Chen Denise F, Farrque Mirza, Karakis Ioannis, Gupta Navnika, Rodriguez Ruiz Andres, Kandiah Prem
Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Neurocrit Care. 2025 Feb 7. doi: 10.1007/s12028-025-02216-1.
Neurologic complications contribute significantly to morbidity and mortality in acute liver failure (ALF). However, clinical assessment of neurologic function in this population is often challenging. Continuous electroencephalography (cEEG) is a low-risk, noninvasive diagnostic tool that can monitor real-time cerebral function. We aimed to investigate cEEG findings and prognostic significance of specific EEG features in a cohort of strictly defined patients with ALF.
This was a retrospective, single-center study of adult patients with ALF who underwent cEEG monitoring for at least 6 h between 2013 and 2022. Clinical, laboratory, imaging, and treatment characteristics were evaluated. cEEG variables included background continuity, background frequency, the presence of sporadic epileptiform discharges, rhythmic or periodic patterns, and electrographic or electroclinical seizures. The primary outcome was mortality or transition to end-of-life care during the index admission.
A total of 32 patients with ALF were included. 56.3% of patients had rhythmic or periodic patterns, of which the majority were generalized periodic discharges (37.5%). 12.5% of patients had sporadic epileptiform discharges, and 6.3% of patients demonstrated electrographic or clinical seizures. Eighteen (56.3%) patients died or were transitioned to end-of-life care during the index admission. Worsening background continuity or frequency over the course of the cEEG recording was significantly associated with poor outcome (p = 0.001, p = 0.007, respectively), with a 100% mortality rate in patients demonstrating these EEG trends. A worst recorded continuity of suppression, attenuation, and burst-suppression was also associated with poor outcome (p = 0.012). The presence of rhythmic or periodic patterns, sporadic epileptiform discharges, or seizures was not predictive of outcome.
Worsening cEEG background continuity or frequency is associated with poor outcome in adults with ALF. cEEG may contribute useful prognostic information in these patients, in conjunction with other laboratory and clinical markers of disease severity.
神经并发症在急性肝衰竭（ALF）的发病和死亡中起重要作用。然而，对该人群神经功能的临床评估往往具有挑战性。连续脑电图（cEEG）是一种低风险、非侵入性的诊断工具，可实时监测脑功能。我们旨在研究一组严格定义的ALF患者的cEEG结果及特定脑电图特征的预后意义。
这是一项对2013年至2022年间接受cEEG监测至少6小时的成年ALF患者进行的回顾性单中心研究。评估了临床、实验室、影像学和治疗特征。cEEG变量包括背景连续性、背景频率、散发性癫痫样放电的存在、节律性或周期性模式以及脑电图或电临床发作。主要结局是在本次住院期间死亡或过渡到临终关怀。
共纳入32例ALF患者。56.3%的患者有节律性或周期性模式，其中大多数为全身性周期性放电（37.5%）。12.5%的患者有散发性癫痫样放电，6.3%的患者出现脑电图或临床发作。18例（56.3%）患者在本次住院期间死亡或过渡到临终关怀。在cEEG记录过程中背景连续性或频率恶化与不良结局显著相关（分别为p = 0.001，p = 0.007），表现出这些脑电图趋势的患者死亡率为100%。记录到的最差抑制、衰减和爆发抑制连续性也与不良结局相关（p = 0.012）。节律性或周期性模式、散发性癫痫样放电或发作的存在不能预测结局。
cEEG背景连续性或频率恶化与成年ALF患者的不良结局相关。cEEG结合其他疾病严重程度的实验室和临床标志物，可能为这些患者提供有用的预后信息。
