Factors associated with fatal outcome in posterior reversible encephalopathy syndrome: a retrospective analysis of the Berlin PRES study

Although often reversible, fatal outcome in posterior reversible encephalopathy syndrome (PRES) is well known. However, data on predictors of PRES-associated in-hospital death are scarce. In this study, we aimed to investigate predictors of in-hospital death in a large cohort. Radiological report databases between January 1999 and February 2015 were retrospectively searched for patients with PRES. Patients were included if they met criteria for PRES after detailed investigation of clinical charts and imaging studies. Various clinical, paraclinical and brain MRI data as well as data on in-hospital mortality were analyzed. 151 patients were included into the study, 64% were female. Seventeen ( 11.2%) patients died during hospital stay. In univariate analyses, higher age (p=0.04), higher levels of C-reactive protein ( p<0.001), etiology of PRES ( sepsis and chemotherapy; p=0.02), altered coagulation ( p=0.002), altered mental state at onset ( p=0.03), and subarachnoid hemorrhage ( SAH; p=0.01) were related to in-hospital death. In multivariate analyses adjusted for age and sex, elevated CRP levels ( OR 1.1 95% CI 1.1-1.2), altered coagulation ( OR 5.1 95% CI 1.8-14.7), subarachnoid hemorrhage ( OR 10.1 95% CI 2.2-46.1) and altered mental state ( OR 3.3; 95% CI 1.1-9.4) were independently associated with in-hospital death. Altered mental state, subarachnoid hemorrhage as well as the higher levels of CRP and altered coagulation were significantly more frequent in patients who died in hospital. However, prospective studies are warranted to establish predictors of fatality in patients with PRES.