Causes of Death in Status Epilepticus
Causes of Death in Status Epilepticus
复制标题
DOI：
10.1097/ccm.0000000000003869
复制
发表时间：
2019-09-01
影响因子：
8.8
通讯作者：
Hocker, Sara
中科院分区：
文献类型：
--
作者：
Hawkes, Maximiliano A.;English, Stephen W.;Hocker, Sara
目的：探讨癫痫持续状态患者的死亡原因。分析癫痫病因、癫痫发作难治性、机械通气的使用、控制癫痫发作的麻醉药物和内科并发症对住院和90天死亡率、住院时间和出院处置的相对影响。设计：回顾性队列。设置：单中心神经科学ICU。参与者：通过回顾性检索2011年1月1日至2016年12月31日的电子数据库，确定癫痫持续状态患者。干预措施：回顾电子病历。测量和主要结果：收集人口统计学资料、临床特征、治疗和结果。单变量和多变量logistic回归分析用于确定麻醉药物的使用、机械通气、癫痫持续状态严重程度评分、癫痫发作难治性、癫痫发作病因或内科并发症是否与住院、90天死亡率或出院处置相关。在244例癫痫持续状态患者中（平均年龄为64岁[四分位距，42-76岁]，55%为男性，中位癫痫持续状态严重程度评分为3 [四分位距，2-4]），24例接受了麻醉药物输注以控制癫痫发作。住院和90天死亡率分别为9.2%和19.2%。19名患者（86.3%）在停止维持生命治疗后死亡，3名患者（13.7%）在心脏骤停后死亡。只有癫痫持续状态严重程度评分与住院和90天死亡率相关，而用于癫痫控制的麻醉药物的使用、机械通气、内科并发症、病因学和癫痫发作的难治性则无关。有内科并发症（p = 0.0091）、难治性癫痫发作（p = 0.0077）和需要麻醉药物控制癫痫发作（p = 0.0035）的患者住院时间较长。难治性癫痫发作的患者出院回家的可能性较小（比值比，0.295; CI，0.143-0.608; p = 0.0009）。结论：在该队列中，死亡主要是由于潜在的神经系统疾病和停止维持生命的治疗，而不是我们的治疗选择。麻醉药物的使用、内科并发症和机械通气与住院和90天死亡率无关。
Objectives: To determine the causes of death in patients with status epilepticus. To analyze the relative contributions of seizure etiology, seizure refractoriness, use of mechanical ventilation, anesthetic drugs for seizure control, and medical complications to in-hospital and 90-day mortality, hospital length of stay, and discharge disposition.Design: Retrospective cohort.Setting: Single-center neuroscience ICU.Participants: Patients with status epilepticus were identified by retrospective search of electronic database from January 1, 2011, to December 31, 2016.Interventions: Review of electronic medical records.Measurements and Main Results: Demographics, clinical characteristics, treatments, and outcomes were collected. Univariable and multivariable logistic regression analysis were used to determine whether the use of anesthetic drugs, mechanical ventilation, Status Epilepticus Severity Score, refractoriness of seizures, etiology of seizures, or medical complications were associated with in-hospital, 90-day mortality or discharge disposition. Among 244 patients with status epilepticus (mean age was 64 yr [interquartile range, 42-76], 55% male, median Status Epilepticus Severity Score 3 [interquartile range, 2-4]), 24 received anesthetic drug infusions for seizure control. In-hospital and 90-day mortality rates were 9.2% and 19.2%, respectively. Death was preceded by withdrawal of life-sustaining treatment in 19 patients (86.3%) and cardiac arrest in three (13.7%). Only Status Epilepticus Severity Score was associated with in-hospital and 90-day mortality, whereas the use of anesthetic drugs for seizure control, mechanical ventilation, medical complications, etiology, and refractoriness of seizures were not. Hospital length of stay was longer in patients with medical complications (p = 0.0091), refractory seizures (p = 0.0077), and in those who required anesthetic drugs for seizure control (p = 0.0035). Patients who had refractory seizures were less likely to be discharged home (odds ratio, 0.295; CI, 0.143-0.608; p = 0.0009).Conclusions: In this cohort, death primarily resulted from the underlying neurologic disease and withdrawal of life-sustaining treatment and not from our treatment choices. Use of anesthetic drugs, medical complications, and mechanical ventilation were not associated with in-hospital and 90-day mortality.