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Predictors of intensive care unit utilization in patients with posterior reversible encephalopathy syndrome

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Abstract

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome that requires prompt, aggressive management to improve outcomes. Our aim was to identify factors that would necessitate care in the intensive care unit (ICU) in patients with PRES and the outcomes on discharge following ICU stay. We retrospectively reviewed the medical records and radiological data of adult PRES patients admitted to our tertiary care medical center. We dichotomized them into two groups based on their need for ICU care and compared their clinical, laboratory, imaging characteristics and discharge outcomes. Outcomes were defined using the modified Rankin Score (mRS) and Glasgow Outcome Score (GOS) on discharge. Out of 100 patients, 67 % required admission to the ICU. On univariate analysis, factors associated with ICU admission were atrial fibrillation (19.4 vs 0 %; p ≤ 0.05), encephalopathy from PRES (89.6 vs 66.7 %; p < 0.05), low Glasgow Coma Score (GCS) (11 ± 4 vs 14 ± 2; p = 0.01) and cortical involvement on imaging (89.6 vs 72.7 %, p = 0.03). On multivariate logistic regression analysis, encephalopathy (odds ratio 10.22; 95 % CI (1.14–91.55; p = 0.04) was the sole predictor of ICU utilization. This correlated with a GCS <12 (odds ratio 5.53; 95 % CI (1.05–29.22; p = 0.04). Despite worse functional outcomes following ICU care based on mRS (2.3 ± 2.1 vs 1.3 ± 1.4, p = 0.02) and GOS (3.9 ± 1.3 vs 4.6 ± 0.7, p ≤ 0.05), only a borderline increase in mortality was observed (10.4 vs 0 %, p = 0.05). The presence of PRES-related encephalopathy might aid in prompt identification of patients who require ICU care.

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Authors and Affiliations

  1. Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Archana Hinduja

  2. Department of Pediatric Neurology, Arkansas Children Hospital, Little Rock, AR, USA

    Kenneth Habetz

  3. Department of Community Medicine, Dr RP Government Medical College, Tanda, India

    Sunil Kumar Raina

  4. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Ryan T. Fitzgerald

  5. Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA

    Archana Hinduja

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  1. Archana Hinduja
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  2. Kenneth Habetz
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  3. Sunil Kumar Raina
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  4. Ryan T. Fitzgerald
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Correspondence to Archana Hinduja.

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The authors declare that they have no conflict of interest to disclose.

Ethical approval

This study was approved by the University of Arkansas for Medical sciences Institutional Review Board.

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This was a retrospective review of medical records with no direct contact with patients. Thus waiver of informed consent was performed.

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Hinduja, A., Habetz, K., Raina, S.K. et al. Predictors of intensive care unit utilization in patients with posterior reversible encephalopathy syndrome. Acta Neurol Belg 117, 201–206 (2017). https://doi.org/10.1007/s13760-016-0703-5

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  • DOI: https://doi.org/10.1007/s13760-016-0703-5

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