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Table 2 The incidence and significance of background abnormalities, periodic and rhythmic discharges and electrographic seizures in sepsis

From: Clinical neurophysiological assessment of sepsis-associated brain dysfunction: a systematic review

 

Ref

Type of EEG abnormality

Details

Rate (number, %)

Diagnostic and prognostic values of the changes

Case series of patients with sepsis

 

21

B

Slow waves; malignant EEG pattern

5/43 (12%); 15/43 (35%)

Malignant EEG pattern associated with chronic leukoencephalopathy and acute brain ischemia.

 

PD/RD

TWs

5/43 (12%)

NA

 

Esz

ESz

13/43 (30%)

NA

 

20

B

Theta-delta; delta; burst-suppression

2/18 (11%); 12/18 (67%); 2/18 (11%)

NA

 

PD/RD

TWs

1/18 (6%)

NA

 

18

B

Theta; delta; suppression; no reactivity

16/62 (26%); 22/62 (35%); 8/62 (13%), 9/62 (15%)

Severity of SAE associated with severity of EEG abnormalities Delta (OR = 2.4) and suppression (OR = 4.5) associated with mortality.

 

PD/RD

TWs

5/60 (10%)

TWs associated with mortality (OR = 1.5)

 

22

B

Theta; delta

4/6 (67%); 2/6 (33%)

NA

 

23

B

Slow wave sleep; Theta-delta; delta; Paroxysmal theta

4/14 (29%); 2/14 (14%); 1/14(7%); 1/14 (7%)

NA

 

PD/RD

Paroxysmal slowing with sharp waves

2/14 (14%)

NA

Case series or case-control studies that included patients with and without sepsis

 

32

B

No reactivity

28/152 (18%)

No reactivity tended to be associated with poor outcome (OR = 2.8, P = 0.13)

 

PD/RD

PEDs (including GPDs, PLEDs and BIPLEDs)

45 (29 %)

PEDs persisting for >24 h associated with poor outcome (OR = 2.9, P = 0.01)

 

Esz

NCSz (including NCSE)

24/154 (16 %) (8/154 (5 %))

NCSz associated with poor outcome (OR = 10.4, P = 0.04)

 

27

B

Predominant theta; theta/delta; no reactivity

30/105 (29%); 55/105 (52%); 22/105(21%)

Lack of EEG background reactivity associated with mortality (OR = 3.7, P = 0.04)

 

PD/RD

TWs

105/105 (100%)

NA

 

28

B

Theta; theta/delta; delta; FIRDA

34/154 (22%); 32/154 (21%); 28/154 (18%); 26/154 (18%)

Theta/delta and delta associated with more severe alteration of consciousness; Theta/delta associated with poor outcome (OR = 2.5, P = 0.03); FIRDA associated with good outcome (OR = 4.8, p = 0.004)

 

PD/RD

TWs

34/154 (22%)

TWs associated with more severe alteration of consciousness and with higher mortality (OR = 4.5, P = 0.005)

 

24

PD/RD

GPDs including TWs;

(50%, case-matched cohort); 63/400 (16%); 24/400 (6%)

No significant difference in poor outcome between GPDs and controls; GPDs associated with a longer ICU stay (18 days versus 15 days, P = 0.002)

 

Esz

(Seizures)

(73/400 (18%))

NA

 

30

PD/RD

PEDs (including GPDs, PLEDs and BIPLEDs)

34/201 (17%);

Diagnostic value of the presence of ESz or PEDs for sepsis (Sen = 0.32; Spe = 0.91; PLR = 3.7; NLR = 0.7) ESz or PEDs associated with mortality or severe disability at hospital discharge (adjusted OR = 19.1, P = 0.001).

 

Esz

ESz

21/201 (10%)

NA

 

31

B

Slow waves

27/27 (100%)

NA

 

PD/RD

TWs

1/27 (4%)

NA

  1. B, background; EEG, electroencephalogram; ESz, electrographic seizures; FIRDA, frontal intermittent delta activity; GPDs, general periodic discharges; NA, not applicable; NCSE, nonconvulsive status epilepticus; NCSz, nonconvulsive seizures; NLR, negative likelihood ratio; OR, odds ratio; (P)(BI)LEDs, (periodic) (bilateral independent) lateralized epileptiform discharges; PD/RD: periodic and rhythmic discharges; PEDs, periodic epileptiform discharges; PLR, positive likelihood ratio; SAE, sepsis-associated encephalopathy; Sen, sensitivity; Spe, specificity; TWs, triphasic waves.