title: Prognosis of status epilepticus in patients requiring intravenous anesthetic drugs (a single center experience).
abstract: OBJECTIVE
  There is concern about the safety of anesthetic drugs (IVADs) in the management of status epilepticus (SE). To clarify this aspect, we aimed to assess the factors associated with a poor prognosis in SE requiring anesthetics.
  
  
  METHODS
  We analyzed all SE requiring IVADs between October 2011 and December 2015. Demographics, clinical data, etiology, SE duration, indications for sedation, electroencephalography features, complications and the prognosis at discharge were collected. Hypoxic etiology was ruled out.
  
  
  RESULTS
  73 patients needed IVADs. These were indicated as third-line treatment for SE in 58.9%, for decreased level of consciousness resulting from previous treatments in 27.4%, and for the underlying etiology in 13.7%. At discharge 41(56.2%) patients showed a bad outcome and 32 a good outcome. Outcome was poorer in patients with higher STESS (p=0.003), lower level of consciousness (p=0.025), non-convulsive SE in coma (p=0.040), potentially fatal etiology-PFE (p=0.006), longer duration (p=0.026), presence of complications (p=0.022), use of IVADs due to the underlying etiology (p=0.020), and periodic epileptiform discharges on electroencephalography (p=0.032). Following multivariate analysis, SE duration >12h (OR=3.266; 95%CI=1.077-9.908; p=0.037), STESS ≥3 (OR=4.816; 95%CI=1.435-16.165; p=0.011), and PFE (OR=3.526; 95%CI=1.184-10.506; p=0.024) were independently associated with a poor functional prognosis. Regarding mortality, duration >12h (OR=7.07; 95%CI=1.836-27.220; p=0.004), low level of consciousness (OR=6.97; 95%CI=1.194-40.718; p=0.031), and presence of complications (OR=21.32; 95%CI=2.440-186.295; p=0.006) were independent predictors of death.
  
  
  CONCLUSIONS
  Lengthy duration of SE in patients requiring IVADs is associated with a poorer prognosis and death. A STESS ≥3 and the etiology seem mainly related to the functional status at discharge, whereas more severely impaired consciousness and complications during sedation are related to mortality.
authors.affiliation: Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain. Electronic address: esantama@vhebron.net.
authors.forename: Estevo
authors.initials: E
authors.lastname: Santamarina
authors.affiliation: Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: González-Cuevas
authors.affiliation: Intensive Care Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Intensive Care Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Gracia
authors.affiliation: Intensive Care Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Porta
authors.affiliation: Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Toledo
authors.affiliation: Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana
authors.affiliation: Neurophysiology Department, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sueiras
authors.affiliation: Neurophysiology Department, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Guzmán
authors.affiliation: Epilepsy Unit, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Salas-Puig
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013226:Status Epilepticus / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality
chemical_list: D018686:Anesthetics, Intravenous
keywords: Anesthetics; Prognosis; Status epilepticus