title: Early-onset status epilepticus in patients with acute encephalitis.
abstract: Status epilepticus (SE) is a common complication of acute encephalitis, but its determinants and prognostic value in this setting are not known.Risk factors for early-onset SE (within 48 hours of intensive care unit [ICU] admission) in consecutive adult patients with all-cause encephalitis admitted to the medical ICU of a university hospital (1991-2013) were evaluated by multivariate logistic regression analysis. To examine the prognostic value of SE, patients were classified into 3 groups: no SE, nonrefractory SE (NRSE), and refractory SE (RSE). Poor neurologic outcome was defined by a modified Rankin score of 4 to 6.Among the 290 patients, 58 (20%, 95% CI: 15%-25%) developed early-onset SE, comprising 44 patients with NRSE and 14 patients with RSE. Coma (adjusted odds ratio [OR]: 3.1, 95% CI: 1.5-6.3), cortical lesions on neuroimaging (adjusted OR: 3.7, 95% CI: 1.8-7.8), and nonneurologic organ failure(s) (adjusted OR: 13.6, 95% CI: 4.9-37.7) were found to be independent risk factors for SE. By contrast, a bacterial etiology had a protective effect (adjusted OR: 0.3, 95% CI: 0.1-0.7). Age, body temperature, and blood sodium levels were not independently associated with SE. Poor neurologic outcomes were observed at day 90 in respectively 23% (95% CI: 17%-28%), 23% (95% CI: 10%-35%), and 71% (95% CI: 48%-95%) of no SE, NRSE, and RSE patients (P < 0.01). After adjusting for confounders, RSE, but not NRSE, remained independently associated with 90-day mortality (adjusted OR: 6.0, 95% CI: 1.5-23.3).Coma, cortical involvement on neuroimaging, and nonneurologic organ failure(s) are independent risk factors for SE in patients with acute encephalitis. Conversely, a bacterial etiology is associated with a lower risk of SE.These findings may help identify patients who may benefit from prophylactic antiepileptic drugs.
authors.affiliation: Univ Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Service de Réanimation Médicale et des Maladies Infectieuses, rue Henri-Huchard, Paris Cedex, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: Eric
authors.initials: E
authors.lastname: Mariotte
authors.forename: Mathilde
authors.initials: M
authors.lastname: Neuville
authors.forename: Sébastien
authors.initials: S
authors.lastname: Minaud
authors.forename: Eric
authors.initials: E
authors.lastname: Magalhaes
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.forename: Marie
authors.initials: M
authors.lastname: Cantier
authors.forename: Guillaume
authors.initials: G
authors.lastname: Voiriot
authors.forename: Aguila
authors.initials: A
authors.lastname: Radjou
authors.forename: Roland
authors.initials: R
authors.lastname: Smonig
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Soubirou
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000208:Acute Disease; D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003128:Coma / Q000453:epidemiology; D004569:Electroencephalography; D004660:Encephalitis / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D015999:Multivariate Analysis; D059906:Neuroimaging; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D013226:Status Epilepticus / Q000453:epidemiology*