Phungoen Pariwat, Khamsai Sittichai, Chotmongkol Verajit, Daungjunchot Ronnakorn, Sawanyawisuth Kittisak, Tangpaisarn Thanat
Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen, 40002, Thailand.
Intern Emerg Med. 2024 Nov 5. doi: 10.1007/s11739-024-03806-1.
Patients presenting with seizure at the emergency department (ED) may have morbidity and mortality. Serum lactate has been shown to be a predictor of diagnosis of seizure versus syncope and mortality in patients presenting with seizure at the ED. There is limited data on using serum lactate as a predictor of the intensive care unit (ICU) admission in patients presenting with seizure at the ED. This study aimed to evaluate if serum lactate can be a predictor of the ICU admission in this setting. This was a retrospective cohort study enrolled adult patients aged 18 years or more, diagnosed with seizures or convulsive status epilepticus at the ED, and who had undergone testing for serum venous lactate. Clinical factors predictive of ICU admission were computed using logistic regression analysis. Of the 288 patients who met the study criteria, 45 patients (15.63%) required ICU admission. Two factors were independently associated with the ICU admission: convulsive status epilepticus and serum lactate. Both factors had adjusted odds ratio (95% confidence interval) of 4.793 (2.119, 10.844) and 1.008 (1.001, 1.016), respectively. Serum lactate of over 63 mg/dL had specificity of 80.25% and sensitivity of 35.56% with the area under ROC curve of 63.30% (95% confidence interval of 54.77%, 71.84%). Serum lactate and convulsive status epilepticus were two predictors of ICU admission in patients presenting with seizure at the ED.
在急诊科（ED）出现癫痫发作的患者可能会有发病和死亡风险。血清乳酸已被证明是在急诊科出现癫痫发作的患者中区分癫痫发作与晕厥诊断以及预测死亡率的一个指标。关于将血清乳酸作为在急诊科出现癫痫发作的患者入住重症监护病房（ICU）的预测指标的数据有限。本研究旨在评估血清乳酸是否可作为这种情况下入住ICU的预测指标。这是一项回顾性队列研究，纳入了年龄在18岁及以上、在急诊科被诊断为癫痫发作或惊厥性癫痫持续状态且接受了血清静脉乳酸检测的成年患者。使用逻辑回归分析计算预测入住ICU的临床因素。在符合研究标准的288例患者中，45例（15.63%）需要入住ICU。有两个因素与入住ICU独立相关：惊厥性癫痫持续状态和血清乳酸。这两个因素的调整比值比（95%置信区间）分别为4.793（2.119，10.844）和1.008（1.001，1.016）。血清乳酸超过63mg/dL时，特异性为80.25%，敏感性为35.56%，ROC曲线下面积为63.30%（95%置信区间为54.77%，71.84%）。血清乳酸和惊厥性癫痫持续状态是在急诊科出现癫痫发作的患者入住ICU的两个预测指标。
