Are seizures predictors of mortality in critically ill patients in the intensive care unit (ICU)?

Silveira, Diosely C.; Sagi, Anirudh; Romero, Raquel

doi:10.1016/j.seizure.2019.10.009

Cited by 6 publications

(8 citation statements)

References 13 publications

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“…All patients were admitted to the NICU and experienced different degrees of consciousness disorders. Several previous studies have found potential links between NCSE and poor stroke outcomes and reported mortality rates ranging from 11.9 to 51% (28)(29)(30)(31). Additionally, advanced age is a well-known independent factor adversely affecting the prognosis of stroke patients (32), which was confirmed in our study.…”

Section: Discussionsupporting

confidence: 87%

“…Whether these study results can be generalized in stroke patients remains to be clarified because there are studies that have reported contrasting data (9). A small-scale prospective cohort study revealed that the overall prognosis in patients diagnosed with NCSE was not significantly different from those without this complication (29,43,44). The findings in another study that included 145 ICU patients indicated that NCSE is a common complication in patients with altered mental status, and both patient outcome and hospital stay did not differ significantly between patients with and al.…”

Section: Discussionmentioning

confidence: 94%

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Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

et al. 2022

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Background and Purpose: Non-convulsive status epilepticus (NCSE) is common in patients with disorders of consciousness and can cause secondary brain injury. Our study aimed to explore the determinants and prognostic significance of NCSE in stroke patients with impaired consciousness.Method: Consecutive ischemic stroke patients with impaired consciousness who were admitted to a neuro intensive care unit were enrolled for this study. Univariate and multivariable logistic regression were used to identify factors associated with NCSE and their correlation with prognosis.Results: Among the 80 patients studied, 20 (25%) died during hospitalization, and 51 (63.75%) had unfavorable outcomes at the 3-month follow-up. A total of 31 patients (38.75%) developed NCSE during 24-h electroencephalogram (EEG) monitoring. Logistic regression revealed that NCSE was significantly associated with an increased risk of death during hospital stay and adverse outcomes at the 3-month follow-up. Patients with stroke involving the cerebral cortex or those who had a severely depressed level of consciousness were more prone to epileptogenesis after stroke.Conclusion: Our results suggest that NCSE is a common complication of ischemic stroke, and is associated with both in-hospital mortality and dependency at the 3-month follow-up. Long-term video EEG monitoring of stroke patients is, therefore required, especially for those with severe consciousness disorders (stupor or coma) or cortical injury.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 94%

Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

et al. 2022

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“…A recent study confirms that seizures are not a predictor of in-hospital mortality in critically ill patients. 8,12 Anoxic encephalopathy accounted for about 30% of patients included in CERTA. The study patients had an overall mortality rate of 48.6%, much higher than the one reported by other observational studies evaluating the impact of cEEG in critical care population with AMS.…”

Section: Commentarymentioning

confidence: 99%

Continuous EEG in ICU: Not a Luxury After All

Bermeo‐Ovalle¹

2020

Epilepsy Curr

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“…There are only few studies on seizures in critically ill patients treated in intensive care units (ICUs) reporting 1–40% of critically ill patients having seizures depending on the awareness of the treating teams, the investigated cohorts, and the electrophysiologic monitoring [ 18 , 21 ]. Limited evidence suggests no clear associations between seizures and specific outcomes [ 17 ], but large studies regarding the promotors of single or recurrent seizures and their impact on the course of underlying diseases, resource utilization, and management of critically ill patients are lacking.…”

Section: Introductionmentioning

confidence: 99%

Seizures and risks for recurrence in critically ill patients: an observational cohort study

et al. 2022

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Background To assess the frequency and clinical characteristics of seizures in adult critically ill patients, to identify predictors of recurrent seizures not transforming into status epilepticus and to characterize their effects on course and outcome. Methods ICU patients at a Swiss academic medical center with seizures not transforming into status epilepticus from 2015 to 2020 were included. Recurrent seizures and associated clinical characteristics were primary, death, and return to premorbid neurologic function were secondary outcomes. Results Two hundred of 26,370 patients (0.8%) with a median age of 65 years had seizures during ICU stay. Seizure semiology was described in 82% (49% generalized; 33% focal) with impaired consciousness during seizures in 80% and motor symptoms in 62%. Recurrent seizures were reported in 71% (36% on EEG) and associated with longer mechanical ventilation (p = 0.031), higher consultation rate by neurologists (p < 0.001), and increased use of EEG (p < 0.001) when compared to single seizures. The use of EEG was not associated with secondary outcomes. Acidosis at seizure onset and prior emergency operations were associated with decreased odds for seizure recurrence (OR 0.43; 95% CI 0.20–0.94 and OR 0.48; 95% CI 0.24–0.97). Epilepsy had increased odds for seizure recurrence (OR 3.56; 95% CI 1.14–11.16). Conclusions Seizures in ICU patients are infrequent, but mostly recurrent, and associated with higher resource utilization. Whenever seizures are observed, clinicians should be vigilant about the increased risk of seizures recurrence and the need for antiseizure treatment must be carefully discussed. While known epilepsy seems to promote recurrent seizures, our results suggest that both acidosis and previous emergency surgery seem to have protective/antiseizure effects. Trial registration Clinicaltrials.gov (No. NCT03860467).

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Are seizures predictors of mortality in critically ill patients in the intensive care unit (ICU)?

Cited by 6 publications

References 13 publications

Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

Associated Factors and Prognostic Implications of Non-convulsive Status Epilepticus in Ischemic Stroke Patients With Impaired Consciousness

Continuous EEG in ICU: Not a Luxury After All

Seizures and risks for recurrence in critically ill patients: an observational cohort study

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