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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.