Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Mortality

 

Hipernatremia como factor pronóstico de mortalidad en trauma encefalocraneano severo. Hypernatremia as a prognostic factor of mortality in patients with severe traumatic brain injury

Background: A severe traumatic brain injury is a frequent pathology, it implies a non-negligible morbidity and mortality. Hypernatremia could be considered a factor associated with poor prognosis in order to optimize treatment in the group of high-risk patients. We aim to determine if hypernatremia is a prognostic factor of mortality in patients with severe traumatic brain injury in a public hospital which is a local reference center in trauma.

Material and Methods: We performed a non-probabilistic sampling of adult patients of both sexes with severe traumatic brain injury from the Intensive Care Unit of the Hospital Regional Docente de Trujillo, Perú during the 2015–2018 period.

Results: Mortality in the group with and without hypernatremia was 38% and 6% respectively (p=0.001). The difference in natremia mean values between the group with and without mortality was 21,86 (95% CI 18.2-25.5) (p=0.000). In the multivariate analysis, we found hypernatremia with adjusted OR of 16.73 (95% CI 1.96-142.82) (p=0.01). The ROC curve showed adequate performance to predict mortality, with an AUC 0.878 (95% CI 0.77-0.97) (p=0.00).

Conclusion: Hypernatremia is a prognostic factor of mortality in patients with severe traumatic brain injury.

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Palabras clave: Hipernatremia, Mortalidad, trauma encefalocraneano severo,

Keywords: Hypernatremia, Mortality, severe traumatic brain injury,

Evaluación de la Utilidad de las Escalas Pronósticas del Status Epiléptico Convulsivo en el Status Epiléptico no Convulsivo. Usefulness Of Status Convulsive Score In Prognosis Of Non-Convulsive Status Epilepticus

Introduction: The Non-Convulsive Status Epilepticus (NCSE) is a rare clinical entity. As of today, a predictive mortality scale has not been developed. Moreover, the risk factors that contribute to the prognosis have not been clearly defined. The aim of this study was to evaluate the usefulness of the prognostic scores for status epilepticus (SE): the epileptic status severity score (STESS), the modified RANKIN scale STESS (mRSTESS) and the epileptic status mortality score based on epidemiology (EMSE-EACEG) applied in patients diagnosed with NCSE.

Results: The sample analyzed for this study consisted of 66 patients with an average age of 59 years (SD 18.5).

The STESS and mRSTESS were significantly associated with higher odds for poor prognosis at the time of discharge in patients with NCSE (p<0.05 and p<0.05, respectively). However, none of the three was associated with mortality.

Conclusion: Considering that the scores used to predict prognosis in patients with SE have not shown equal diagnostic accuracy in the NCSE, we believe that a validated predictive scale of morbidity and mortality would be of great help for these patients.

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Palabras clave: Mortalidad, Pronóstico, Status epiléptico no convulsivo,

Keywords: Mortality, Non convulsive status epilepticus, Prognosis,

Meningitis Criptocócica. Diferentes Contextos Clínicos y Complicaciones. Serie de 7 Casos. Cryptococal Meningitis. Different Clinical Context And Complications. Seven Cases.

Introduction. Cryptococcal meningitis (CM) is a serious infection of the Central Nervous System. The diagnosis and treatment of these patients is often complex, due to the severity of the clinical manifestations and their complications. The aim of this study is to describe the different clinical contexts, the neuroradiological characteristics and the complications of patients with CM.

Patients. We performed a retrospective review of clinical and radiological factors of 7 patient’s diagnosis and treated with CM during the period October 2016 and September 2017, at the Eugenio Espejo Hospital.

Results. Male sex was predominant (6/7), with an average age of 31.6 years (Range 19-44). The average time for the diagnosis was 8.1 weeks. Immunosuppression causes were evidenced in 5 patients, two HIV positive, one case with Acute Lymphoblastic Leukemia, CD4 idiopathic lymphopenia and Primary Intestinal Linfagectasia respectively. Three patients developed complications as disseminated cryptococcosis, visual acuity and hearing loss, mortality rate reach 26.8% of patients. Hypoglycorrhachia was a relevant feature with average 12.7mmg / dl. In MRI, the most common lesion was dilatation of Virchow Robins spaces (5/7), followed by ischemic lesions.

Conclusions. CM is characterized for high morbidity and mortality, initial symptoms may be nonspecific and delays the diagnosis as well as initiation of antifungal agents. Several predisposing immunosuppressive conditions can be found and sometimes a diagnostic challenge.

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Palabras clave: comorbilidades, complicaciones, Criptococo Neoformans, meningitis, Meningitis Criptocócica, Mortalidad, resonancia magnética,

Keywords: comorbidities, complication, Cryptococcal meningitis, Cryptococcal Neoformans, Magnetic Resonance Image, meningitis, Mortality,

Estatus Epiléptico. Factores Asociados a Una Evolución Desfavorable en un Centro Terciario. Status Epilepticus. Prognostic Variables For An Unfavorable Outcome In A Tertiary Center Of Care.

Introduction. Status Epilepticus (SE) is a frequent neurologic emergency. Little research has been done in South America to evaluate the prognostic variables of mortality and disability in patients with SE. Objective. To determine the variables associated to an unfavorable outcome at hospital discharge in the patients who were treated for SE. Methods. A retrospective study was performed during the period of January 2016–June 2017. A total of 26 patients were diagnosed of SE and its different variants. The effects of clinical, radiological, and electroencephalographic features on hospital outcome according Rankin scale were evaluated  Results. Twelve (46.2%) patients had an unfavorable outcome at hospital discharge, while the mortality rate reached 23.1%. There was a predominance of males with a 76.9% of all the patients. The independent variables associated with an unfavorable outcome were the number of comorbidities (p=0.01, OR: 4.27-95%CI1.33-13.6), structural lesions on the Magnetic Resonance Image (MRI) (p=0.04, OR: 3.92-95%CI1.05-14.61) and refractory SE (p=0.01, OR: 12.52-95%CI1.85-84.44). There was also a trend for age (p=0.07 OR: 1.03-95%CI0.99-1.07). While an initial good clinical condition, according to the Glasgow Scale represent a protective factor (p=0.00 OR: 0.49-IC95% 0.29-0.84) of an unfavorable outcome. Conclusions. The unfavorable outcome was marginally associated with patient age, clinical status at the onset of SE according to the Glasgow Coma Scale, as well as brain lesions on brain MRI. Refractory SE and more than 4 comorbidities are predictors of an unfavorable outcome at hospital discharge.

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Palabras clave: Discapacidad, Epilepsia, Estatus epiléptico, Estatus Epiléptico refractario, Mortalidad,

Keywords: Disability, Epilepsy, Mortality, outcome, Refractory status Epilepticus, Status Epilepticus,

Mortalidad por enfermedades cerebrovasculares en Ecuador 2001- 2015: Estudio de tendencias, aplicación del modelo de regresión joinpoint. Mortality due to cerebrovascular diseases in Ecuador 2001- 2015: a trend study, application of the joinpoint regression model.

Objective. To analyze the mortality trend for cerebrovascular diseases in Ecuador and to identify the presence of changes in the temporal trend using the joinpoint regression model.

Materials and Methods. A mixed ecological study was carried out. Standardized mortality rates for the last 15 years (2001 to 2015) in Ecuador were calculated and stratified by age, sex, and provinces. A joinpoint regression analysis was used for analysis of trends.

Results. From 2001 to 2015, there were 48,621 deaths from cerebrovascular diseases in Ecuador. In the joinpoint regression analysis, age-adjusted rates in men declined from 71.4 to 59.5 deaths per 100,000 population, with an annual decline of 1.51% (p <0.05) in females from 61.2 to 55.5 deaths per 100,000 population, with an annual decrease of 1.11% (p <0.05). In the analysis by provinces, Sucumbíos presented a growing trend of 3.17% per year (p <0.05).

Conclusions. Mortality from cerebrovascular disease has declined in Ecuador in the last 15 years. The downward trend was observed in almost all age demographics.

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Palabras clave: Accidente Cerebrovascular, Análisis de Regresión, Mortalidad,

Keywords: Cerebrovascular diseases, Mortality, Regression Analysis,

Tabaquismo y su Asociación con Mortalidad Intrahospitalaria en Pacientes con Ictus Hemorrágico. Cigarette Smoking And Its Association With In-Hospital Mortality In Hemorrhagic Stroke Patients.

Background: Smoking is a well-known reversible risk factor associated with acute ischemic stroke (AIS), however, some data showed that in-hospital mortality rates among smoker’s patients with hemorrhagic stroke is lower when compared with non-smokers patients. The objective of this analysis was to assess in-hospital patient mortality rate between smokers and non-smokers patients with confirmed diagnosis of hemorrhagic stroke. Methods and Results: We analyzed all the data from patients diagnosed with hemorrhagic stroke that were registered in the Florida Stroke database from 2008-2012. Among the 21,013 patients diagnosed with hemorrhagic stroke, 10.9% of patients were smokers. A Multivariable model was used to estimate the adjusted odds ratio of in-hospital mortality rate in smokers versus non-smokers.  Smoking was associated with lower in-hospital mortality in hemorrhagic patients. (UOR= 0.71 vs. AOR= 0.75). Other risk factors like hypertension, BMI>40 and hyperlipidemia, remained significantly associated after modeling, and some others like gender, race, health insurance coverage, and diabetes became insignificant. The difference between unadjusted and adjusted odds ratios for smoking (0.71 versus 0.75) indicates no presence of substantial confounding by age and other control variables. Conclusions: Among patients hospitalized for hemorrhagic stroke, smoking is a risk factor for early age of onset, even among those with few vascular risk factors. The persistent association with lower in-hospital mortality after adjusted analyses probably represents other unmeasured confounding, although a biological effect of smoking cannot be excluded. Further clinical and prospective population-based studies are needed to explore variables that contribute to outcomes in these patients.

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Palabras clave: enfermedad cerebrovascular, Ictus, Mortalidad, Tabaquismo,

Keywords: cerbrovascular disease, Mortality, Smoking, stroke,

Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones

Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.

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Palabras clave: Ecuador, enfermedad cerebrovascular, Ictus, Mortalidad,

Keywords: Cerebrovascular diseases, Ecuador, Mortality, stroke,
 
 
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