Abstracts

In-icu and Post-icu Complications in Patients with Status Epilepticus and Their Impact on Outcome

Abstract number : 2.15
Submission category : 4. Clinical Epilepsy / 4D. Prognosis
Year : 2022
Submission ID : 2204989
Source : www.aesnet.org
Presentation date : 12/4/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:27 AM

Authors :
Charlotte Damien, MD – CUB Erasme; Fang Yuan, MD, PhD – Neurology – CUB Erasme; Nicolas Gaspard, MD, PhD – Neurology – CUB Erasme

Rationale: Status epilepticus (SE) is a common neurological emergency with a mortality rate up to 40%. It often requires admission in the Intensive Care Units (ICU) either for treatment of SE itself either for treatment of complications of SE.  These complications can involve several organs and may result in life-threatening conditions. Previous studies have demonstrated the association of respiratory and infectious complications with an unfavorabler outcome in patients with SE. A recent study showed a mortality rate more than twice higher after ICU discharge compared to mortality during ICU stay, without available data on potential cause of this excess of mortality. The aim of this study was to determine the mortality rate and identify complications associated with mortality during and after the ICU stay.

Methods: We retrospectively included all consecutive adult patients with SE admitted in the ICU or with SE identified during their ICU stay between January 1, 2015, and December 31, 2020. Clinical data were collected from medical records. The primary outcome was mortality at ICU or hospital discharge.

Results: A total of 249 patients were included: 164 survived (66 %), 56 (22.5 %) died during their ICU stay (ICU deaths) and 29 (11.5 %) after ICU discharge (ward deaths). Patients who died were older and with more comorbidities (Table 1). They had more frequently refractory SE with a higher need of continuous intravenous anaesthetic drugs (CIVADs). ICU deaths needed more frequent mechanical ventilation (MV) and had a higher burden of complications, especially the need of vasopressors, infectious, respiratory, renal, hepatic and pancreatic complications, compared to ICU survivors. Ward deaths had a higher burden of complications after ICU discharge than hospital survivors but had a similar burden during their ICU stay. They also more often needed vasopressors and had more respiratory complications. ICU and ward deaths had a similar clinical profile of age, comorbidities and refractoriness. ICU deaths required more often CIVADs, mechanical ventilation and vasopressors, with a higher burden of complications than ward deaths. The rate of withdrawal of life support therapy was similar between patients who died in the ICU or after ICU discharge (66.1% vs. 62.1%).

Conclusions: Mortality was associated with an older age, more comorbidities and refractoriness. ICU mortality was associated with a greater burden of complications in the ICU, the need of CIVADs, vasopressors and mechanical ventilation, while mortality after ICU discharge was related to respiratory complications.
This study provides information to design targeted interventions to prevent death in ICU survivors of SE.

Funding: Fonds Erasme pour la Recherche Médicale
Clinical Epilepsy