Unreactive EEG Background Is Associated With Unfavorable Outcome in Patients With Disorders of Consciousness of Various Etiologies: An Adult Cohort Study

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2025-07-28 DOI:10.1111/ene.70312

Sarah Benghanem, Jan Novy, Kaspar A. Schindler, Stephan Rüegg, Vincent Alvarez, A. O. Rossetti

{"title":"Unreactive EEG Background Is Associated With Unfavorable Outcome in Patients With Disorders of Consciousness of Various Etiologies: An Adult Cohort Study","authors":"Sarah Benghanem, Jan Novy, Kaspar A. Schindler, Stephan Rüegg, Vincent Alvarez, A. O. Rossetti","doi":"10.1111/ene.70312","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Prognostication of neurological outcome in critically ill patients presents significant challenges. While EEG reactivity may be associated with outcome in hypoxic–ischemic brain injury (HIBI), it has received scarce attention in other etiological conditions. Our objective was to investigate the association of EEG reactivity to clinical outcome in patients with disorders of consciousness of various etiologies.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>This is an ancillary study of the randomized CERTA trial (NCT03129438), which included adults with disorders of consciousness randomized to continuous EEG for 30–48 h or two routine EEGs (20–30 min). We explored the association between EEG characteristics and neurological outcome at 6 months, a modified Rankin Scale (mRS) 3–6 being considered unfavorable.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 364 patients were included. Among them, 112 patients had HIBI, 85 intracranial hemorrhage (ICH), 28 ischemic stroke, 48 traumatic brain injury (TBI), 23 toxic-metabolic encephalopathy, 7 encephalitis, and 114 had unknown or other etiologies. In the overall cohort, abnormal background continuity (OR 2.33, 95% CI [1.15–4.76], <i>p</i> = 0.019), ictal–interictal continuum features (OR 2.78, 95% CI [1.16–6.67], <i>p</i> = 0.021) and unreactive background (OR 10.9, 95% CI [1.97–58.82], <i>p</i> = 0.006) were independently associated with unfavorable outcome. In the overall cohort, unreactive EEG had specificity of 97.3% (95% CI [94.3–100]) and sensitivity of 22.1% (95% CI [17–27.2]) for unfavorable outcome. In HIBI, specificity was 97% (95% CI [91.1–100]) and sensitivity 46.8% (95% CI [35.8–57.8]); in ICH, specificity was 94.1% (95% CI [83–100]) and sensitivity 8.8% (95% CI [2.05–15.55]); in TBI, specificity was 94.1% (95% CI [83–100]) and sensitivity 22.6% (95% CI [7.8–37.3]).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>In this etiologically mixed cohort of critically ill adults, unreactive EEG predicted unfavorable outcome at 6 months with high specificity. EEG reactivity may reduce prognostic uncertainty not only for patients with HIBI, but also for other types of acute brain injury, such as TBI and ICH.</p>\n </section>\n </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70312","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ene.70312","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Prognostication of neurological outcome in critically ill patients presents significant challenges. While EEG reactivity may be associated with outcome in hypoxic–ischemic brain injury (HIBI), it has received scarce attention in other etiological conditions. Our objective was to investigate the association of EEG reactivity to clinical outcome in patients with disorders of consciousness of various etiologies.

Method

This is an ancillary study of the randomized CERTA trial (NCT03129438), which included adults with disorders of consciousness randomized to continuous EEG for 30–48 h or two routine EEGs (20–30 min). We explored the association between EEG characteristics and neurological outcome at 6 months, a modified Rankin Scale (mRS) 3–6 being considered unfavorable.

Results

A total of 364 patients were included. Among them, 112 patients had HIBI, 85 intracranial hemorrhage (ICH), 28 ischemic stroke, 48 traumatic brain injury (TBI), 23 toxic-metabolic encephalopathy, 7 encephalitis, and 114 had unknown or other etiologies. In the overall cohort, abnormal background continuity (OR 2.33, 95% CI [1.15–4.76], p = 0.019), ictal–interictal continuum features (OR 2.78, 95% CI [1.16–6.67], p = 0.021) and unreactive background (OR 10.9, 95% CI [1.97–58.82], p = 0.006) were independently associated with unfavorable outcome. In the overall cohort, unreactive EEG had specificity of 97.3% (95% CI [94.3–100]) and sensitivity of 22.1% (95% CI [17–27.2]) for unfavorable outcome. In HIBI, specificity was 97% (95% CI [91.1–100]) and sensitivity 46.8% (95% CI [35.8–57.8]); in ICH, specificity was 94.1% (95% CI [83–100]) and sensitivity 8.8% (95% CI [2.05–15.55]); in TBI, specificity was 94.1% (95% CI [83–100]) and sensitivity 22.6% (95% CI [7.8–37.3]).

Conclusion

In this etiologically mixed cohort of critically ill adults, unreactive EEG predicted unfavorable outcome at 6 months with high specificity. EEG reactivity may reduce prognostic uncertainty not only for patients with HIBI, but also for other types of acute brain injury, such as TBI and ICH.

Abstract Image

查看原文本刊更多论文

无反应性脑电图背景与各种病因的意识障碍患者的不良预后相关：一项成人队列研究

目的危重症患者神经预后预测面临重大挑战。虽然脑电图反应性可能与缺氧缺血性脑损伤（HIBI）的预后有关，但在其他病因性疾病中却很少受到关注。我们的目的是研究脑电图反应性与不同病因的意识障碍患者临床预后的关系。方法：本研究是随机CERTA试验（NCT03129438）的一项辅助研究，该试验纳入了意识障碍的成年人，随机分为连续脑电图30-48小时或两次常规脑电图（20-30分钟）。我们探讨了6个月时脑电图特征与神经预后之间的关系，改良的Rankin量表（mRS） 3-6被认为是不利的。结果共纳入364例患者。其中HIBI 112例，颅内出血85例，缺血性脑卒中28例，外伤性脑损伤48例，毒性代谢性脑病23例，脑炎7例，其他病因不明或其他病因114例。在整个队列中，异常背景连续性（OR 2.33, 95% CI [1.15-4.76], p = 0.019）、发作-发作间期连续特征（OR 2.78, 95% CI [1.16-6.67], p = 0.021）和无反应性背景（OR 10.9, 95% CI [1.97-58.82], p = 0.006）与不良结局独立相关。在整个队列中，无反应性脑电图对不良结局的特异性为97.3% (95% CI[94.3-100])，敏感性为22.1% （95% CI[17-27.2]）。HIBI的特异性为97% (95% CI[91.1-100])，敏感性为46.8% (95% CI [35.8-57.8])；脑出血的特异性为94.1% (95% CI[83-100])，敏感性为8.8% (95% CI [2.05-15.55])；TBI的特异性为94.1% (95% CI[83-100])，敏感性为22.6% （95% CI[7.8-37.3]）。结论在这个病因混合的危重成人队列中，无反应性脑电图预测6个月时的不良结局具有高特异性。脑电图反应性不仅可以减少HIBI患者的预后不确定性，也可以减少其他类型的急性脑损伤，如TBI和ICH。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).