Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation

Critical Care

Research

Paulina S. C. Kliem¹  Pascale Grzonka¹  Sira M. Baumann¹  Caroline E. Gebhard²  Raoul Sutter³  Sabina Hunziker⁴  Stephan Marsch⁵  Stephan Rüegg⁶  Gian Marco De Marchis⁷  Margitta Seeck⁸  Andreas Kleinschmidt⁸  Pia De Stefano⁹  Oana E. Sarbu⁹  Jérôme Pugin^1,10  Hervé Quintard^1,10 

[1] Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland;Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland;Department of Clinical Research, University of Basel, Basel, Switzerland;Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland;Department of Neurology, University Hospital Basel, Basel, Switzerland;Medical Faculty of the University of Basel, Basel, Switzerland;Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland;Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland;Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland;Department of Clinical Research, University of Basel, Basel, Switzerland;Clinic for Intensive Care Medicine, Department of Acute Care, University Hospital Basel, Basel, Switzerland;Medical Faculty of the University of Basel, Basel, Switzerland;Department of Neurology, University Hospital Basel, Basel, Switzerland;Medical Faculty of the University of Basel, Basel, Switzerland;Department of Neurology, University Hospital Basel, Basel, Switzerland;Medical Faculty of the University of Basel, Basel, Switzerland;Department of Clinical Research, University of Basel, Basel, Switzerland;EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland;Medical Faculty of the University of Geneva, Geneva, Switzerland;Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland;EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland;Neuro-Intensive Care Unit, Department of Intensive Care, University Hospital of Geneva, Geneva, Switzerland;Medical Faculty of the University of Geneva, Geneva, Switzerland;

关键词: Status epilepticus;    Sex;    Neurocritical care;   

DOI  :  10.1186/s13054-023-04592-6

 received in 2023-06-26, accepted in 2023-07-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundConflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers.MethodsIn this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women.ResultsAmong 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004).ConclusionsThis study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

40517_2023_261_Article_IEq40.gif

Fig. 1

40517_2023_261_Article_IEq35.gif

Fig. 2