Predictors of intensive care unit utilization in patients with posterior reversible encephalopathy syndrome.
Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome that requires prompt, aggressive management to improve outcomes. Our aim was to identify factors that would necessitate care in the intensive care unit (ICU) in patients with PRES and the outcomes on discharge following ICU stay. We retrospectively reviewed the medical records and radiological data of adult PRES patients admitted to our tertiary care medical center. We dichotomized them into two groups based on their need for ICU care and compared their clinical, laboratory, imaging characteristics and discharge outcomes. Outcomes were defined using the modified Rankin Score (mRS) and Glasgow Outcome Score (GOS) on discharge. Out of 100 patients, 67 % required admission to the ICU. On univariate analysis, factors associated with ICU admission were atrial fibrillation (19.4 vs 0 %; p ≤ 0.05), encephalopathy from PRES (89.6 vs 66.7 %; p < 0.05), low Glasgow Coma Score (GCS) (11 ± 4 vs 14 ± 2; p = 0.01) and cortical involvement on imaging (89.6 vs 72.7 %, p = 0.03). On multivariate logistic regression analysis, encephalopathy (odds ratio 10.22; 95 % CI (1.14-91.55; p = 0.04) was the sole predictor of ICU utilization. This correlated with a GCS <12 (odds ratio 5.53; 95 % CI (1.05-29.22; p = 0.04). Despite worse functional outcomes following ICU care based on mRS (2.3 ± 2.1 vs 1.3 ± 1.4, p = 0.02) and GOS (3.9 ± 1.3 vs 4.6 ± 0.7, p ≤ 0.05), only a borderline increase in mortality was observed (10.4 vs 0 %, p = 0.05). The presence of PRES-related encephalopathy might aid in prompt identification of patients who require ICU care.
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. archanahinduja@yahoo.com.|Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. archanahinduja@yahoo.com.
Archana
A
Hinduja
Department of Pediatric Neurology, Arkansas Children Hospital, Little Rock, AR, USA.
Kenneth
K
Habetz
Department of Community Medicine, Dr RP Government Medical College, Tanda, India.
Sunil Kumar
SK
Raina
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Ryan T
RT
Fitzgerald
D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome; D012189:Retrospective Studies
Hypertensive encephalopathy; PRES; Posterior reversible encephalopathy syndrome