Abstracts

Rationale: Refractory status epilepticus (RSE) is one of the most life-threatening neurological emergencies with high mortality and morbidity. The aim of this study was to elucidate and quantify associations of clinical characteristics of RSE patients with outcome. Methods: Comprehensive medical chart review was performed of all consecutive patients treated for RSE between 2005 and 2011 on the ICUs of the University Hospital Basel (Switzerland). Patients' demographics, RSE etiologies and duration, comorbidities as well as outcomes were assessed. Associations of clinical characteristics and outcomes were quantified. Results: Of 260 patients with status epilepticus 111 developed RSE with a mean duration of 101 hours. Hypoxic-ischemic encephalopathy (23%), brain tumors (14%), known epilepsy (10%), and ischemic stroke (8%) were the main etiologies. Cessation of RSE was achieved in 82%. Short-term outcome was favorable in 45%, unfavorable in 55%, and 38% of patients died. Coronary artery disease, brain tumors, metabolic/toxic problems, and cardiopulmonary resuscitation (CPR) had high odds ratios for death. These associations remained significant after multiple adjustments for brain tumors (OR 6.3; p=0.004) and cardiopulmonary resuscitation (OR 18.3; p<0.0001), indicating an independence of these associations. Corresponding, the estimated hazard ratio of death for patients with CPR was 3.1 (p=0.001) as compared to patients without CPR while it was 1.1 (p=0.745) for patients with brain tumors as compared to patients without. Conclusions: Brain tumors and CPR were distinct and independent associations with death in our cohort of critically ill patients with RSE. Prospective studies are warranted to strengthen our findings and elucidate underlying mechanisms.