title: Independent impact of infections on the course and outcome of status epilepticus: a 10-year cohort study.
abstract: Infections are frequent in patients with status epilepticus (SE). It remains unclear if infections merely reflect severity of the underlying illness or if they independently predict unfavourable course and outcome. We sought to determine if infections diagnosed within 48 h from SE onset are independent predictors of poor course and outcome and if their effect is modified by clinical characteristics. From 2005 to 2014, pertinent clinical data, microbiology, death, return to functional baseline, and unfavourable outcome in survivors were assessed in SE patients treated in the intensive care units (ICU) of an academic medical care center. Among 352 consecutive patients, 81 (23 %) were diagnosed with infections at SE onset. In-hospital mortality was higher in patients with infections (26 %) compared to 10 % in patients without infections (p < 0.001). Infections at SE onset increased the odds ratios (OR) for prolonged ICU (OR = 4.1, 95 %CI 1.87-6.74) and hospital stay (OR = 5.4, 95 %CI 1.24-9.63), refractory SE (OR = 3.1, 95 %CI 1.79-5.34), prolonged mechanical ventilation (OR = 3.8, 95 %CI 2.15-6.79), no return to functional baseline (OR = 2.1, 95 %CI 1.10-4.02), unfavourable outcome in survivors (OR = 2.0, 95 %CI 1.02-3.81), and death (OR = 2.5, 95 %CI 1.28-4.99). All associations were independent of confounders and without significant effect modification by age, level of consciousness, types and severity of SE, and etiologies. In addition, the number of infections increased the probability of unfavourable course and outcome. Infections at SE onset are frequent and associated with prolonged medical care, treatment refractory SE, higher morbidity and mortality independently of potential confounders calling for the evaluation of treatment strategies.
authors.affiliation: Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Saskia
authors.initials: S
authors.lastname: Semmlack
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tschudin-Sutter
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.affiliation: University of Basel, Basel, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Valença
authors.affiliation: Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Rüegg
authors.affiliation: Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.affiliation: Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. raoul.sutter@usb.ch.|Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland. raoul.sutter@usb.ch.
authors.forename: Raoul
authors.initials: R
authors.lastname: Sutter
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013226:Status Epilepticus / Q000150:complications* / Q000453:epidemiology*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D000927:Anticonvulsants; D002097:C-Reactive Protein
keywords: Infections; Neurocritical care; Outcome; Status epilepticus; Systemic inflammation