Yoğun bakım hastalarına ait rutin EEG sonuçlarının prognostik değeri
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Tarih
2025
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Prognozu öngörmek, etkin bir tedavi planı yapabilmek, hasta ve hasta yakını ile daha doğru bir iletişim kurabilmek için önemlidir. EEG incelemesi de çeşitli faktörler ile birlikte değerlendirildiğinde prognoz hakkında değerli bilgiler sunmaktadır. Çalışmamızın birincil amacı yoğun bakım ünitelerinde (YBÜ) takipli hastalara ait rutin EEG’lerde elde edilen bulgulardan prognoz üzerinde bağımsız risk faktörü olanların belirlenmesidir. İkincil amaç ise prognoz açısından bağımsız risk faktörü olan EEG bulguları ile klinik, laboratuvar ve görüntüleme yöntemlerinin ilişkisini değerlendirmektir.
Metod: Çalışmamızda hastanemiz EEG laboratuvarında çekilmiş olan yoğun bakım hastalarına ait EEG traseleri ve bu hastaların klinik, radyolojik ve laboratuvar bulguları retrospektif olarak değerlendirilmiştir. Çalışmaya 18 yaş üstünde, herhangi bir nedenle yoğun bakım takibi ve tedavisi gereken ve herhangi bir ön tanı nedeniyle rutin EEG çekilen tüm hastalar dahil edilmiştir. Elde edilen EEG bulgularından prognoz açısından bağımsız risk faktörü olanlar belirlenerek istatistiksel olarak incelenmiştir.
Bulgular: Çalışmaya YBÜ’lerde takip edilen ve rutin EEG’leri çekilen 203 hastaya ait veriler dahil edilmiştir. Hastaların 91’i (%44,8) kadın, 112’si (%55,2) erkek olup yaş ortalaması 61,62±18,712 olarak bulunmuştur. Anormal EEG varlığı, trifazik dalga paterni, diffüz serebral disfonksiyon (DSD) ve elektrofizyolojik sessizlik ile mortalite arasında anlamlı ilişki olduğu gösterilmiştir. Lateralize periyodik deşarjların (LPDs) sağkalım üzerinde anlamlı koruyucu etkiye sahip olduğu görülmüştür. Kalsiyum, hemoglobin ve kan şekeri mortalite için anlamlı risk faktörleri olarak elde edilmiştir. Nötrofil/lenfosit oranı (NLO), sistemik immün inflamatuvar indeks (SII) mortalite riskini arttıran bağımsız bir risk faktörü olarak bulunmuştur. YBÜ’de nöbet geçirmiş olmanın mortaliteyi arttırdığı tespit edilmiştir. Tüm değişkenlerin ortak etkisini değerlendiren Enter metodunda mortalite için anlamlı olan invaziv solunum desteğinin bu etkisinin anlamsız etkenlerin elenerek en anlamlı modelin oluşturulduğu Wald metodunda anlamını yitirdiği görülmüştür. Cox regresyon analizinde tüm değişkenler tek tek incelendiğinde Glaskow Koma Skalası (GKS) skorunun mortalite üzerinde anlamlı etkisi saptanmamıştır.
Sonuç: Çalışmamızda literatür ile benzer şekilde anormal EEG varlığı, trifazik dalga paterni, DSD ve elektrofizyolojik sessizlik ile mortalite arasında anlamlı bir ilişki olduğu görülmüştür. Ancak literatürün aksine LPDs’nin sağkalım üzerinde anlamlı koruyucu bir etkisi olduğu bulunmuştur. Bu bulgu, LPDs’e sahip bir beyinde epileptogenezis olsa dahi reaktivitenin hala devam ettiği, yaygın beyin hasarına yol açmadığı için yaşam süresi üzerinde koruyucu etkiye sahip olduğu yönünde yorumlanmıştır. Laboratuvar parametrelerinin ve tedavilerin etkisi incelendiğinde ise belirli eşik değerleri ve/veya diğer faktörler ile birlikte değerlendirilmeleri gerektiği tespit edilmiştir. Elde edilen bu bulgular, EEG paternlerinin ve beraberindeki klinik/laboratuvar parametrelerinin, özellikle YBÜ’de takip edilen kritik hastalarda erken dönem prognoz ve mortalitenin tahmin edilmesinde değerli biyobelirteçler olabileceğini göstermektedir.
Background: It is important to predict the prognosis, to make an effective treatment plan and to establish a more accurate communication with the patient and the patient's relatives. EEG examination provides valuable information about prognosis when evaluated together with various factors. The primary aim of our study was to determine the findings obtained from routine EEGs of patients followed up in intensive care units (ICU), which have independent risk factors on prognosis. The secondary aim was to evaluate the relationship between EEG findings, which are independent risk factors for prognosis, and clinical, laboratory and imaging methods. Method: In our study, EEG tracings of intensive care unit patients and their clinical, radiological and laboratory findings were retrospectively evaluated. All patients over the age of 18 years, who required intensive care follow-up and treatment for any reason and who underwent routine EEG for any prediagnosis were included in the study. Among the EEG findings, those with independent risk factors for prognosis were determined and analysed statistically. Results: Data of 203 patients who were followed up in ICUs and had routine EEGs were included in the study. Of the patients, 91 (44.8%) were female and 112 (55.2%) were male with a mean age of 61.62±18.712 years. The presence of abnormal EEG, triphasic wave pattern, diffuse cerebral dysfunction (DSD) and electrophysiological silence have been shown to be significantly associated with mortality. Lateralised periodic discharges (LPDs) were found to have a significant protective effect on survival. Calcium, haemoglobin and blood glucose were found to be significant risk factors for mortality. Neutrophil/lymphocyte ratio (NLR), systemic immune inflammatory index (SII) was found to be an independent risk factor increasing the risk of mortality. Having a seizure in the ICU was found to increase mortality. It was observed that this effect of invasive respiratory support, which was significant for mortality in the Enter method, which evaluated the joint effect of all variables,lost its significance in the Wald method, in which the most significant model was created by eliminating meaningless factors. When all variables were analysed individually in Cox regression analysis, no significant effect of Glasgow Coma Scale (GCS) score on mortality was found. Conclusion: In our study, similar to the literature, there was a significant relationship between the presence of abnormal EEG, triphasic wave pattern, DSD and electrophysiological silence and mortality. However, contrary to the literature, LPDs were found to have a significant protective effect on survival. This finding was interpreted that even if epileptogenesis occurs in a brain with LPDs, reactivity still persists and does not lead to widespread brain damage and thus has a protective effect on survival. When the effects of laboratory parameters and treatments were analysed, it was determined that they should be evaluated with certain threshold values and/or other factors. These findings suggest that EEG patterns and accompanying clinical/laboratory parameters may be valuable biomarkers in predicting early prognosis and mortality, especially in critically ill patients followed up in the ICU.
Background: It is important to predict the prognosis, to make an effective treatment plan and to establish a more accurate communication with the patient and the patient's relatives. EEG examination provides valuable information about prognosis when evaluated together with various factors. The primary aim of our study was to determine the findings obtained from routine EEGs of patients followed up in intensive care units (ICU), which have independent risk factors on prognosis. The secondary aim was to evaluate the relationship between EEG findings, which are independent risk factors for prognosis, and clinical, laboratory and imaging methods. Method: In our study, EEG tracings of intensive care unit patients and their clinical, radiological and laboratory findings were retrospectively evaluated. All patients over the age of 18 years, who required intensive care follow-up and treatment for any reason and who underwent routine EEG for any prediagnosis were included in the study. Among the EEG findings, those with independent risk factors for prognosis were determined and analysed statistically. Results: Data of 203 patients who were followed up in ICUs and had routine EEGs were included in the study. Of the patients, 91 (44.8%) were female and 112 (55.2%) were male with a mean age of 61.62±18.712 years. The presence of abnormal EEG, triphasic wave pattern, diffuse cerebral dysfunction (DSD) and electrophysiological silence have been shown to be significantly associated with mortality. Lateralised periodic discharges (LPDs) were found to have a significant protective effect on survival. Calcium, haemoglobin and blood glucose were found to be significant risk factors for mortality. Neutrophil/lymphocyte ratio (NLR), systemic immune inflammatory index (SII) was found to be an independent risk factor increasing the risk of mortality. Having a seizure in the ICU was found to increase mortality. It was observed that this effect of invasive respiratory support, which was significant for mortality in the Enter method, which evaluated the joint effect of all variables,lost its significance in the Wald method, in which the most significant model was created by eliminating meaningless factors. When all variables were analysed individually in Cox regression analysis, no significant effect of Glasgow Coma Scale (GCS) score on mortality was found. Conclusion: In our study, similar to the literature, there was a significant relationship between the presence of abnormal EEG, triphasic wave pattern, DSD and electrophysiological silence and mortality. However, contrary to the literature, LPDs were found to have a significant protective effect on survival. This finding was interpreted that even if epileptogenesis occurs in a brain with LPDs, reactivity still persists and does not lead to widespread brain damage and thus has a protective effect on survival. When the effects of laboratory parameters and treatments were analysed, it was determined that they should be evaluated with certain threshold values and/or other factors. These findings suggest that EEG patterns and accompanying clinical/laboratory parameters may be valuable biomarkers in predicting early prognosis and mortality, especially in critically ill patients followed up in the ICU.
Açıklama
Anahtar Kelimeler
Elektroensefalografi, Electroencephalography, yoğun bakım, intensive care, bilinç bulanıklığı, confusion, prognoz, prognosis, mortalite, mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Yıldırım, B. Y. (2025). Yoğun bakım hastalarına ait rutin EEG sonuçlarının prognostik değeri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Nöroloji Anabilim Dalı, Konya.
