Table 1.
Clinical, laboratory and EEG variables associated with periodic discharges
| Total (n = 92) | Periodic discharges | p | Multivariate analysis | ||||
|---|---|---|---|---|---|---|---|
| Absent (n = 69) | Present (n = 23) | p | OR | IC 95% | |||
| Age. years | 65 [55.8–73.3] | 66 [59–74] | 62 [50–73] | 0.46 | – | ||
| Female | 30 (33%) | 17 (25%) | 13 (57%) | 0.005 | 0.006 | 4.2 | [1.50–11.82] |
| Sepsis origin | |||||||
| Abdominal | 37 (40%) | 30 (43%) | 7 (30%) | 0.48 | – | ||
| Respiratory | 27 (29%) | 19 (28%) | 8 (35%) | – | |||
| Urinary | 10 (11%) | 8 (12%) | 2 (9%) | – | |||
| Soft tissue | 9 (10%) | 7 (10%) | 2 (9%) | – | |||
| Unknown | 5 (5%) | 2 (3%) | 3 (13%) | – | |||
| Other | 4 (4%) | 3 (4%) | 1 (4%) | – | |||
| Septic shock | 42 (47%) | 30 (43%) | 12 (53%) | 0.47 | |||
| APACHE II | 22 [16–29] | 21 [16–26.5] | 27 [21–31] | 0.049 | 0.021 | 1.07 | [1.01–1.14] |
| Non-neuro APACHE II | 18 [11–24] | 18 [12–23] | 19 [12–26] | 0.46 | – | ||
| CRS-R | 18 [2–23] | 22 [6–23] | 5 [0–7] | < 0.001 | – | ||
| Sepsis-associated encephalopathy | 66 (72%) | 44 (64%) | 22 (96%) | 0.003 | – | ||
| GCS | 14 [6–15] | 14 [10–15] | 7 [3–13] | < 0.001 | – | ||
| CAM-ICU+ | 29/70 (41%) | 21/58 (36%) | 8/12 (67%) | 0.051 | – | ||
| RASS < − 3 | 22 (24%) | 11 (16%) | 11 (48%) | 0.002 | – | ||
| Sedation during EEG | 30 (33%) | 17 (25%) | 13 (57%) | 0.006 | – | ||
| Propofol dose (mg/kg/day) | 20 [14.5–35.5] | 15 [4.5–20] | 39 [33–53] | < 0.001 | – | ||
| Propofol duration (days) | 2 [1–4] | 1 [1–2] | 5 [3–6.3] | < 0.001 | – | ||
| Mdz dose (mg/kg/day) | 0.35 [0.1–0.7] | 0.5 [0.2–0.6] | 0.3 [0.1–0.7] | 0.78 | – | ||
| Mdz duration (days) | 2 [1–3] | 2 [1.3–2.8] | 2 [1–3] | 0.96 | – | ||
| Dxd dose (mcg/kg/day) | 7.5 [6.3–12.3] | 7.1 [5.5–7.5] | 25.4 [na] | 0.5 | – | ||
| Dxd duration (days) | 2 [1.8–2.5] | 2 [2–3] | 1 [na] | 0.35 | – | ||
| ICU length stay (days) | 3 [2–5] | 3 [2–4] | 4 [2.5–6] | 0.063 | – | ||
| Duration of cEEG (h) | 70.5 [25–141] | 66 [22–96] | 128 [93.5–169] | < 0.001 | – | ||
| Mechanical ventilation | 64 (70%) | 44 (64%) | 20 (87%) | 0.036 | – | ||
| Pa/Fio2 | 227 [162–184] | 225 [158–283] | 230 [167–301] | 0.52 | – | ||
| Vasoactive drugs | 76 (83%) | 55 (80%) | 21 (91%) | 0.2 | – | ||
| Temperature (°C) | 37.5 [37.1–38] | 37.2 [36.6–37.9] | 37.2 [37.1–37.6] | 0.15 | – | ||
| Laboratory variables | |||||||
| WBC | 18.5 [13.3–26.8] | 15 [10.4–23.2] | 15.9 [12.3–24.6] | 0.62 | – | ||
| Creatinine | 1.5 [1.04–3.06] | 1.4 [0.96–2.4] | 1.76 [1.4–4] | 0.15 | – | ||
| Bilirubin | 1.05 [0.56–1.7] | 0.9 [0.46–1.4] | 0.73 [0.5–1.3] | 0.16 | – | ||
| NSE | 18.8 [13.9–30.5] | 16 [13.5–25.3] | 21.6 [13.9–30.4] | 0.36 | – | ||
| Na+ | 137 [135–139] | 137 [135–139] | 136 [135–138] | 0.46 | – | ||
| NH4+ | 78 [68–93] | 71 [64–121] | 85 [68–87] | 0.93 | – | ||
| PaCO2 | 34 [30–38] | 34 [30–37] | 34 [32–38] | 0.62 | – | ||
| Acute liver injury | 26 (28%) | 20 (29%) | 6 (26%) | 0.79 | – | ||
| Acute kidney injury | 63 (68%) | 47 (68%) | 16 (70%) | 0.89 | – | ||
| Chronic kidney injury | 10 (11%) | 5 (7%) | 5 (22%) | 0.053 | – | ||
| Antibiotics | |||||||
| Beta-lactams | 78 (85%) | 59 (85%) | 19 (83%) | 0.74 | – | ||
| Cephalosporin | 20 (22%) | 14 (20%) | 6 (26%) | 0.56 | – | ||
| Metronidazole | 14 (15%) | 10 (14%) | 4 (17%) | 0.74 | – | ||
| Other | 35 (38%) | 24 (35%) | 11 (45%) | 0.26 | – | ||
Data are presented as median [interquartile range] or count (percentage)
APACHE-II Acute physiological and chronic health evaluation, CRS-R The Coma Recovery Scale-Revised, Pa/FiO2 Ratio of arterial oxygen partial pressure to fractional inspired oxygen, CAM-ICU The Confusion Assessment Method for the ICU, considered as positive if patients presented with delirium and RASS > -4, RASS Richmond agitation sedation scale, Mdz Midazolam, Dxd Dexmedetomidine, ICU Intensive care unit, (c)EEG (Continuous) electroencephalogram, T° Body temperature, WBC White blood cells count, NSE Neuron-specific enolase, NH4 Ammonemia in µg/dL, PDs Periodic discharges, RDA Rhythmic delta activity, PDR Posterior dominant rhythm. Mann–Whitney, Fisher’s exact and χ2 tests were used to analyze differences in variables between groups, as appropriate. p < 0.05 was considered statistically significant and marked in bold in the table. For the T° and the other laboratories variables (WBC, creatinine, bilirubin, NSE), the highest value during the ICU period was considered. For the definition of acute/chronic liver/kidney injury, please refer to the text