November 8, 2019

Are Seizures Predictors of Mortality in Critically Ill Patients in the Intensive Care Unit (ICU)?

PURPOSE: This study aimed to determine if seizures in critically ill patients are predictive of in-hospital mortality.

METHODS: Patients above the age of 55 who underwent continuous electroencephalogram (cEEG) monitoring between 2015 and 2018 at the Hackensack Meridian Health and JFK Neuroscience Institute were included in the present study. Patients were subdivided into those with and without seizures. Age, sex, seizure types, CNS disorders, and other associated comorbidities were collected by chart review. After descriptive analysis, we used multiple logistic regression analyses to evaluate if seizures and mortality were associated. P-values less than 0.05 were considered statistically significant.

RESULTS: One hundred and one critically ill patients (62.4% female) were included in this study. Sixty-six (65.3%) were between 55 and 75 years of age, while 35 (34.7%) were above 75 years of age. Most patients (n = 31, 83.8%) had focal-onset seizures, and 10 had nonconvulsive status epilepticus (NCSE). Twelve (11.9%) patients with seizures did not survive. However, seizures were not independently associated with mortality in either unadjusted (OR 1.13, CI 0.47-2.72, p = 0.773) or adjusted (OR 1.20, CI 0.35-4.05, p = 0.760) regression models. Secondary predictors of mortality included mechanical ventilation (OR 5.36, CI 1.69-16.96,  p = 0.001) and acute ischemic stroke (OR 2.77, CI 1.08-7.09, p = 0.034).

CONCLUSION: Seizures did not predict in-hospital mortality in critically ill patients. Larger prospective studies are needed to confirm our current findings.

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