title: Acute-phase proteins and mortality in status epilepticus: a 5-year observational cohort study.
abstract: OBJECTIVE
  Acute-phase proteins, such as C-reactive protein and albumin, may be related with course and outcome in status epilepticus, as changes of cytokine levels and blood-brain barrier breakdown during status epilepticus have been demonstrated. The aim of this study was to elucidate the association of C-reactive protein and albumin with course and outcome of status epilepticus.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  This study was performed on the ICU of a university-affiliated tertiary care center.
  
  
  METHODS
  All consecutive patients with status epilepticus from 2005 to 2009 were selected from a prospectively established electroencephalography database.
  
  
  METHODS
  None.
  
  
  METHODS
  Albumin was assessed at admission and status epilepticus onset, and C-reactive protein was assessed during the first 3 days of status epilepticus. Outcomes were defined as refractory status epilepticus and death.
  
  
  RESULTS
  One hundred thirty-five consecutive status epilepticus patients were analyzed. Patients with higher levels of albumin at status epilepticus onset had significant lower odds for the development of refractory status epilepticus and death (with every 1g/L: odds ratio 0.91, 95% confidence interval 0.86-0.96, p = 0.001; odds ratio 0.88, 95% confidence interval 0.82-0.95, p < 0.0001, respectively). These associations remained significant after multiple adjustments for possible confounders and correction for multiple comparisons (with every 1g/L: odds ratio 0.92, 95% confidence interval 0.86-0.97, p = 0.004; odds ratio 0.87, 95% confidence interval 0.80-0.94, p = 0.001, respectively). Increased C-reactive protein levels at status epilepticus onset were associated with higher rates of refractory status epilepticus and death (with every 1mg/L: odds ratio 1.01, 95% confidence interval 1.00-1.02, p = 0.021; odds ratio 1.01, 95% confidence interval 1.00-1.02, p < 0.007, respectively). These associations were inconsistent after adjustment for possible confounders and corrections for multiple comparisons (with every 1mg/L: odds ratio 1.01, 95% confidence interval 1.00-1.02, p = 0.109; odds ratio 1.01, 95% confidence interval 1.00-1.02, p = 0.043).
  
  
  CONCLUSIONS
  Albumin levels measured early in status epilepticus are independently associated with refractory epileptic activity and death while C-reactive protein levels were inconsistent. Further studies are needed to assess the potential of acute-phase proteins for inclusion in prediction models allowing to identify patients with poor outcome of status epilepticus.
authors.affiliation: Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. SutterR@uhbs.ch
authors.forename: Raoul
authors.initials: R
authors.lastname: Sutter
authors.forename: Leticia
authors.initials: L
authors.lastname: Grize
authors.forename: Peter
authors.initials: P
authors.lastname: Fuhr
authors.forename: Stephan
authors.initials: S
authors.lastname: Rüegg
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
mesh_terms: D000209:Acute-Phase Proteins / Q000096:biosynthesis*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000096:biosynthesis; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012709:Serum Albumin / Q000096:biosynthesis; D013226:Status Epilepticus / Q000097:blood* / Q000378:metabolism / Q000401:mortality*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein