Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome

Shivaprakash B Hiremath; Karine Massicotte-Tisluck; Santanu Chakraborty

doi:10.1007/s10072-022-06271-w

Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome

Neurol Sci. 2022 Nov;43(11):6461-6470. doi: 10.1007/s10072-022-06271-w. Epub 2022 Jul 19.

Authors

Shivaprakash B Hiremath^{1

2}, Karine Massicotte-Tisluck^{1

3}, Santanu Chakraborty⁴

Affiliations

¹ Division of Neuroradiology, Department of Radiology, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
² Department of Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, M5G1X8, Canada.
³ Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
⁴ Division of Neuroradiology, Department of Radiology, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. schakraborty@toh.ca.

PMID: 35852658
DOI: 10.1007/s10072-022-06271-w

Abstract

Purpose: Assess factors in posterior reversible encephalopathy syndrome (PRES) related to intensive care unit (ICU) admissions, mechanical ventilation, and length of stay (LoS).

Methods: Retrospectively, we collected clinical, biochemical, and imaging data of PRES patients. MRI studies were assessed for imaging severity, and complications, including restricted diffusion and hemorrhage. Univariate and multivariate regression analyses were performed for factors associated with ICU admission, mechanical ventilation, and LoS. We assessed for association between clinical and biochemical factors and imaging severity grading systems and complications.

Results: We had 57 subjects with mean ± SD age of 56.3 ± 14.5 years and 68.3% were females. In 60 cases, 36.7% had hypertension, 23.3% had chronic renal disease, 18.3% had sepsis, 16.7% were on active chemotherapy, 10% underwent hematopoietic stem cell transplantation (HSCT), 10% with active cancer, 6.7% were eclampsia/preeclampsia, and 1.7% had radiotherapy. We had 17 (26.6%) grade 1, 26 (46.8%) grade 2, 17 (26.6%) grade 3 PRES based on vasogenic edema extent, and 28 (46.7%) severe PRES (≥ 5 areas) cases. 19 (31.7%) had restricted diffusion with hemorrhage in 19 (31.7%) cases. On multivariate analysis, ICU admissions showed significant association with hypertension (OR = 5.57, 95% CI: 0.96-32.23; p = 0.05), and raised INR (OR = 119, 95% CI: 1.1-1244.3; p = 0.04); LoS with HSCT, mean arterial pressure (MAP), intraparenchymal hematoma, and sepsis; and extent of vasogenic edema with restricted diffusion (OR = 4.31, 95% CI: 1.5-12.33; p < 0.01).

Conclusion: In summary, PRES with hypertension and elevated INR are associated with ICU admissions. HSCT, MAP, intraparenchymal hematoma, and sepsis correlated with LoS. Imaging severity grading based on vasogenic edema extent may be better due to association with restricted diffusion.

Keywords: Brain edema; Hemorrhage; Intensive care units; Ischemia; Length of stay; Posterior reversible encephalopathy syndrome.

MeSH terms

Adult
Aged
Female
Hematoma / complications
Hospitalization
Humans
Hypertension* / complications
Magnetic Resonance Imaging
Male
Middle Aged
Posterior Leukoencephalopathy Syndrome* / complications
Posterior Leukoencephalopathy Syndrome* / etiology
Pregnancy
Retrospective Studies
Sepsis* / complications
Sepsis* / diagnostic imaging