Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study.

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL ACS Applied Energy Materials Pub Date : 2023-12-25 eCollection Date: 2023-01-01 DOI:10.1177/17562864231214846

Dongmei Wang, Meirong Li, Yue Pan, Zhenzhou Lin, Zhong Ji, Xiaomei Zhang, Miaoqin Tan, Suyue Pan, Yongming Wu, Shengnan Wang

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Abstract

Background: Generalized convulsive status epilepticus (GCSE) is one of the most challenging life-threatening neurological emergencies. If GCSE becomes super-refractory, it is associated with significant mortality. Although aggressive management of prolonged status epilepticus was conducted, the mortality has not decreased since the late 1990s.

Objectives: The present study aimed to explore the risk factors for progression to super-refractory in patients with generalized convulsive status epilepticus (GCSE). Moreover, we illustrated the risk factors for mortality in GCSE patients.

Design: An observational retrospective cohort study.

Methods: We conducted a retrospective study of patients with GCSE admitted to our neurocritical unit, in Guangzhou, China, from October 2010 to February 2021. The data of sociodemographic information, etiology, laboratory results, treatment, and prognosis were collected and analyzed.

Results: A total of 106 patients were enrolled; 51 (48%) of them developed super-refractory status epilepticus (SRSE). Multivariate logistic regression analysis demonstrated that patients with autoimmune encephalitis (p = 0.015) and intracranial infection (p = 0.019) are likely to progress to SRSE. The in-hospital mortality was 11.8% and 9.1% for patients in the SRSE and non-SRSE groups, respectively (p = 0.652). Multivariate logistic regression analysis showed that neutrophil-to-lymphocyte ratios (NLR) at admission were independently associated with in-hospital mortality. Up to 31.4% of SRSE patients and 29.1% of non-SRSE patients died within 6 months after discharge (p = 0.798). Multivariate logistic regression analysis showed that plasma exchange (PE) was a protective factor for 6-month mortality. A high NLR at discharge was a risk factor for 6-month mortality.

Conclusion: In the current study, about 48% of GCSE patients progressed to SRSE. Regarding etiology, autoimmune encephalitis or intracranial infection was prone to SRSE. No significant differences were observed in the in-hospital and 6-month mortality between SRSE and non-SRSE groups. Multivariate logistic regression analysis showed that NLR at admission and discharge was an independent predictor of in-hospital and 6-month mortality, respectively. Moreover, PE significantly reduced the 6-month mortality.

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全身抽搐性癫痫状态超级难治性和死亡率的风险因素：一项为期 10 年的回顾性队列研究。

背景：全身抽搐性癫痫（GCSE）是最具挑战性的危及生命的神经系统急症之一。如果 GCSE 变成超级难治性，死亡率就会很高。尽管对癫痫持续状态采取了积极的治疗措施，但自 20 世纪 90 年代末以来，死亡率并未降低：本研究旨在探讨全身抽搐性癫痫状态（GCSE）患者进展为超级难治性癫痫状态的风险因素。此外，我们还说明了GCSE患者死亡的风险因素：设计：一项观察性回顾性队列研究：方法：我们对 2010 年 10 月至 2021 年 2 月在中国广州神经重症监护病房收治的 GCSE 患者进行了回顾性研究。收集并分析了社会人口学信息、病因、实验室结果、治疗和预后等数据：结果：共纳入 106 例患者，其中 51 例（48%）发展为超级难治性癫痫状态（SRSE）。多变量逻辑回归分析表明，患有自身免疫性脑炎（p = 0.015）和颅内感染（p = 0.019）的患者很可能发展为 SRSE。SRSE组和非SRSE组患者的院内死亡率分别为11.8%和9.1%（p = 0.652）。多变量逻辑回归分析显示，入院时的中性粒细胞与淋巴细胞比率（NLR）与院内死亡率密切相关。多达31.4%的SRSE患者和29.1%的非SRSE患者在出院后6个月内死亡（p = 0.798）。多变量逻辑回归分析显示，血浆置换（PE）是6个月死亡率的保护因素。出院时的高 NLR 是 6 个月死亡率的危险因素：在本研究中，约48%的GCSE患者进展为SRSE。关于病因，自身免疫性脑炎或颅内感染易导致 SRSE。SRSE组和非SRSE组的院内死亡率和6个月死亡率无明显差异。多变量逻辑回归分析显示，入院和出院时的 NLR 分别是院内和 6 个月死亡率的独立预测因子。此外，PE能明显降低6个月的死亡率。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.