Discharges With Triphasic Morphology as Marker of the Risk of Death in Acute Encephalopathy

Abstract

Introduction. In clinical practice, it is difficult to define the prognosis of patients with acute encephalopathy; a syndrome characterized by cognitive dysfunction and altered sensorium. Discharges with triphasic morphology (DTM) are an electroencephalographic pattern that might be useful to establish the risk of death. The aim of this study was to define the prognostic value of DTM regarding mortality in patients with acute encephalopathy. Methods. We conducted an observational retrospective cohort study including patients with acute encephalopathy with and without DTM paired by age and gender in a 1:2 ratio. We calculated the odds ratio (OR) to determine the association between DTM and mortality. In addition, we calculated sensibility, specificity, and predictive values. Results. We included 72 patients, 24 with DTM and 48 without DTM. Mortality was higher in patients with DTM (41.6% vs 14.5%, P = .01). Factors associated with a higher risk of death were DTM (OR = 4.1, 95% confidence interval [CI] 1.3-13, P = .01) and sequential organ failure assessment score (OR = 1.3, 95% CI 1.04-1.67, P = .02). A higher Glasgow coma scale score was associated with a lower risk of death (OR = 0.65, 95% CI 0.51-0.83, P = .001). The sensibility and specificity of DTM were 59% and 75%, respectively. Positive and negative likelihood ratios were 2.36 and 0.55. Discussion. Our results revealed high mortality in patients with acute encephalopathy and DTM. This electroencephalographic pattern was associated with 4 times higher risk of death. However, its usefulness for predicting death was limited.

Keywords

electroencephalogram (EEG)discharges triphasic mortality encephalopathy

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References

Marcantonio

. Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456–1466.

Merchán

Salamea

Ochoa

Martínez

. Niveles de lactato sérico y mortalidad en pacientes críticos. Rev Médica del Hosp José Carrasco Arteaga. 2014;6(2):121–124.

Knaus

Draper

Wagner

Zimmerman

. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–829.

Vincent

Moreno

Takala

, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707–710.

Bermeo-Ovalle

. Triphasic waves: swinging the pendulum back in this diagnostic dilemma. Epilepsy Curr. 2017;17(1):40–42.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association Publishing 5th ed., 2013.

Hirsch

Laroche

Gaspard

, et al. American Clinical Neurophysiology Society's standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27.

Kaplan

. Delirium and epilepsy. Dialogues Clin Neurosci. 2003;5(2):187–200.

Sutter

Kaplan

. Uncovering clinical and radiological associations of triphasic waves in acute encephalopathy: a case-control study. Eur J Neurol. 2014;21(4):660–666.

10.

Sutter

Stevens

Kaplan

. Significance of triphasic waves in patients with acute encephalopathy: a nine-year cohort study. Clin Neurophysiol. 2013;124(10):1952–1958.

11.

Sutter

Stevens

Kaplan

. Clinical and imaging correlates of EEG patterns in hospitalized patients with encephalopathy. J Neurol. 2013;260(4):1087–1098.

12.

Bryan Young

Bolton

Archibald

Austin

Wells

. The electroencephalogram in sepsis- associated encephalopathy. J Clin Neurophysiol. 1992;9(1):145–152.

13.

Bahamon-Dussan

Celesia

Grigg-Damberger

. Prognostic significance of EEG triphasic waves in patients with altered state of consciousness. J Clin Neurophysiol. 1989;6(4):313–319.

14.

Kaplan

Sutter

. Affair with triphasic waves—their striking presence, mysterious significance, and cryptic origins: what are they? J Clin Neurophysiol. 2015;32(5):401–405.