Early predictors of status epilepticus-associated mortality and morbidity in children
Yoshihiro Maegaki1, Youichi Kurozawa2, Akiko Tamasaki1
1Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan.
Insights
Identifying early predictors for pediatric status epilepticus (SE) outcomes is crucial. Young age, intractable seizures, abnormal glucose, and elevated AST/CRP levels predict poor outcomes in children with SE.
Area of Science:
- Pediatric Neurology
- Epileptology
- Critical Care Medicine
Background:
- Systematic studies on early predictors of mortality and morbidity associated with pediatric status epilepticus (SE) are lacking.
- This knowledge gap hinders the identification of high-risk pediatric patients requiring prompt intervention.
Purpose of the Study:
- To identify reliable early predictors of mortality and morbidity in pediatric SE.
- To determine the etiology of SE-associated sequelae in Japanese children.
Main Methods:
- A prospective, multicenter study was conducted.
- Clinical findings and initial laboratory data at SE onset were collected.
- Outcomes, including in-hospital death and neurological sequelae, were assessed.
Main Results:
- Of 201 children with first SE episode, 16 had poor outcomes, often linked to acute encephalopathy.
- Univariate analysis identified young age, prolonged seizures, intractable seizures, abnormal glucose, elevated AST, and CRP as risk factors.
- Multivariate analysis confirmed young age, seizure intractability, abnormal glucose, and elevated AST/CRP as significant predictors.
Conclusions:
- Young age and seizure intractability are strong predictors of poor outcomes in pediatric SE.
- Abnormal blood glucose, elevated AST, and CRP levels may indicate underlying etiologies like acute encephalopathy or severe infections.
Background:
Early predictors of status epilepticus (SE)-associated mortality and morbidity have not been systematically studied in children, considerably impeding the identification of patients at risk.
Objectives:
To determine reliable early predictors of SE-associated mortality and morbidity and identify the etiology of SE-associated sequelae in Japanese children.
Methods:
We conducted a prospective multicenter study of clinical findings and initial laboratory data acquired at SE onset, and assessed outcomes at the last follow-up examination. In-hospital death during the acute period and neurological sequelae were classified as poor outcomes.
Results:
Of the 201 children who experienced their first SE episode, 16 exhibited poor outcome that was most commonly associated with acute encephalopathy. Univariate analysis revealed that the following were associated with poor outcomes: young age (⩽24 months); seizure duration >90 min; seizure intractability (failure of the second anticonvulsive drug); biphasic seizures; abnormal blood glucose levels (<61 or >250 mg/dL); serum aspartate aminotransferase (AST) ⩾56 U/L; and C-reactive protein (CRP) levels >2.00 mg/dL. Multivariate analysis revealed that young age, seizure intractability, abnormal blood glucose levels, and elevated AST and CRP levels were statistically significant.
Conclusions:
Young age and seizure intractability were highly predictive of poor outcomes in pediatric SE. Moreover, abnormal blood glucose levels and elevated AST and CRP levels were predictors that might be closely associated with the etiology, especially acute encephalopathy and severe bacterial infection (sepsis and meningitis) in Japanese children.
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