Abstracts

Rationale: The overall hospital mortality for patients admitted to ICUs in US decreased significantly in the past two decades despite an increase in age. Older patients usually have multiple comorbid conditions that may influence the patient’s outcome. Seizures are commonly seen in critically ill patients and the availability of continuous video-EEG (cVEEG) in the ICU allows early detection of seizures and prompt treatment. However, it remains unclear whether there is an association between seizures and mortality. Therefore, the main goal of this study is to determine whether seizure in the ICU setting is a predictor of in-hospital mortality in older patients. Methods: This is a retrospective study. Individuals with ages 55 years-old or older admitted to the ICU at Hackensack Meridian Health and JFK Neuroscience Institute that underwent cVEEG monitoring from June 1st, 2015 to June 30, 2018 were included in this study. Some patients also had stat EEG prior to cVEEG. Patients were subdivided into two groups, those with seizures, either clinical, electrographic seizures or status epilepticus (SE), and those without seizures. We used the STATA Version 15.0 for statistical analysis. We first analyzed a simple model of seizures and mortality, then adjusted for age, gender, and other covariates, including respiratory failure with mechanical ventilation, sepsis and/or pneumonia, chronic kidney disease, vascular risk factors, active cancer, encephalopathy of any etiology, dementia, acute ischemic stroke, intra- and extra-cerebral hemorrhages, primary brain neoplasms and metastatic brain lesions. Results: There were 101 patients with ages between 55 and 93 years old, and 63 were female. The overall in-hospital mortality was 30.9%. In total, 37 patients had seizures and the vast majority (89.2%) of patients had focal-onset seizures. Amongst 12 patients with seizures that died, seven had recurrent seizures or nonconvulsive SE (NCSE) for more than 48 hours. However, there was no statistically significant association between seizures and in-hospital mortality when either unadjusted (odds ratio = 1.13, p = 0.77) or adjusted for age category, gender or other covariates (odds ratio = 0.71, p = 0.64). Conclusions: Seizures did not predict in-hospital mortality in critically ill older patients in this retrospective study. Further larger prospective study is necessary to confirm our preliminary findings. Funding: No funding