Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus: A post-hoc study of a randomized controlled trial.

Objective To evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day-1 and neurologic outcomes 90 days after convulsive status epilepticus. Methods Post hoc analysis of the HYBERNATUS multicenter open-label controlled trial that randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32–34°C for 24 hours) plus standard care or standard care alone, between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus. Results The 172 men and 93 women had a median age of 57 years (45–68). Among them, 130 (49%) had a previous history of epilepsy and 59 (29%) a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients and total seizure duration was 67 minutes (35–120). The 90-day outcome was unfavorable in 126 (48%) patients. By multivariate analysis, none of the systemic secondary brain insults was associated with outcome; achieving an unfavorable outcome was associated with age above 65 years (OR, 2.17; 95% CI, 1.20–3.85; p = 0.01), refractory convulsive status epilepticus (OR, 2.00; 95% CI, 1.04–3.85; p = 0.04), and primary brain insult (OR, 2.00; 95% CI, 1.02–4.00; p = 0.047); and no bystander-witnessed seizure onset (OR, 2.49; 95% CI, 1.05–5.59; p = 0.04). Conclusions In our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus. Clinical trails registration ClinicalTrials.gov registration #NCT01359332.