Objective: To explore the relationship between flash visual evoked potential (fVEP) and severity and prognosis in critically ill patients in intensive care unit (ICU).
Methods: Sixty-nine critically ill patients were divided into two groups according to survival (35 cases) or death (34 cases) in 28 days. fVEP, Glasgow coma scale (GCS) score, acute physiology and chronic health evaluation II (APACHE II) score and sepsis-related organ failure assessment (SOFA) score of survivors were compared with those of nonsurvivors. Also, according to primary disease, the patients were divided into a group of patients with primary intracranial disease and patients with mental disturbance but without primary intracranial lesion. Above mentioned indexes were compared, and clinical outcome was predicted with their correlation with fVEP in each patient.
Results: The latent period of fVEP peak appeared later in nonsurvivors than those in survivors [(228.6+/-41.7) ms vs. (190.5+/-49.2) ms, P<0.01]. APACHE II score (25.9+/-6.4 vs. 22.5+/-6.7) and SOFA score (6.7+/-2.0 vs. 5.4+/-2.5) were higher in nonsurvivors than those in survivors (both P<0.05 ), while the changes in GCS score was in contrary (6.3+/-2.4 vs. 7.0+/-3.0, P<0.05). fVEP peak latency showed a negative correlation with GCS score (r=-0.332, P<0.01). The death rate of the group of patients with primary intracranial lesion was similar to that of the total. fVEP peak latency of the group with no primary intracranial lesion but with mental impairment in nonsurvivors was significantly longer than that of survivors [(226.0+/-46.7) ms vs. (168.8+/-54.1) ms, P<0.05], fVEP peak latency was positively correlated with SOFA score (r=0.526, P<0.05). Area under receiver operator characteristic (ROC) curve of fVEP peak latency was 0.800+/-0.104 (P<0.05) for predicting outcome of patients, while that of SOFA score was 0.650+/-0.131 (P>0.05). The former could be used for predicting death.
Conclusion: fVEP reflects the prognosis and severity of critically ill patients in ICU. Especially, it maybe used as a tool for predicting death and multiple organ dysfunction syndrome (MODS) in the patients with no primary intracranial lesion but with mental impairment.