: 10.1186/s13613-023-01110-3.
BACKGROUND
Electroencephalography (EEG) is recommended for the practical approach to the diagnosis and prognosis of encephalitis. We aimed to investigate the prognostic value of standard EEG (EEG) in adult patients with severe herpes simplex encephalitis.
METHODS
We performed a retrospective analysis of consecutive ICU patients with severe herpes simplex encephalitis in 38 French centers between 2006 and 2016. Patients with at least one EEG study performed at ICU admission were included. EEG findings were reviewed independently by two investigators. The association between EEG findings (i.e., background activity, lateralized periodic discharges, seizures/status epilepticus, and reactivity to painful/auditory stimuli) and poor functional outcome, defined by a score on the modified Rankin Scale (mRS) of 3 to 6 (moderate to severe disability or death) at 90 days, were investigated.
RESULTS
We included 214 patients with at least one available EEG study. The first EEG was performed after a median time of one (interquartile range (IQR) 0 to 2) day from ICU admission. At the time of recording, 138 (64.5%) patients were under invasive mechanical ventilation. Lateralized periodic discharges were recorded in 91 (42.5%) patients, seizures in 21 (9.8%) and status epilepticus in 16 (7.5%). In the whole population, reactivity to auditory/noxious stimuli was tested in 140/214 (65.4%) patients and was absent in 71/140 (33.2%) cases. In mechanically ventilated patients, EEG reactivity was tested in 91/138 (65.9%) subjects, and was absent in 53/91 (58.2%) cases. Absence of reactivity was the only independent EEG finding associated with poor functional outcome in the whole population (OR 2.80, 95% CI 1.19 to 6.58) and in the subgroup of mechanically ventilated patients (OR 4.99, 95% CI 1.6 to 15.59). Adjusted analyses for common clinical predictors of outcome and sedation at time of EEG revealed similar findings in the whole population (OR 2.03, 95% CI 1.18 to 3.49) and in mechanically ventilated patients (OR 2.62, 95% CI 1.25 to 5.50).
CONCLUSIONS
Absence of EEG reactivity to auditory/noxious stimuli is an independent marker of poor functional outcome in severe herpes simplex encephalitis.
背景
脑电图（EEG）被推荐用于脑炎诊断及预后评估的实际操作中。我们旨在研究标准脑电图（EEG）对成年重症单纯疱疹病毒性脑炎患者的预后价值。
方法
我们对2006年至2016年间法国38个中心收治的连续性重症单纯疱疹病毒性脑炎ICU患者进行了回顾性分析。纳入在ICU入院时至少进行过一次脑电图检查的患者。两名研究人员独立复查脑电图结果。研究脑电图结果（即背景活动、周期性一侧性癫痫样放电、癫痫发作/癫痫持续状态以及对疼痛/听觉刺激的反应性）与90天时改良Rankin量表（mRS）评分为3至6分（中度至重度残疾或死亡）所定义的不良功能结局之间的关联。
结果
我们纳入了214例至少有一次可用脑电图检查的患者。首次脑电图检查在ICU入院后中位时间1天（四分位间距（IQR）0至2天）进行。记录时，138例（64.5%）患者正在接受有创机械通气。91例（42.5%）患者记录到周期性一侧性癫痫样放电，21例（9.8%）患者出现癫痫发作，16例（7.5%）患者出现癫痫持续状态。在整个人群中，140/214例（65.4%）患者接受了对听觉/有害刺激的反应性测试，其中71/140例（33.2%）无反应。在机械通气患者中，91/138例（65.9%）受试者接受了脑电图反应性测试，其中53/91例（58.2%）无反应。无反应性是整个人群（比值比（OR）2.80，95%置信区间（CI）1.19至6.58）和机械通气患者亚组（OR 4.99，95% CI 1.6至15.59）中与不良功能结局相关的唯一独立脑电图表现。对脑电图检查时常见的临床结局预测因素和镇静情况进行校正分析后，在整个人群（OR 2.03，95% CI 1.18至3.49）和机械通气患者（OR 2.62，95% CI 1.25至5.50）中得到了相似的结果。
结论
脑电图对听觉/有害刺激无反应性是重症单纯疱疹病毒性脑炎不良功能结局的独立标志物。
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