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Hospital Mortality in Primary Admissions of Septic Patients With Status Epilepticus in the United States*

Urtecho, Jacqueline MD1,2; Snapp, Meredith MD1; Sperling, Michael MD1; Maltenfort, Mitchell PhD5; Vibbert, Matthew MD1,2; Athar, M. Kamran MD2,3; McBride, William MD1,4; Moussouttas, Michael MD1,4; Bell, Rodney MD1,2,4; Jallo, Jack MD, PhD, FACS2; Rincon, Fred MD, MSc, MBE, FACP, FCCP, FCCM1,2

doi: 10.1097/CCM.0b013e31828a3994
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Objective: To determine the prevalence of status epilepticus, associated factors, and relationship with in-hospital mortality in primary admissions of septic patients in the United States.

Design: Cross-sectional study.

Setting: Primary admissions of adult patients more than 18 years old with a diagnosis of sepsis and status epilepticus from 1988 to 2008 identified through the Nationwide Inpatient Sample.

Participants: A total of 7,669,125 primary admissions of patients with sepsis.

Interventions: None.

Results: During the 21-year study period, the prevalence of status epilepticus in primary admissions of septic patients increased from 0.1% in 1988 to 0.2% in 2008 (p < 0.001). Status epilepticus was also more common among later years, younger admissions, female gender, Black race, rural hospital admissions, and in those patients with organ dysfunctions. Mortality of primary sepsis admissions decreased from 20% in 1988 to 18% in 2008 (p < 0.001). Mortality in status epilepticus during sepsis decreased from 43% in 1988 to 28% in 2008. In-hospital mortality after admissions for sepsis was associated with status epilepticus, older age, and Black and Native American/Eskimo race; patients admitted to a rural or urban private hospitals; and patients with organ dysfunctions.

Conclusion: Our analysis demonstrates that status epilepticus after admission for sepsis in the United States was rare. Despite an overall significant reduction in mortality after admission for sepsis, status epilepticus carried a higher risk of death. More aggressive electrophysiological monitoring and a high level of suspicion for the diagnosis of status epilepticus may be indicated in those patients with central nervous system organ dysfunction after sepsis.

1Division of Critical Care and Neurotrauma, Department of Neurology, Thomas Jefferson University, Philadelphia, PA.

2Division of Critical Care and Neurotrauma, Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.

3Department of Medicine, Thomas Jefferson University, Philadelphia, PA.

4Division of Cerebrovascular Diseases, Thomas Jefferson University, Philadelphia, PA.

5Division of Biostatistics, The Rothman Institute, Philadelphia, PA.

*See also p. 2033.

Drs. Urtecho, Snapp, Maltenfort, and Rincon had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Drs. Maltenfort and Rincon involved in statistical analysis. Drs. Urtecho, Snapp, Sperling, Moussouttas, and Rincon contributed for analysis and interpretation. Drs. Urtecho, Snapp, Sperling, Maltenfort, Vibbert, Athar, McBride, Moussouttas, Bell, Jallo and Rincon drafted the manuscript for important intellectual content. Drs. Bell, Jallo, and Rincon provided administrative, technical, or material support. Drs. Sperling and Rincon involved in study supervision. Drs. Urtecho, Snapp, Sperling, Maltenfort, and Rincon helped in conception and design. Drs. Urtecho, Snapp, Moussouttas, and Rincon involved in acquisition of data.

Dr. Rincon has received salary support from the American Heart Association (AHA 12CRP12050342).

Dr. Snapp is employed by the Thomas Jefferson University Hospital. Dr. Sperling received grant support from the National Institutes of Health (studies of cognition using intracranial EEG). Dr. Sperling is a board member with the Epilepsy Foundation of Eastern Pennsylvania (volunteer no payment) and consults for Upsher-Smith, Sunovion (Consultant for trial design for investigational antiepileptic drug). Dr. Bell provided expert testimony for the US Government-Defense of the Government. Dr. Bell lectured for Medicines (hypertension in the ICU). Dr. Rincon received grant support from the American Heart Association. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Fred Rincon, MD, MBE, Division of Critical Care and Neurotrauma, Department of Neurological Surgery, Thomas Jefferson University and Jefferson College of Medicine, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107. E-mail: fred.rincon@jefferson.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins