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18.04.2022 | Original work

Neurological Prognostication After Hypoglycemic Coma: Role of Clinical and EEG Findings

verfasst von: Douaae Bouyaknouden, Teja N. Peddada, Nidhi Ravishankar, Safoora Fatima, Joanna Fong-Isariyawongse, Emily J. Gilmore, Jong Woo Lee, Aaron F. Struck, Nicolas Gaspard, for the CCEMRC

Erschienen in: Neurocritical Care | Ausgabe 1/2022

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Abstract

Background

Hypoglycemic coma (HC) is an uncommon but severe clinical condition associated with poor neurological outcome. There is a dearth of robust neurological prognostic factors after HC. On the other hand, there is an increasing body of literature on reliable prognostic markers in the postanoxic coma, a similar—albeit not identical—situation. The objective of this study was thus to investigate the use and predictive value of these markers in HC.

Methods

We conducted a retrospective, multicenter, cohort study within five centers of the Critical Care EEG Monitoring Research Consortium. We queried our electroencephalography (EEG) databases to identify all patients undergoing continuous EEG monitoring after admission to an intensive care unit with HC (defined as Glasgow Coma Scale < 8 on admission and a first blood glucose level < 50 mg/dL or not documented but in an obvious clinical context) between 01/01/2010 and 12/31/2020. We studied the association of findings at neurological examination (Glasgow Coma Scale motor subscale, pupillary light and corneal reflexes) and at continuous EEG monitoring(highly malignant patterns, reactivity, periodic discharges, seizures) with best neurological outcome within 3 months after hospital discharge, defined by the Cerebral Performance Category as favorable (1–3: recovery of consciousness) versus unfavorable (4–5: lack of recovery of consciousness).

Results

We identified 60 patients (30 [50%] women; age 62 [51–72] years). Thirty-one and 29 patients had a favorable and unfavorable outcome, respectively. The presence of pupillary reflexes (24 [100%] vs. 17 [81%]; p value 0.04) and a motor subscore > 2 (22 [92%] vs. 12 [63%]; p value 0.03) at 48–72 h were associated with a favorable outcome. A highly malignant EEG pattern was observed in 7 of 29 (24%) patients with unfavorable outcome versus 0 of 31 (0%) with favorable outcome, whereas the presence of EEG reactivity was observed in 28 of 31 (90%) patients with favorable outcome versus 13 of 29 (45%) with unfavorable outcome (p < 0.001 for comparison of all background categories).

Conclusions

This preliminary study suggests that highly malignant EEG patterns might be reliable prognostic markers of unfavorable outcome after HC. Other EEG findings, including lack of EEG reactivity and seizures and clinical findings appear less accurate. These findings should be replicated in a larger multicenter prospective study.
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Metadaten
Titel
Neurological Prognostication After Hypoglycemic Coma: Role of Clinical and EEG Findings
verfasst von
Douaae Bouyaknouden
Teja N. Peddada
Nidhi Ravishankar
Safoora Fatima
Joanna Fong-Isariyawongse
Emily J. Gilmore
Jong Woo Lee
Aaron F. Struck
Nicolas Gaspard
for the CCEMRC
Publikationsdatum
18.04.2022
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 1/2022
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-022-01495-2

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