Tesis

Luaran Pasien Ensefalopati Metabolik dengan Status Epileptikus Non Konvulsivus = The Outcome of Patients with Metabolic Encephalopathy with Nonconvulsive Status Epilepticus.

Latar belakang: Status epileptikus non konvulsivus (SENK) merupakan salah satu diagnosis banding pasien dengan penurunan kesadaran termasuk pada ensefalopati metabolik (EM). Luaran pasien EM dengan SENK masih belum banyak diteliti. Metode penelitian: Penelitian ini bersifat observasional dengan disain potong lintang terhadap pasien EM dengan gambaran elektroensefalogram (EEG) SENK berdasarkan kriteria Salzburg yang dirawat di ruang emergensi, ruang rawat intensif, dan ruang rawat inap Rumah Sakit Umum Pusat Nasional Cipto Mangunksumo pada bulan Juli 2016-Juli 2017. Pasien dilakukan pencatatan, pemeriksaan EEG, dan observasi hingga akhir perawatan atau 30 hari perawatan. Luaran dinilai dalam mortalitas dan status fungsional dalam modified Rankin scale (mRS) yang dibagi menjadi baik (mRS 0-2) dan buruk (3-5). Analisa bivariat dilakukan untuk mencari faktor demografis, klinis, dan gambaran EEG yang berpotensi mempengaruhi luaran. Hasil: Dari total 32 subjek penelitian, didapatkan mortalitas sebesar 40,6%. Dari 19 subjek hidup, 84,2% memiliki status fungsional buruk. Pada subjek yang meninggal, 84,6% memiliki latar belakang teta, 100% tidak responsif terhadap suara, 92,3% tidak responsif terhadap nyeri, dan 76,9% memiliki gambaran aktivitas delta/teta ritmik dengan frekuensi >0,5Hz. Sepsis dan jumlah etiologi penurunan kesadaran memiliki berpotensi mempengaruhi luaran subjek (p0,5Hz. Sepsis dan jumlah etiologi berpotensi mempengaruhi luaran.
Kata kunci: luaran; mortalitas; status fungsional; ensefalopati metabolik; status epileptikus non konvulsivus


Background: Nonconvulsive status epilepticus (NCSE) is one of the important differential diagnoses in patients with altered consciousness including metabolic encephalopathy (ME)y. The outcome of ME patients with NCSE has not been studied extensively. Method: This is an observational cross-sectional study in ME patients with NCSE based on EEG findings that fulfilled the Salzburg criteria treated in the emergency, intensive care, and inpatient units of Cipto Mangunkusumo hospital in July 2016July 2017. Subjects underwent documentation, EEG recording, and observation until discharge or 30 days of treatment. Outcome was measured in mortality and functional status in modified Rankin scale divided into favorable (mRS 0-2) and poor (mRS 3-5). Bivariate analysis was done to find the potential demographic, clinical, and electrographic factors to influence outcome. Result: Out of total 32 subjects, the mortality rate was 40.6%. From 19 survivors, 84,2% had poor functional status. In fatal subjects, 84.6% had theta background rhythm, 100% unresponsive to sound, 92.3% unresponsive to pain, and 76.9% had rhythmic delta/theta activity >0.5Hz. Sepsis and the number of etiologies causing altered consciousness had the potential to influence outcome (p0.5Hz. Sepsis and the number of etiologies had the potential to influence outcome.
Keywords: mortality; functional status; metabolic encephalopathy; nonconvulsive status epilepticus