Service de Neurologie, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 808 Route de Lennik, Bruxelles 1070, Belgium.
Service de Neurologie, Hôpital Universitaire de Bruxelles - Hôpital Erasme, 808 Route de Lennik, Bruxelles 1070, Belgium; Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 250 East Changgang Road, Guangzhou 510260, China.
Clin Neurol Neurosurg. 2024 Nov;246:108554. doi: 10.1016/j.clineuro.2024.108554. Epub 2024 Sep 13.
Status Epilepticus (SE) is a neurological emergency with high mortality rate that often requires admission in Intensive Care Units (ICU). Several factors of worse outcome have been identified in prior studies. The aim of our study was to determine the mortality in ICU and in the ward in patients with SE admitted to an ICU and to identify risk factors of mortality.
Retrospective cohort study of patients admitted with SE treated in the ICU of a tertiary medical center between 2015 and 2020. The primary outcome measure was mortality in the ICU (ICU death) or in the ward after ICU discharge (post-ICU death).
252 patients were included, with a mean age of 63 (±16) years and 127 males (50 %). 58 died in the ICU, 27 died in the ward. Overall mortality was associated with a higher burden of comorbidities (OR:1.28, p < 0.001), the use of vasopressors (OR: 5.65, p < 0.001) and a higher burden of ICU complications (OR: 1.32, p = 0.002). Mortality rate was higher in more severe SE episodes (nonconvulsive, acute symptomatic and refractoriness. In-ICU mortality was associated with the use of vasopressors (OR: 7.92, p<0.001) and mechanical ventilation (OR: 3.13, p = 0.031), the length of in-ICU stay (OR: 0.91, p = 0.005) and a higher burden of ICU complications (OR: 1.37, p = 0.001). Compared to post-ICU deaths, ICU deaths also had higher Sequential Organ Failure Assessment (SOFA) score on ICU admission (p<0.001). Post-ICU mortality was associated with a higher burden of comorbidities (OR: 1.34, p<0.001), a higher burden of complications after ICU-discharge (OR: 1.33, p = 0.01), and more often refractory SE episode (OR: 2.63, p = 0.01). Compared to survivors, post-ICU deaths experienced mostly infectious and respiratory complications, after ICU-discharge.
Death was more frequent in more severe SE episodes: non convulsive semiology, acute etiology, and refractoriness. In-ICU, post-ICU and all-cause mortality in patients with SE admitted to an ICU are all associated with a higher burden of comorbidities, which are non-modifiable prognostic factors, but also with a higher burden of complications, some of which are preventable, such as respiratory infections.
癫痫持续状态（SE）是一种具有高死亡率的神经急症，通常需要入住重症监护病房（ICU）。既往研究已经确定了一些预后不良的因素。本研究旨在确定入住 ICU 的 SE 患者在 ICU 内和 ICU 出院后的病房内的死亡率，并确定死亡的危险因素。
这是一项对 2015 年至 2020 年期间在三级医疗中心 ICU 接受治疗的 SE 患者进行的回顾性队列研究。主要结局指标为 ICU 内（ICU 死亡）或 ICU 出院后的病房内（ICU 后死亡）的死亡率。
共纳入 252 例患者，平均年龄为 63（±16）岁，男性 127 例（50%）。58 例患者在 ICU 死亡，27 例患者在病房死亡。总体死亡率与合并症负担更高（OR：1.28，p＜0.001）、使用血管加压素（OR：5.65，p＜0.001）和 ICU 并发症负担更高（OR：1.32，p=0.002）相关。更严重的 SE 发作（非惊厥性、急性症状性和难治性）的死亡率更高。在 ICU 内死亡与使用血管加压素（OR：7.92，p＜0.001）和机械通气（OR：3.13，p=0.031）、在 ICU 内的住院时间（OR：0.91，p=0.005）和 ICU 并发症负担更高（OR：1.37，p=0.001）相关。与 ICU 后死亡相比，ICU 内死亡患者的 ICU 入院时序贯器官衰竭评估（SOFA）评分也更高（p＜0.001）。ICU 后死亡率与合并症负担更高（OR：1.34，p＜0.001）、ICU 后并发症负担更高（OR：1.33，p=0.01）以及更常见的难治性 SE 发作（OR：2.63，p=0.01）相关。与幸存者相比，ICU 后死亡患者在 ICU 出院后更多地经历感染和呼吸系统并发症。
更严重的 SE 发作（非惊厥性半侧发作、急性病因和难治性）中死亡更为常见。入住 ICU 的 SE 患者的 ICU 内、ICU 后和全因死亡率均与合并症负担更高相关，合并症负担是不可改变的预后因素，但也与并发症负担更高相关，其中一些是可预防的，例如呼吸道感染。
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