Abstracts

Rationale: Status epilepticus (SE) is a neurological emergency requiring intensive care. Numerous studies have tried to identify prognostic factors for refractory SE (RSE) and death. Changes of cytokine levels during SE have been demonstrated. Therefore, acute phase proteins, such as C-reactive protein (CRP) and albumin may be useful to predict SE course and outcome. The aim of this study was to determine the association and predictive value of CRP and albumin regarding course and outcome of SE.Methods: Records of patients with SE from 2005 to 2010 were selected from a prospectively collected EEG database. CRP and albumin were measured during three days after SE onset. RSE, SE duration, days on ICU, comorbidities, and outcome were assessed. We further compared the overall predictive value of albumin and CRP, as well as their ratio (CRP at SE onset to albumin on admission) for the outcomes death and RSE by calculating receiver operating characteristic (ROC) analysis with and without adjustment for age, gender, and number of comorbidities.Results: 160 consecutive SE patients were identified. Higher levels of albumin at SE onset were associated with lower rates of RSE, death, and shorter ICU stay (p=0.0017,p<0.0001,p<0.0001). Increasing risk for RSE, death, and longer ICU stay was observed for elevated CRP (p=0.0202,p=0.0005,p=0.0007). Hazard ratios for death increased significantly for both, higher CRP levels at SE onset and lower albumin levels at admission. The negative predictive value (NPV) of albumin >26g/l at SE onset was 85% for RSE and death. According to the ROC-analysis, a value below the cutoff of 0.2208 of the ratio of CRP at SE onset to albumin on admission had a NPV of 90% for death.Conclusions: CRP and albumin at SE onset are readily accessible biomarkers allowing for predicting SE course and outcome. These laboratory parameters may help to identify patients early in the course of SE, who would profit from intensified and comprehensive SE management.