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      Factores clínicos y epidemiológicos relacionados a mortalidad en pacientes con estatus epiléptico en un hospital de Lima: una serie comparativa de casos Translated title: Clinical and epidemiological factors related with mortality in patients with status epilepticus in a general hospital in Lima: a comparative case series

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          Abstract

          Objetivos: El objetivo del estudio es comparar, entre dos grupos de pacientes, una serie de factores clínicoepidemiológicos relacionados a mortalidad: edad, sexo, comorbilidades, tipo de estatus epiléptico y uso de ventilación mecánica. Material y Métodos: El estudio se realizó en el Hospital Cayetano Heredia entre enero de 2012 hasta diciembre de 2014. Incluyó 94 pacientes con el diagnóstico de estatus epiléptico admitidos durante el período establecido. El estudio comparó datos de los supervivientes contra datos de los fallecidos. Se recolectó la información de las historias clínicas en una ficha de datos para la elaboración de una base de datos. Resultados: La mortalidad intrahospitalaria fue de 8,51%. La media de edad fue de 41,8 años. Las principales etiologías halladas fueron la epilepsia idiopática (28,72%), la neurocisticercosis (14,89%) y la enfermedad cerebrovascular (14,89%). Se encontró que un 19,5% de pacientes habían abandonado el tratamiento antiepiléptico. El análisis bivariado demostró, para la mortalidad intrahospitalaria, una relación significativa (p<0,05) con un alto Índice de Comorbilidad Charlson y el uso de ventilación mecánica. Conclusiones: La presencia de comorbilidades y el uso de ventilación mecánica se relacionan significativamente con mortalidad en pacientes con estatus epiléptico.

          Translated abstract

          Objectives: The goal of this study is to compare, among two groups of patients, a series of clinical-epidemiological factors related to mortality: age, sex, comorbidity, type of status epilepticus and use of mechanical ventilation. Material and Methods: The study was carried out in the Hospital Cayetano Heredia from January 2012 to December 2014. It includes 94 patients with status epilepticus admitted during the established period. The study compared data from the survivors against data from the deceased. Information from medical records was collected in a Data Sheet to elaborate a data bank. Results: In-hospital mortality was 8.51%. The mean of age was 41,8 años. The main etiologies found were idiopathic epilepsy (28.72%), neurocysticercosis (14.89%) and cerebrovascular disease (14.89%). It was found that 19.5% of patients had discontinued antiepileptic treatment. Bivariate analysis showed, for in-hospital lethality, a significant relationship (p<0.05) with a high Charlson Index and the use of mechanical ventilation. Conclusions: The presence of comorbidities and the use of mechanical ventilation are significantly related with in-hospital mortality in patients with status epilepticus.

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          Most cited references18

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.

            The ICD-9-CM adaptation of the Charlson comorbidity score has been a valuable resource for health services researchers. With the transition into ICD-10 coding worldwide, an ICD-10 version of the Deyo adaptation was developed and validated using population-based hospital data from Victoria, Australia. The algorithm was translated from ICD-9-CM into ICD-10-AM (Australian modification) in a multistep process. After a mapping algorithm was used to develop an initial translation, these codes were manually examined by the coding experts and a general physician for face validity. Because the ICD-10 system is country specific, our goal was to keep many of the translated code at the three-digit level for generalizability of the new index. There appears to be little difference in the distribution of the Charlson Index score between the two versions. A strong association between increasing index scores and mortality exists: the area under the ROC curve is 0.865 for the last year using the ICD-9-CM version and remains high, at 0.855, for the ICD-10 version. This work represents the first rigorous adaptation of the Charlson comorbidity index for use with ICD-10 data. In comparison with a well-established ICD-9-CM coding algorithm, it yields closely similar prevalence and prognosis information by comorbidity category.
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              A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia.

              This report presents the initial analysis of a prospective, population-based study of status epilepticus (SE) in the city of Richmond, Virginia. The incidence of SE was 41 patients per year per 100,000 population. The frequency of total SE episodes was 50 per year per 100,000 population. The mortality rate for the population was 22%, 3% for children and 26% for adults. Evaluation of the seizure types for adult and pediatric patients demonstrated that both partial and generalized SE occur with a high frequency in these populations. Based on the incidence of SE actually determined in Richmond, Virginia, we project 126,000 to 195,000 SE events with 22,200 to 42,000 deaths per year in the United States. The majority of SE patients had no history of epilepsy. These results indicate that SE is a common neurologic emergency.
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                Author and article information

                Journal
                rnp
                Revista de Neuro-Psiquiatría
                Rev Neuropsiquiatr
                Universidad Peruana Cayetano Heredia. Facultad de Medicina (Lima, , Peru )
                0034-8597
                October 2016
                : 79
                : 4
                : 207-215
                Affiliations
                [02] Lima orgnameHospital Nacional Cayetano Heredia Perú
                [01] Lima orgnameUniversidad Peruana Cayetano Heredia orgdiv1Facultad de Medicina Alberto Hurtado Perú
                [03] Lima orgnameHospital Nacional Arzobispo Loayza Perú
                Article
                S0034-85972016000400003 S0034-8597(16)07900400003
                10.20453/rnp.v79i4.2975
                ba937c33-fefd-441f-a56e-8f610b82946e

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 20 June 2015
                : 21 November 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 9
                Product

                SciELO Peru

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Artículos originales

                respiración artificial,neurocisticercosis,comorbilidad,mortalidad,Estado epiléptico,artificial respiration,neurocysticercosis,comorbidity,mortality,Status epilepticus

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