Mortality and recovery from refractory status epilepticus in the intensive care unit: A 7-year observational study

Authors

  • Raoul Sutter,

    Corresponding author
    1. Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland
    Current affiliation:
    1. Division of Neurosciences Critical Care, Department of Anesthesiology, Critical Care Medicine and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
    • Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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  • Stephan Marsch,

    1. Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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  • Peter Fuhr,

    1. Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland
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  • Stephan Rüegg

    1. Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland
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Address correspondence to Raoul Sutter, Departments of Neurology and Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. E-mail: sutterr@uhbs.ch

Summary

Purpose

Refractory status epilepticus (RSE) is a life-threatening neurologic emergency with high mortality and morbidity. The aim of this study was to identify and quantify associations between clinical characteristics of adult RSE patients and outcome.

Methods

Comprehensive medical chart review was performed of all consecutive adult RSE patients treated on the intensive care units of an academic tertiary care center between 2005 and 2011. Demographics, RSE etiologies and duration, comorbidities, as well as outcomes were assessed. Associations between clinical characteristics and death were quantified.

Key Findings

Of 260 patients with status epilepticus, 111 developed RSE. Hypoxic encephalopathy (23%), brain tumors (14%), known and uncontrolled epilepsy (10%), and ischemic stroke (8%) were the main etiologies. During hospitalization 38% of patients died. Hypoxic encephalopathy (HE) and brain tumors were independently associated with death (relative risk [RR] 2.41, 95% confidence interval [CI] 1.40–4.12; p = 0.001 and RR 2.81, 95%CI 1.59–4.96; p < 0.0001). The estimated hazard ratio of death was 3.1 (95% CI1.6–6.0; p = 0.001) for patients with HE and 1.1 (95% CI 0.5–2.3; p = 0.745) for patients with brain tumors. RSE duration and nonconvulsive status epilepticus in coma were independently associated with death (for every hour RR 1.001; 95%CI 1.00–1.002; p = 0.011 and RR 3.62; 95%CI 1.34–9.77; p = 0.005).

Significance

Brain tumors and HE had high relative risks for death and were independently associated with mortality in our cohort of critically ill RSE patients. Other clinical characteristics, as well as the use of intravenous anesthetic drugs and mechanical ventilation, may not be strongly related to outcome and should therefore be used cautiously for informed decision making regarding treatment.

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