Epilepsy Risk Among Survivors of Intensive Care Unit Hospitalization for Sepsis
Abstract number :
2.387
Submission category :
16. Epidemiology
Year :
2019
Submission ID :
2421830
Source :
www.aesnet.org
Presentation date :
12/8/2019 4:04:48 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Tresah C. Antaya, Western University; Britney N. Allen, ICES Western; Lucie Richard, ICES Western; Salimah Z. Shariff, ICES Western; Gustavo Saposnik, University of Toronto; Jorge G. Burneo, Western University
Rationale: Despite the growing body of evidence that survivors of sepsis are at risk of long-term neurological impairment and seizures, epilepsy risk has rarely been explored in this population. Therefore, our objectives were to estimate the risk of new-onset epilepsy among survivors of intensive care unit (ICU) treatment for sepsis and to identify those at highest risk. Methods: We conducted a population-based, retrospective matched cohort study using linked, administrative healthcare databases. We used the Discharge Abstract Database to identify Ontario residents 18 years of age and older who were discharged from an ICU between January 1, 2010, and December 31, 2015. The study population was stratified by exposure and propensity score matched up to four to one with a caliper width of 0.2 standard deviations. Figure 1 depicts the details of our cohort build. We used Cox proportional hazards regression models to estimate epilepsy risk and to identify sepsis survivors at highest risk. We also used Fine-Gray subdistribution hazards regression models to account for the competing risk of death. Results: 143,892 patients were included; 32,252 (22.4%) of whom were exposed. Sepsis survivors were at significantly higher epilepsy risk (HR=1.44, 95% CI=1.15-1.80). However, epilepsy risk was not significant after controlling for the competing risk of death (HR=1.16, 95% CI=0.93-1.45). In bivariate analysis of sepsis survivors, younger age (p<0.001), chronic kidney disease (p<0.01), and congestive heart failure (p=0.01) at baseline were significantly associated with epilepsy. In multivariable analysis (Table 1), younger age (HR=0.97, 95% CI=0.96-0.99) and having chronic kidney disease (HR=2.25, 95% CI=1.48-3.43) remained significant epilepsy risk factors. Results were similar after accounting for the competing risk of death. Conclusions: Sepsis survivors, particularly those who are younger and have chronic kidney disease, are at significantly higher epilepsy risk. These findings indicate that sepsis may be an unrecognized epilepsy risk factor. Possible mechanisms include damage to the blood-brain barrier as a result of renal dysfunction, persisting inflammation after the acute episode, and increased risk of cardiovascular events following sepsis. Funding: This project was supported by ICES Western which receives funding from Ontario’s Ministry of Health and Long-Term Care, the Academic Medical Organization of Southwestern Ontario, Western University’s Schulich School of Medicine and Dentistry, Lawson Health Research Institute, and the Canadian Institutes of Health Research.
Epidemiology