A real-world study of the effect of carbapenems on the efficacy of sodium valproate in the treatment of epilepsy in the emergency department
Objective Using real-world data to analyze whether the administration of carbapenems within 7 days before the treatment or during the treatment will reduce the effectiveness of sodium valproate in patients with status epilepticus(SE)and seizure clusters(SC).Methods The clinical data of SE and SC patients who received intravenous administration of sodium valproate in the Department of Emergency of Zhongshan Hospital,Fudan University from 2017 to 2021 were collected.The main endpoint was the failure to terminate epileptic seizures after sodium valproate injection.Univariate analysis and multivariate Logistic regression model were used to analyze whether the carbapenems was an independent risk factor for the failure of sodium valproate treatment.Results Finally,142 SE patients and 181 SC patients were included.Univariate analysis revealed that the use of carbapenems within 7 days before or during the treatment was a risk factor for the failure of sodium valproate treatment in SC patients(x2=5.498,P=0.019),but was not a risk factor for the failure of sodium valproate treatment in SE patients(x2=3.015,P=0.082).Through multiple factor analysis,it was found that the use of carbapenems was an independent risk factor for the seizures not terminatd by sodium valproate in SC patients(OR=3.462,95％CI 1.180-10.157);the interval between onset and medication≥4 hours increased the risk of sodium valproate treatment failure in SE patients(OR=4.591,95％CI 1.443-14.607);simultaneously using benzodiazepines could reduce the risk of sodium valproate treatment failure in SE patients(OR=0.300,95％CI 0.128-0.703).Conclusions The use of carbapenems by SC patients within 7 days before or during treatment may lead to the failure of sodium valproate treatment.In clinical practice,the use of sodium valproate as a medication to terminate seizures in SC patients can be determined based on their medication records.
NETL
NSTL
万方数据
