Abstract
BackgroundLittle is known about the causes, clinical course and long-term outcome of comatose patients with prolonged hypoglycemic encephalopathy.MethodsIn a multicenter retrospective study conducted in patients hospitalized from July 1, 2004, to July 1, 2014, we investigated functional long-term prognosis and identified prognosis factors of patients admitted in an intensive care unit (ICU) with prolonged neurological manifestations related to hypoglycemia. Eligible patients were adults admitted to the ICU with a Glasgow Coma Score <8 due to hypoglycemia and persistent consciousness disorders after normalizing blood glucose levels. Patients with possible other causes of consciousness disorders, previous cognitive disorders, hypothermia <35 °C or circulatory arrest within 24 h after ICU admission, were excluded. Follow-up phone call was used to determine patients’ functional outcome using modified Rankin Scale (mRS) at a minimum of 1-year follow-up with mRS 0–3 defining good and mRS 4–6 poor outcomes.ResultsForty-nine patients were included. Causes of hypoglycemia were various, mainly including insulin or oral antidiabetic drugs abuse (65%) and neuroendocrine carcinoma (16%). Twenty (41%) patients died in the ICU, two (4%) patients further died and nine (18%) patients had a poor outcome at long-term follow-up. Five patients discharged from the ICU with mRS > 3 improved enough to be in the good outcome group 1 year later. Twenty-two (45%) patients underwent therapeutic limitation, mainly related to no expected hope for improvement. On multivariate analysis, only low mRS prior to ICU admission (OR 2.6; 95% CI 1.1–6.3; P = 0.03) and normal brain imaging (OR 7.1; 95% CI 1.1–44; P = 0.03) were significantly predictive of a good outcome. All patients (n = 15) who remained hypoglycemic >480 min had a poor outcome.ConclusionPoor outcome was observed in about 60% of this population of hypoglycemic encephalopathy. However, some patients can recover satisfactorily over time.
Highlights
Little is known about the causes, clinical course and long-term outcome of comatose patients with prolonged hypoglycemic encephalopathy
The hypoglycemic encephalopathy has been demonstrated to induce early lesions of the internal capsule that may secondarily reach the white matter [6, 7]. Their prognostic value is debated owing to the variability of the lesions [7] and the absence of correlation between severity of imaging lesions and patient prognosis [1, 6,7,8]. The objective of this multicenter study was to study causes, initial consequences and the vital and functional long-term prognosis of patients admitted to the intensive care unit (ICU) with prolonged neurological manifestations related to obvious hypoglycemia
The diagnosis of prolonged hypoglycemic encephalopathy was considered in all patients >18 years old admitted in the ICU with (1) a Glasgow Coma Score lower than 8 on presentation, (2) hypoglycemic etiology of coma confirmed or highly likely with at least one measurement of blood glucose concentration
Summary
Little is known about the causes, clinical course and long-term outcome of comatose patients with prolonged hypoglycemic encephalopathy. The hypoglycemic encephalopathy has been demonstrated to induce early lesions of the internal capsule that may secondarily reach the white matter [6, 7] Their prognostic value is debated owing to the variability of the lesions [7] and the absence of correlation between severity of imaging lesions and patient prognosis [1, 6,7,8]. The objective of this multicenter study was to study causes, initial consequences and the vital and functional long-term prognosis of patients admitted to the ICU with prolonged neurological manifestations related to obvious hypoglycemia
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