Early Standard Electroencephalogram Abnormalities Predict Mortality in Septic Intensive Care Unit Patients.
Early Standard Electroencephalogram Abnormalities Predict Mortality in Septic Intensive Care Unit Patients.
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DOI：
10.1371/journal.pone.0139969
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Groupe d'Explorations Neurologiques en Réanimation (GENER)
中科院分区：
文献类型：
--
作者：
Azabou E;Magalhaes E;Braconnier A;Yahiaoui L;Moneger G;Heming N;Annane D;Mantz J;Chrétien F;Durand MC;Lofaso F;Porcher R;Sharshar T;Groupe d'Explorations Neurologiques en Réanimation (GENER)
重症监护病房(ICU)患者的脓毒症与死亡率增加、精神错乱和长期认知障碍有关。脓毒症急性期出现的脑电异常可能与脑功能障碍的严重程度有关。早期标准脑电异常对ICU脓毒症患者死亡率的预测价值仍有待评估。在这项前瞻性、单中心、观察性研究中，对因脓毒症而在ICU住院的连续患者进行了标准EEG检查，并根据Synek和Young EEG评分进行了分析和分类。在记录脑电时评估精神错乱、昏迷和镇静程度，并在随访期间评估镇静时间、ICU内精神错乱的发生或死亡。采用多元Logistic回归进行校正分析。纳入110例患者，平均年龄63.8(±18.1)岁，SAPS-II评分中位数38(29-55)。在记录脑电时，46例(42%)患者被镇静，22例(20%)出现精神错乱。总体而言，54名患者(49%)出现精神错乱，其中32名(29%)发生在脑电记录后的几天。23例(21%)患者死于ICU。脑电无反应性27例(25%)，周期性放电(PD)21例(19%)，脑电惊厥(ESZ)17例(15%)。ICU病死率独立地与以下因素有关：三角洲优势背景(OR：3.36；95%CI[1.08-10.4])、缺乏脑电反应性(OR：4.44；95%CI[1.37-14.3])、PDS(OR：3.24；95%CI[1.03-10.2])、Synek分级≥3(OR：5.35；95%CI[1.66-17.2])和Young>；1(OR：3.44；调整入院时简化急性生理学评分(SAPS-II)和镇静水平后95%可信区间[1.09~10.8]。未服用镇静剂的患者中，脑电时的精神错乱与ESZ有关(32%比10%，p=0.037)；与Synek分级≥3(36%比7%)和Young分级1(36%比17%，p<；0.001)相关。在脑电检查后的数天内，精神错乱的发生与以三角洲为主的背景(48%比15%，p=0.001)、缺乏反应性(39%比10%，p=0.003)、≥3级(42%比17%，p=0.001)和杨氏1级(58%比17%，p=0.0001)有关。在这组110名败血症ICU患者的前瞻性队列中，早期标准脑电明显受到干扰。入院后1至3天无脑电反应性、以增量为主的背景、PD、Synek分级、≥3级和Young分级1是ICU死亡率的独立预测因素，并与神志障碍的发生有关。ESZ和PDS，在我们大约20%的患者中发现。如果使用连续脑电图更彻底地诊断他们，他们的患病率可能会更高，具有更高的预测价值。
Sepsis is associated with increased mortality, delirium and long-term cognitive impairment in intensive care unit (ICU) patients. Electroencephalogram (EEG) abnormalities occurring at the acute stage of sepsis may correlate with severity of brain dysfunction. Predictive value of early standard EEG abnormalities for mortality in ICU septic patients remains to be assessed. In this prospective, single center, observational study, standard EEG was performed, analyzed and classified according to both Synek and Young EEG scales, in consecutive patients acutely admitted in ICU for sepsis. Delirium, coma and the level of sedation were assessed at the time of EEG recording; and duration of sedation, occurrence of in-ICU delirium or death were assessed during follow-up. Adjusted analyses were carried out using multiple logistic regression. One hundred ten patients were included, mean age 63.8 (±18.1) years, median SAPS-II score 38 (29–55). At the time of EEG recording, 46 patients (42%) were sedated and 22 (20%) suffered from delirium. Overall, 54 patients (49%) developed delirium, of which 32 (29%) in the days after EEG recording. 23 (21%) patients died in the ICU. Absence of EEG reactivity was observed in 27 patients (25%), periodic discharges (PDs) in 21 (19%) and electrographic seizures (ESZ) in 17 (15%). ICU mortality was independently associated with a delta-predominant background (OR: 3.36; 95% CI [1.08 to 10.4]), absence of EEG reactivity (OR: 4.44; 95% CI [1.37–14.3], PDs (OR: 3.24; 95% CI [1.03 to 10.2]), Synek grade ≥ 3 (OR: 5.35; 95% CI [1.66–17.2]) and Young grade > 1 (OR: 3.44; 95% CI [1.09–10.8]) after adjustment to Simplified Acute Physiology Score (SAPS-II) at admission and level of sedation. Delirium at the time of EEG was associated with ESZ in non-sedated patients (32% vs 10%, p = 0.037); with Synek grade ≥ 3 (36% vs 7%, p< 0.05) and Young grade > 1 (36% vs 17%, p< 0.001). Occurrence of delirium in the days after EEG was associated with a delta-predominant background (48% vs 15%, p = 0.001); absence of reactivity (39% vs 10%, p = 0.003), Synek grade ≥ 3 (42% vs 17%, p = 0.001) and Young grade >1 (58% vs 17%, p = 0.0001). In this prospective cohort of 110 septic ICU patients, early standard EEG was significantly disturbed. Absence of EEG reactivity, a delta-predominant background, PDs, Synek grade ≥ 3 and Young grade > 1 at day 1 to 3 following admission were independent predictors of ICU mortality and were associated with occurence of delirium. ESZ and PDs, found in about 20% of our patients. Their prevalence could have been higher, with a still higher predictive value, if they had been diagnosed more thoroughly using continuous EEG.