Chen Dongmei, Zhang Qin, Miao Hongjun, Xu Jin, Li Wenjing
Emergency Department/Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, 210008, People's Republic of China.
Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, 210008, People's Republic of China.
Neuropsychiatr Dis Treat. 2025 Aug 14;21:1689-1702. doi: 10.2147/NDT.S542918. eCollection 2025.
Pediatric patients admitted to the pediatric intensive care unit (PICU) often present with diverse clinical conditions that influence their prognosis. Identifying key prognostic factors is crucial for optimizing treatment strategies and improving patient outcomes.
A retrospective analysis was conducted on the clinical data of 203 pediatric patients with status epilepticus (SE) admitted to the PICU from January 2020 and December 2024. Based on result of the GOS score at 3 months after discharge, patients were categorized into the good prognosis group and the poor prognosis group. Perform statistical analysis on the data of two groups to identify risk factors associated with poor prognosis. The predictive value of the STEPSS and END-IT scoring systems was evaluated using ROC curve analysis.
Among the 203 pediatric patients, the proportion of patients in the good prognosis group (68.5%) was significantly higher than that in the poor prognosis group (31.5%). The median hospital stay was longer in the poor prognosis group [11.0 (7.0, 16.0) days] compared to the good prognosis group [9.0 (7.0, 13.0) days]. The presence of comorbidities (79.7% vs 63.3%), abnormal EEG findings (98.0% vs 89.0%), and polypharmacy with ASMs (82.8% vs 31.7%) were significantly associated with poor prognosis. Logistic regression analysis indicated that the use of multiple ASMs was an independent risk factor for poor prognosis, with patients receiving two or more ASMs being 4.48 times more likely to have an unfavorable outcome (95% CI: 2.223-9.029). The predictive value of the STEPSS and END-IT scoring systems was limited, with AUC values of 0.475 (P = 0.570) and 0.535 (P = 0.419), respectively.
Comorbidities, abnormal EEG findings, and increased ASM use are significant risk factors for poor prognosis in PICU patients with SE. ASM usage plays a crucial role in patient outcomes. Further research is needed to refine prognostic models and enhance clinical decision-making.
入住儿科重症监护病房（PICU）的儿科患者常常表现出多种影响其预后的临床状况。识别关键的预后因素对于优化治疗策略和改善患者结局至关重要。
对2020年1月至2024年12月入住PICU的203例癫痫持续状态（SE）儿科患者的临床资料进行回顾性分析。根据出院后3个月的GOS评分结果，将患者分为预后良好组和预后不良组。对两组数据进行统计分析，以确定与预后不良相关的危险因素。使用ROC曲线分析评估STEPSS和END-IT评分系统的预测价值。
在203例儿科患者中，预后良好组患者的比例（68.5%）显著高于预后不良组（31.5%）。预后不良组的中位住院时间[11.0（7.0，16.0）天]比预后良好组[9.0（7.0，13.0）天]更长。合并症的存在（79.7%对63.3%）、脑电图异常结果（98.0%对89.0%）以及抗癫痫药物（ASM）的联合用药（82.8%对31.7%）与预后不良显著相关。逻辑回归分析表明，使用多种ASM是预后不良的独立危险因素，接受两种或更多种ASM治疗的患者出现不良结局的可能性高4.48倍（95%CI：2.223-9.029）。STEPSS和END-IT评分系统的预测价值有限，AUC值分别为0.475（P=0.570）和0.535（P=0.419）。
合并症、脑电图异常结果以及ASM使用增加是PICU中SE患者预后不良的重要危险因素。ASM的使用对患者结局起着关键作用。需要进一步研究以完善预后模型并加强临床决策。
