Can lactate levels predict progression to status epilepticus in generalized convulsive epileptic seizures?

The aim of this study was to analyze the factors predicting the progression to status epilepticus (SE) in patients who presented with generalized convulsive epileptic (GCE) seizures.

Patients included in the study were grouped as SE (+) and (-) patients. In addition to hemogram, biochemistry and blood gas parameters, the levels of antiepileptic drugs used by the patients at the time of presentation to the emergency department (ED) were also studied. Blood gas parameters at the 2nd hour of follow-up were retaken and lactate clearance was calculated and recorded on the data form.

26.7% of the patients were SE (+). A statistically significant, moderate correlation was observed between postictal time and both lactate₀(r = 0.663; p < 0.001) and lactate₂levels (r = 0.626; p < 0.001). In the analyses performed for the association with the presence of SE, presence of seizures within the last week (OR: 17.15, 95% CI: 1.322-222.505, p = 0.030), lactate₂(OR: 2.055, 95% CI: 1.367-3.090, p = 0.001), lactate₀(OR: 1.520, 95% CI: 1.030-1.283, p = 0.006), pulse rate (OR: 1.150, 95% CI: 1.150, 95% CI: 11.012-3.054, p = 0. 045) and leukocyte (OR: 0.469, 95% CI: 0.254-0.868, p = 0.016) values were independent predictors of the presence of SE. In the ROC analysis, it was determined that lactate₀value had the highest predictive power (AUC: 0.908, 95% GA 0.860-0.955, p < 0.001).

According to the study data, the presence of a significant increase in lactate levels at emergency department presentation should alert the clinician to status epilepticus.