An observational study on the clinical profile, management approaches, and outcomes of adult patients admitted to the intensive care unit for status epilepticus.

Abstract

Objectives: Status epilepticus (SE) is a serious neurological condition with a high risk of complications and mortality. We described adult patients who required admission to the intensive care unit (ICU) for SE and assessed their prognosis.

Methods: We retrospectively analyzed consecutive adult ICU admissions for SE between 2016 and 2021. We performed multivariable logistic regression to determine the predictors of an unfavorable outcome (discharge Glasgow Coma Scale <14 or death).

Results: We studied 115 patients (median age 38 years; males 62.6%; prior antiepileptic therapy 59.1%; median presenting Glasgow Coma Scale 7; median Status Epilepticus Severity Score 4). Brain computed tomography revealed acute/sub-acute stroke in 5.2% of cases, intracranial hemorrhage in 2.6%, and brain tumors in 5.2%. Cerebrospinal fluid analysis in 41 patients detected bacteria or herpes simplex virus in 4. Intravenous lorazepam was used to abort seizures in 80.0% of patients (median dose 3 mg). Mechanical ventilation was needed for 87 patients for a median of 4 days. Thirty-five patients (30.4%) experienced an unfavorable outcome, and hospital mortality was 5.2%. Infections present on admission were associated with an unfavorable outcome (odds ratio 3.61, 95% confidence interval 1.35-9.63).

Conclusion: Most ICU admissions for SE involved young patients with few having abnormalities on brain imaging and cerebrospinal fluid and most needing intubation. Hospital mortality was 5.2% with the presence of an infection on admission linked to an unfavorable outcome.