| Objective: To analyze the factors that affect the prognosis of convulsive status epilepticus(CSE),so that to provide reference for the improvement of CSE treatment.Methods: A retrospective analysis of 202 patients with CSE who were hospitalized from January 2010 to May 2017 at the Epilepsy Center of the Sichuan Provincial People's Hospital.The main indicator was death during hospitalization,and the secondary indicator was functional outcome at discharge(recovery to the baseline/functional deterioration).The modified Rankin Scale(MRS)was used to assess the neurological status of patients at discharge and before hospital admission.Chi-square test was performed to analyze associations between age of onset,sex,previous history of epilepsy,etiology,duration,intra-hospital complications and prognosis.Multiple logistic regression was applied to identify independent risk factors for mortality and deterioration of function.Results: 1.A total of 202 CSE cases were included,including 122 males(60.4%),80 females(39.6%).2.The age of onset was 1 to 90 years old and the median age was 38 years(IQR 11-66.3),?15 years old 60 cases(29.7%),16 to 59 years old 77 cases(38.1%),?60 years old 65 cases(32.2%).3.Etiology: Acute symptomatic etiology was the main cause 109 cases(54.0%),the second was remote symptomatic,with 53 cases(26.2%),cryptogenic 32 cases(15.8%),progressive encephalopathy 8 cases(4.0%).4.Inducing factors: 71 cases(35.1%)had inducing factors,which mainly were upper respiratory tract infections and fever,about 37 cases(18.2%),self-reduce or withdrawal of antiepileptic drugs in 16 cases(7.9%),10 patients lack of sleep(5.0%),other incentives(such as heavy drinking,mood swings,etc)in 8 cases(4.0%).5.Delayed treatment time: The minimum is 10 minute and the maximum is 4 hours,of these,125 patients(61.9%)were treated within 30 minutes.6.Comorbidities at admission: 150 patients(74.3%)had comorbidities at admission,among them,91 cases(45%)were respiratory diseases,including 44 cases of pneumonia,9 cases were chronic obstructive pulmonary disease,33 cases were bronchitis,5 cases were pneumonia and respiratory failure.Hypertension was present in 38 cases(18.8%),intracranial infection in 26 cases(12.9%),diabetes mellitus in 16 cases(7.9%),cardiopathy in 15 cases(7.4%),chronic kidney disease in 14 cases(6.9%),previous stroke in 15 cases(7.4%),other central nervous system(CNS)diseases(Parkinson disease,multiple sclerosis,cerebrovascular malformation,etc)in 17 cases(8.4%),other(depression,hydatid disease of liver,isoniazid poisoning,etc.)in 10 cases(5.0%).7.Intra-hospital complications:119 cases(59%)had complications,which mainly were water and electrolyte acid-base disturbances,account for 59 cases(29.2%),pneumonia in 35(17.3%),anemia in 34 cases(16.8%),metabolic acidosis in 28 cases(13.9%),respiratory failure in 31 cases(15.3%),hypoproteinemia in 23 cases(11.4%),acute kidney injury in 13 cases(6.4%),gastrointestinal bleeding in 11 cases(5.4%),myocardial injury in 8 cases(4.0%),intestinal infection in 7 cases(3.4%),urinary tract infection in 6 cases(3.0%),shock in 7 cases(3.4%),other(multiple organ failure,lower extremitiy deep venous thrombosis,etc.)in 16 cases(7.9%).8.Prognosis: A total of 32 deaths occurred during hospitalization with a mortality rate of 15.8% in 202 patients with CSE.The median MRS score was 2(IQR2-3)before admission and 3(IQR2-4)at discharge,and 65.3% of patients returned to baseline upon discharge.9.Univariate analysis : Age of onset,previous history of epilepsy,RSE,CSE occurring before admission,status epilepticus severity score(STESS)at admission,etiology,level of consciousness after seizure,duration of SE,delayed treatment time,comorbidities at admission,mechanical ventilation and intra-hospital complications was associated with short-term death and functional deterioration of CSE(P<0.05).Age of onset,previous history of epilepsy,refractory status epilepticus(RSE),CSE occurring before admission,status epilepticus severity score(STESS)at admission,etiology,inducing factors,level of consciousness after seizure,duration of SE,delayed treatment time,comorbidities at admission,mechanical ventilation and intra-hospital complications was associated with functional deterioration of CSE(P<0.05).10.Multivariate analysis: Post-onset coma,RSE,mechanical ventilation,concurrent pneumonia,respiratory failure,and gastrointestinal bleeding were independent risk factors and predictors of short-term CSE death.Coma after onset,concurrent pneumonia,respiratory failure,and metabolic acidosis were independent risk factors and predictors of CSE function deterioration.There was a negative correlation between remote symptomatic etiology and short-term death of CSE,previous history of epilepsy was negatively correlatedwith the deterioration of CSE function.Conclusion: 1.Acute symptomatic etiology was the main cause in this group of CSE patients,among which viral encephalitis,acute cerebral infarction and intracerebral hemorrhage were the most common causes.The most common inducing factors were upper respiratory tract infections and fever and spontaneous antiepileptic drug withdrawal.2.Mortality and morbidity rates of CSE in China are high,65.3% of patients returned to baseline upon discharge,In-hospital mortality rate was 15.8%.3.Coma after onset,intra-hospital complications,mechanical ventilation and RSE were associated with poor prognosis.Remote symptomatic etiology and previous history of epilepsy were related to the better outcome of CSE.The results also show that early identification of risk factors for poor prognosis,timely pre-hospital and in-hospital intervention,enhancement of airway management are important for improving prognosis of CSE in clinical practice. |
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