Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments
[Display omitted] •Functional impairments at baseline concerned 11.6% of patients with convulsive status epilepticus requiring intensive care unit admission.•Functional impairments at baseline were more frequent in patients with a history of epilepsy and preexisting, ultimately fatal comorbidities.•...
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| Veröffentlicht in: | Epilepsy & behavior 2023-04, Vol.141, p.109083-109083, Article 109083 |
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| creator | Vieille, Thibault Jacq, Gwenaëlle Merceron, Sybille Huriaux, Laetitia Chelly, Jonathan Quenot, Jean-Pierre Legriel, Stéphane |
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•Functional impairments at baseline concerned 11.6% of patients with convulsive status epilepticus requiring intensive care unit admission.•Functional impairments at baseline were more frequent in patients with a history of epilepsy and preexisting, ultimately fatal comorbidities.•Status epilepticus patients with functional impairments at baseline had higher frequencies of life-sustaining treatment-limitation decisions.•Preadmission functional status was not independently associated with the 1-year functional outcome.
Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired.
We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure.
The 206 women and 293 men had a median age of 59 years [47–70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P |
| doi_str_mv | 10.1016/j.yebeh.2023.109083 |
| format | Article |
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•Functional impairments at baseline concerned 11.6% of patients with convulsive status epilepticus requiring intensive care unit admission.•Functional impairments at baseline were more frequent in patients with a history of epilepsy and preexisting, ultimately fatal comorbidities.•Status epilepticus patients with functional impairments at baseline had higher frequencies of life-sustaining treatment-limitation decisions.•Preadmission functional status was not independently associated with the 1-year functional outcome.
Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired.
We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure.
The 206 women and 293 men had a median age of 59 years [47–70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55–3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71–4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43–3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75–4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37–3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31–1.22, P = 0.17).
Preadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives.
Study Registration: #NCT03457831.</description><identifier>ISSN: 1525-5050</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2023.109083</identifier><identifier>PMID: 36803873</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Cognitive science ; Critical Illness ; Evaluation/Disability ; Female ; Glasgow Outcome Scale ; Humans ; Intensive care unit ; Intensive Care Units ; Male ; Middle Aged ; Neuroscience ; Outcome ; Retrospective Studies ; Status Epilepticus - complications ; Status Epilepticus - epidemiology ; Status Epilepticus - therapy ; Status epilepticus/etiology</subject><ispartof>Epilepsy & behavior, 2023-04, Vol.141, p.109083-109083, Article 109083</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c343t-3c78b15a309a22d953ca3c2c23d182cab27cebd8f6d83d2e29bed3e780e380373</cites><orcidid>0000-0002-8198-1239 ; 0000-0003-4782-6734</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S152550502300001X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36803873$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04068559$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Vieille, Thibault</creatorcontrib><creatorcontrib>Jacq, Gwenaëlle</creatorcontrib><creatorcontrib>Merceron, Sybille</creatorcontrib><creatorcontrib>Huriaux, Laetitia</creatorcontrib><creatorcontrib>Chelly, Jonathan</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Legriel, Stéphane</creatorcontrib><title>Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments</title><title>Epilepsy & behavior</title><addtitle>Epilepsy Behav</addtitle><description>[Display omitted]
•Functional impairments at baseline concerned 11.6% of patients with convulsive status epilepticus requiring intensive care unit admission.•Functional impairments at baseline were more frequent in patients with a history of epilepsy and preexisting, ultimately fatal comorbidities.•Status epilepticus patients with functional impairments at baseline had higher frequencies of life-sustaining treatment-limitation decisions.•Preadmission functional status was not independently associated with the 1-year functional outcome.
Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired.
We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure.
The 206 women and 293 men had a median age of 59 years [47–70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55–3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71–4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43–3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75–4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37–3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31–1.22, P = 0.17).
Preadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives.
Study Registration: #NCT03457831.</description><subject>Adult</subject><subject>Cognitive science</subject><subject>Critical Illness</subject><subject>Evaluation/Disability</subject><subject>Female</subject><subject>Glasgow Outcome Scale</subject><subject>Humans</subject><subject>Intensive care unit</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neuroscience</subject><subject>Outcome</subject><subject>Retrospective Studies</subject><subject>Status Epilepticus - complications</subject><subject>Status Epilepticus - epidemiology</subject><subject>Status Epilepticus - therapy</subject><subject>Status epilepticus/etiology</subject><issn>1525-5050</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kT-P1DAQxS0E4v7AJ0BCLqHYxfZcEqegOJ3gDmkRDdSWY09Yr5w42M6etuaL45BjS6oZjX7znmYeIW8423LG6w-H7Qk73G8FE1AmLZPwjFzySlSbitXt83NfsQtyldKBMc4r4C_JBdSSgWzgkvz-qkf9EwccM9WjpWHOJgyYaOipiS47o70_Uec91Xb2mU46uwIn-ujynpowHmef3BFpyjrPieLkPE5lr_SL4BRR28Gl5MJI-3k0uTTaUzdM2sXFN70iL3rtE75-qtfkx-dP3-8eNrtv91_ubncbAzeQN2Aa2fFKA2u1ELatwGgwwgiwXAqjO9EY7KzsayvBChRthxawkQyhnNvANXm_6u61V1N0g44nFbRTD7c7tczYDatlVbVHXth3KzvF8GvGlFW5waD3esQwJyWaRrYNcKgLCitqYkgpYn_W5kwtSamD-puUWpJSa1Jl6-2TwdwNaM87_6IpwMcVwPKSo8OokimfN2hdRJOVDe6_Bn8A5SKogA</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Vieille, Thibault</creator><creator>Jacq, Gwenaëlle</creator><creator>Merceron, Sybille</creator><creator>Huriaux, Laetitia</creator><creator>Chelly, Jonathan</creator><creator>Quenot, Jean-Pierre</creator><creator>Legriel, Stéphane</creator><general>Elsevier Inc</general><general>[San Diego CA]: Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-8198-1239</orcidid><orcidid>https://orcid.org/0000-0003-4782-6734</orcidid></search><sort><creationdate>20230401</creationdate><title>Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments</title><author>Vieille, Thibault ; Jacq, Gwenaëlle ; Merceron, Sybille ; Huriaux, Laetitia ; Chelly, Jonathan ; Quenot, Jean-Pierre ; Legriel, Stéphane</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c343t-3c78b15a309a22d953ca3c2c23d182cab27cebd8f6d83d2e29bed3e780e380373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Cognitive science</topic><topic>Critical Illness</topic><topic>Evaluation/Disability</topic><topic>Female</topic><topic>Glasgow Outcome Scale</topic><topic>Humans</topic><topic>Intensive care unit</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neuroscience</topic><topic>Outcome</topic><topic>Retrospective Studies</topic><topic>Status Epilepticus - complications</topic><topic>Status Epilepticus - epidemiology</topic><topic>Status Epilepticus - therapy</topic><topic>Status epilepticus/etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vieille, Thibault</creatorcontrib><creatorcontrib>Jacq, Gwenaëlle</creatorcontrib><creatorcontrib>Merceron, Sybille</creatorcontrib><creatorcontrib>Huriaux, Laetitia</creatorcontrib><creatorcontrib>Chelly, Jonathan</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Legriel, Stéphane</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Epilepsy & behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vieille, Thibault</au><au>Jacq, Gwenaëlle</au><au>Merceron, Sybille</au><au>Huriaux, Laetitia</au><au>Chelly, Jonathan</au><au>Quenot, Jean-Pierre</au><au>Legriel, Stéphane</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments</atitle><jtitle>Epilepsy & behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>141</volume><spage>109083</spage><epage>109083</epage><pages>109083-109083</pages><artnum>109083</artnum><issn>1525-5050</issn><eissn>1525-5069</eissn><abstract>[Display omitted]
•Functional impairments at baseline concerned 11.6% of patients with convulsive status epilepticus requiring intensive care unit admission.•Functional impairments at baseline were more frequent in patients with a history of epilepsy and preexisting, ultimately fatal comorbidities.•Status epilepticus patients with functional impairments at baseline had higher frequencies of life-sustaining treatment-limitation decisions.•Preadmission functional status was not independently associated with the 1-year functional outcome.
Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired.
We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure.
The 206 women and 293 men had a median age of 59 years [47–70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55–3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71–4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43–3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75–4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37–3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31–1.22, P = 0.17).
Preadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives.
Study Registration: #NCT03457831.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36803873</pmid><doi>10.1016/j.yebeh.2023.109083</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-8198-1239</orcidid><orcidid>https://orcid.org/0000-0003-4782-6734</orcidid></addata></record> |
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| subjects | Adult Cognitive science Critical Illness Evaluation/Disability Female Glasgow Outcome Scale Humans Intensive care unit Intensive Care Units Male Middle Aged Neuroscience Outcome Retrospective Studies Status Epilepticus - complications Status Epilepticus - epidemiology Status Epilepticus - therapy Status epilepticus/etiology |
| title | Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments |
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