Determinants of recovery from severe posterior reversible encephalopathy syndrome.
<h4>Objective</h4>Few outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.<h4>Design</h4>70 patients with severe PRES admitted to 24 ICUs in 2001-2010 w...
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2012
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oai:doaj.org-article:7ef86b3eec5c4876bac1e56aee57fe7c2021-11-18T07:05:33ZDeterminants of recovery from severe posterior reversible encephalopathy syndrome.1932-620310.1371/journal.pone.0044534https://doaj.org/article/7ef86b3eec5c4876bac1e56aee57fe7c2012-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0044534https://doaj.org/toc/1932-6203<h4>Objective</h4>Few outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.<h4>Design</h4>70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.<h4>Main results</h4>Consciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOS<5 were highest glycaemia on day 1 (OR, 1.22; 95%CI, 1.02-1.45, p = 0.03) and time to causative-factor control (OR, 3.3; 95%CI, 1.04-10.46, p = 0.04), whereas GOS = 5 was associated with toxaemia of pregnancy (preeclampsia/eclampsia) (OR, 0.06; 95%CI, 0.01-0.38, p = 0.003).<h4>Conclusions</h4>By day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement.Stephane LegrielOlivier SchraubElie AzoulayPhilippe HantsonEric MagalhaesIsaline CoquetCedric BretonniereOlivier GilhodesNadia AnguelBruno MegarbaneLaurent BenayounDavid SchnellGaetan PlantefeveJulien CharpentierLaurent ArgaudBruno MourvillierArnaud GalboisLudivine Chalumeau-LemoineMichel RivoalFrançois DurandArnaud GeffroyMarc SimonAnnabelle StoclinJean-Louis PallotCharlotte ArbelotMartine NyungaOlivier LesieurGilles TrochéFabrice BruneelYves-Sébastien CordolianiJean-Pierre BedosFernando PicoCritically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS)Public Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 9, p e44534 (2012) |
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Medicine R Science Q Stephane Legriel Olivier Schraub Elie Azoulay Philippe Hantson Eric Magalhaes Isaline Coquet Cedric Bretonniere Olivier Gilhodes Nadia Anguel Bruno Megarbane Laurent Benayoun David Schnell Gaetan Plantefeve Julien Charpentier Laurent Argaud Bruno Mourvillier Arnaud Galbois Ludivine Chalumeau-Lemoine Michel Rivoal François Durand Arnaud Geffroy Marc Simon Annabelle Stoclin Jean-Louis Pallot Charlotte Arbelot Martine Nyunga Olivier Lesieur Gilles Troché Fabrice Bruneel Yves-Sébastien Cordoliani Jean-Pierre Bedos Fernando Pico Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS) Determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| description |
<h4>Objective</h4>Few outcome data are available about posterior reversible encephalopathy syndrome (PRES). We studied 90-day functional outcomes and their determinants in patients with severe PRES.<h4>Design</h4>70 patients with severe PRES admitted to 24 ICUs in 2001-2010 were included in a retrospective cohort study. The main outcome measure was a Glasgow Outcome Scale (GOS) of 5 (good recovery) on day 90.<h4>Main results</h4>Consciousness impairment was the most common clinical sign, occurring in 66 (94%) patients. Clinical seizures occurred in 57 (81%) patients. Median mean arterial pressure was 122 (105-143) mmHg on scene. Cerebral imaging abnormalities were bilateral (93%) and predominated in the parietal (93%) and occipital (86%) white matter. Median number of brain areas involved was 4 (3-5). Imaging abnormalities resolved in 43 (88%) patients. Ischaemic and/or haemorrhagic complications occurred in 7 (14%) patients. The most common causes were drug toxicity (44%) and hypertensive encephalopathy (41%). On day 90, 11 (16%) patients had died, 26 (37%) had marked functional impairments (GOS, 2 to 4), and 33 (56%) had a good recovery (GOS, 5). Factors independently associated with GOS<5 were highest glycaemia on day 1 (OR, 1.22; 95%CI, 1.02-1.45, p = 0.03) and time to causative-factor control (OR, 3.3; 95%CI, 1.04-10.46, p = 0.04), whereas GOS = 5 was associated with toxaemia of pregnancy (preeclampsia/eclampsia) (OR, 0.06; 95%CI, 0.01-0.38, p = 0.003).<h4>Conclusions</h4>By day 90 after admission for severe PRES, 44% of survivors had severe functional impairments. Highest glycaemia on day 1 and time to causative-factor control were strong early predictors of outcomes, suggesting areas for improvement. |
| format |
article |
| author |
Stephane Legriel Olivier Schraub Elie Azoulay Philippe Hantson Eric Magalhaes Isaline Coquet Cedric Bretonniere Olivier Gilhodes Nadia Anguel Bruno Megarbane Laurent Benayoun David Schnell Gaetan Plantefeve Julien Charpentier Laurent Argaud Bruno Mourvillier Arnaud Galbois Ludivine Chalumeau-Lemoine Michel Rivoal François Durand Arnaud Geffroy Marc Simon Annabelle Stoclin Jean-Louis Pallot Charlotte Arbelot Martine Nyunga Olivier Lesieur Gilles Troché Fabrice Bruneel Yves-Sébastien Cordoliani Jean-Pierre Bedos Fernando Pico Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS) |
| author_facet |
Stephane Legriel Olivier Schraub Elie Azoulay Philippe Hantson Eric Magalhaes Isaline Coquet Cedric Bretonniere Olivier Gilhodes Nadia Anguel Bruno Megarbane Laurent Benayoun David Schnell Gaetan Plantefeve Julien Charpentier Laurent Argaud Bruno Mourvillier Arnaud Galbois Ludivine Chalumeau-Lemoine Michel Rivoal François Durand Arnaud Geffroy Marc Simon Annabelle Stoclin Jean-Louis Pallot Charlotte Arbelot Martine Nyunga Olivier Lesieur Gilles Troché Fabrice Bruneel Yves-Sébastien Cordoliani Jean-Pierre Bedos Fernando Pico Critically III Posterior Reversible Encephalopathy Syndrome Study Group (CYPRESS) |
| author_sort |
Stephane Legriel |
| title |
Determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| title_short |
Determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| title_full |
Determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| title_fullStr |
Determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| title_full_unstemmed |
Determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| title_sort |
determinants of recovery from severe posterior reversible encephalopathy syndrome. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2012 |
| url |
https://doaj.org/article/7ef86b3eec5c4876bac1e56aee57fe7c |
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