Anesthetics and Outcome in Status Epilepticus

A Matched Two-Center Cohort Study

Raoul Sutter, Gian Marco de Marchis, Saskia Semmlack, Peter Fuhr, Stephan Rüegg, Stephan Marsch, Wendy C Ziai, Peter W Kaplan

Research output: Contribution to journalArticle

Abstract

Background: The use of anesthetics has been linked to poor outcome in patients with status epilepticus (SE). This association, however, may be confounded, as anesthetics are mostly administered in patients with more severe SE and critical illnesses. Objective: To minimize treatment-selection bias, we assessed the association between continuously administered intravenous anesthetic drugs (IVADs) and outcome in SE patients by a matched two-center study design. Methods: This cohort study was performed at the Johns Hopkins Bayview Medical Center, Baltimore, MD, USA and the University Hospital Basel, Basel, Switzerland. All consecutive adult SE patients from 2005 to 2013 were included. Odds ratios (ORs) for death and unfavorable outcome (Glasgow Outcome Score [GOS] 1–3) associated with administration of IVADs were calculated. To account for confounding by known outcome determinants (age, level of consciousness, worst seizure type, acute/fatal etiology, mechanical ventilation, and SE duration), propensity score matching and coarsened exact matching were performed in addition to multivariable regression models. Results: Among 406 consecutive patients, 139 (34.2%) were treated with IVADs. Logistic regression analyses of the unmatched and matched cohorts revealed increased odds for death and unfavorable outcome in survivors who had received IVADs (unmatched: ORdeath = 3.13, 95% confidence interval [CI] 1.47–6.60 and ORGOS1–3 = 2.51, 95% CI 1.37–4.60; propensity score matched: ORdeath = 3.29, 95% CI 1.35–8.05 and ORGOS1–3 = 2.27, 95% CI 1.02–5.06; coarsened exact matched: ORdeath = 2.19, 95% CI 1.27–3.78 and ORGOS1–3 = 3.94, 95% CI 2.12–7.32). Conclusion: The use of IVADs in SE is associated with death and unfavorable outcome in survivors independent of known confounders and using different statistical approaches. Randomized trials are needed to determine if these associations are biased by outcome predictors not yet identified and hence not accounted for in this study.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalCNS Drugs
DOIs
StateAccepted/In press - Nov 29 2016

Fingerprint

Status Epilepticus
Intravenous Anesthetics
Anesthetics
Cohort Studies
Confidence Intervals
Propensity Score
Survivors
Baltimore
Selection Bias
Consciousness
Switzerland
Artificial Respiration
Critical Illness
Seizures
Logistic Models
Odds Ratio
Regression Analysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Sutter, R., de Marchis, G. M., Semmlack, S., Fuhr, P., Rüegg, S., Marsch, S., ... Kaplan, P. W. (Accepted/In press). Anesthetics and Outcome in Status Epilepticus: A Matched Two-Center Cohort Study. CNS Drugs, 1-10. https://doi.org/10.1007/s40263-016-0389-5

Anesthetics and Outcome in Status Epilepticus : A Matched Two-Center Cohort Study. / Sutter, Raoul; de Marchis, Gian Marco; Semmlack, Saskia; Fuhr, Peter; Rüegg, Stephan; Marsch, Stephan; Ziai, Wendy C; Kaplan, Peter W.

In: CNS Drugs, 29.11.2016, p. 1-10.

Research output: Contribution to journalArticle

Sutter R, de Marchis GM, Semmlack S, Fuhr P, Rüegg S, Marsch S et al. Anesthetics and Outcome in Status Epilepticus: A Matched Two-Center Cohort Study. CNS Drugs. 2016 Nov 29;1-10. https://doi.org/10.1007/s40263-016-0389-5
Sutter, Raoul ; de Marchis, Gian Marco ; Semmlack, Saskia ; Fuhr, Peter ; Rüegg, Stephan ; Marsch, Stephan ; Ziai, Wendy C ; Kaplan, Peter W. / Anesthetics and Outcome in Status Epilepticus : A Matched Two-Center Cohort Study. In: CNS Drugs. 2016 ; pp. 1-10.
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title = "Anesthetics and Outcome in Status Epilepticus: A Matched Two-Center Cohort Study",
abstract = "Background: The use of anesthetics has been linked to poor outcome in patients with status epilepticus (SE). This association, however, may be confounded, as anesthetics are mostly administered in patients with more severe SE and critical illnesses. Objective: To minimize treatment-selection bias, we assessed the association between continuously administered intravenous anesthetic drugs (IVADs) and outcome in SE patients by a matched two-center study design. Methods: This cohort study was performed at the Johns Hopkins Bayview Medical Center, Baltimore, MD, USA and the University Hospital Basel, Basel, Switzerland. All consecutive adult SE patients from 2005 to 2013 were included. Odds ratios (ORs) for death and unfavorable outcome (Glasgow Outcome Score [GOS] 1–3) associated with administration of IVADs were calculated. To account for confounding by known outcome determinants (age, level of consciousness, worst seizure type, acute/fatal etiology, mechanical ventilation, and SE duration), propensity score matching and coarsened exact matching were performed in addition to multivariable regression models. Results: Among 406 consecutive patients, 139 (34.2{\%}) were treated with IVADs. Logistic regression analyses of the unmatched and matched cohorts revealed increased odds for death and unfavorable outcome in survivors who had received IVADs (unmatched: ORdeath = 3.13, 95{\%} confidence interval [CI] 1.47–6.60 and ORGOS1–3 = 2.51, 95{\%} CI 1.37–4.60; propensity score matched: ORdeath = 3.29, 95{\%} CI 1.35–8.05 and ORGOS1–3 = 2.27, 95{\%} CI 1.02–5.06; coarsened exact matched: ORdeath = 2.19, 95{\%} CI 1.27–3.78 and ORGOS1–3 = 3.94, 95{\%} CI 2.12–7.32). Conclusion: The use of IVADs in SE is associated with death and unfavorable outcome in survivors independent of known confounders and using different statistical approaches. Randomized trials are needed to determine if these associations are biased by outcome predictors not yet identified and hence not accounted for in this study.",
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AU - Sutter, Raoul

AU - de Marchis, Gian Marco

AU - Semmlack, Saskia

AU - Fuhr, Peter

AU - Rüegg, Stephan

AU - Marsch, Stephan

AU - Ziai, Wendy C

AU - Kaplan, Peter W

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N2 - Background: The use of anesthetics has been linked to poor outcome in patients with status epilepticus (SE). This association, however, may be confounded, as anesthetics are mostly administered in patients with more severe SE and critical illnesses. Objective: To minimize treatment-selection bias, we assessed the association between continuously administered intravenous anesthetic drugs (IVADs) and outcome in SE patients by a matched two-center study design. Methods: This cohort study was performed at the Johns Hopkins Bayview Medical Center, Baltimore, MD, USA and the University Hospital Basel, Basel, Switzerland. All consecutive adult SE patients from 2005 to 2013 were included. Odds ratios (ORs) for death and unfavorable outcome (Glasgow Outcome Score [GOS] 1–3) associated with administration of IVADs were calculated. To account for confounding by known outcome determinants (age, level of consciousness, worst seizure type, acute/fatal etiology, mechanical ventilation, and SE duration), propensity score matching and coarsened exact matching were performed in addition to multivariable regression models. Results: Among 406 consecutive patients, 139 (34.2%) were treated with IVADs. Logistic regression analyses of the unmatched and matched cohorts revealed increased odds for death and unfavorable outcome in survivors who had received IVADs (unmatched: ORdeath = 3.13, 95% confidence interval [CI] 1.47–6.60 and ORGOS1–3 = 2.51, 95% CI 1.37–4.60; propensity score matched: ORdeath = 3.29, 95% CI 1.35–8.05 and ORGOS1–3 = 2.27, 95% CI 1.02–5.06; coarsened exact matched: ORdeath = 2.19, 95% CI 1.27–3.78 and ORGOS1–3 = 3.94, 95% CI 2.12–7.32). Conclusion: The use of IVADs in SE is associated with death and unfavorable outcome in survivors independent of known confounders and using different statistical approaches. Randomized trials are needed to determine if these associations are biased by outcome predictors not yet identified and hence not accounted for in this study.

AB - Background: The use of anesthetics has been linked to poor outcome in patients with status epilepticus (SE). This association, however, may be confounded, as anesthetics are mostly administered in patients with more severe SE and critical illnesses. Objective: To minimize treatment-selection bias, we assessed the association between continuously administered intravenous anesthetic drugs (IVADs) and outcome in SE patients by a matched two-center study design. Methods: This cohort study was performed at the Johns Hopkins Bayview Medical Center, Baltimore, MD, USA and the University Hospital Basel, Basel, Switzerland. All consecutive adult SE patients from 2005 to 2013 were included. Odds ratios (ORs) for death and unfavorable outcome (Glasgow Outcome Score [GOS] 1–3) associated with administration of IVADs were calculated. To account for confounding by known outcome determinants (age, level of consciousness, worst seizure type, acute/fatal etiology, mechanical ventilation, and SE duration), propensity score matching and coarsened exact matching were performed in addition to multivariable regression models. Results: Among 406 consecutive patients, 139 (34.2%) were treated with IVADs. Logistic regression analyses of the unmatched and matched cohorts revealed increased odds for death and unfavorable outcome in survivors who had received IVADs (unmatched: ORdeath = 3.13, 95% confidence interval [CI] 1.47–6.60 and ORGOS1–3 = 2.51, 95% CI 1.37–4.60; propensity score matched: ORdeath = 3.29, 95% CI 1.35–8.05 and ORGOS1–3 = 2.27, 95% CI 1.02–5.06; coarsened exact matched: ORdeath = 2.19, 95% CI 1.27–3.78 and ORGOS1–3 = 3.94, 95% CI 2.12–7.32). Conclusion: The use of IVADs in SE is associated with death and unfavorable outcome in survivors independent of known confounders and using different statistical approaches. Randomized trials are needed to determine if these associations are biased by outcome predictors not yet identified and hence not accounted for in this study.

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