“PREDICTORES DE MORBIMORTALIDAD RELACIONADOS A ESTATUS EPILEPTICO. UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA. OCTUBRE 2016 –OCTUBRE 2018”

Abstract

The status epilepticus is a pathology recognized worldwide, by the impact as a predictor of morbidity and mortality, characterized by epileptogenic neuronal discharges. OBJECTIVE: To determine the predictors of morbidity and mortality related to epileptic status in the intensive care unit of the Luis Vernaza Hospital. METHODOLOGY: A total of 106 patients with a diagnosis of epileptic status were analyzed in the Critical Care Medicine Service. The patients were selected based on clinical and electroencephalographic criteria, with the subsequent analysis of factors associated with poor prognosis such as: age, sex, etiology, history of epilepsy, type of crisis, level of awareness upon admission, clinical complications inherent in the therapeutic, STESS (Severity score in epileptic status> of 3 unfavorable result). RESULTS: 106 patients were evaluated, consisting of 41 women and 65 men. The age ranges between 17 and 71 years, with a median of 38 years. The diagnoses found were cranioencephalic trauma, neuroinfection, cerebral vascular event, encephalopathies, cryptogenic, autoimmune, immunomodulatory drugs, brain tumors, cessation of antiepileptic drug. The most frequent factors associated with poor prognosis were age (patients> 65 years of age increased the risk of mortality); sex (male worse prognosis by correlation to etiology); the etiology most associated with mortality is trauma, neuroinfections and encephalopathies (sepsis / anoxic); cranioencephalic trauma expressed according to Marshall in relation to Rankin shows worse prognosis, without reaching statistical significance; the most frequent complication is pneumonia with a mortality of 45%; according to the type of crisis (non-convulsive) with a mortality of 53.8%; According to STESS, 57% of patients present an unfavorable prognosis. CONCLUSIONS: The Epileptic Status had a mortality of 50%, therefore the detection of risk predictors would allow an early intervention; considering that the progression of the neurological lesion increases in relation to the time of crisis, we recommend a management protocol according to our local reality, a comprehensive pharmacology analysis of the sedative and antiepileptic drugs most used in our service, accompanied by a bundle of indicators of systemic complications that allow us to avoid deleterious effects of the patient with epileptic status.