# Propofol-related biological alterations and incidence of propofol infusion syndrome in status epilepticus: a 10-year cohort study

## TL;DR

This study examines the biological effects of propofol in patients with status epilepticus and finds that it causes lipid and kidney changes, along with inflammation, but propofol infusion syndrome remains rare in monitored settings.

## Contribution

The study identifies specific biological markers affected by propofol and confirms the low incidence of PRIS in a specialized neurointensive care unit.

## Key findings

- Propofol use was linked to lipid dysregulation, including increased triglycerides and reduced HDL-cholesterol.
- Propofol exposure caused impaired renal function and mild respiratory acidosis.
- Propofol was associated with a pro-inflammatory profile, independent of the patient's clinical status.

## Abstract

Continuous anesthetics are often required for the management of refractory status epilepticus. While essential to achieving seizure control, these agents carry significant adverse effects. In particular, propofol may induce hypotension, respiratory depression, metabolic acidosis, or pancreatitis, with the most feared complication being propofol infusion syndrome (PRIS).

The primary objective was to investigate the biological effects of propofol in patients with status epilepticus admitted to the neurointensive care unit of Pitié-Salpêtrière Hospital (Paris, France) for at least 48 h between September 2015 and October 2024. Twenty biological parameters reflecting acid–base balance, organ function, lipid metabolism, and inflammation were analyzed. To capture delayed effects, biological tests from day t + 1 were used to assess propofol exposure on day t. A linear mixed-effects model was applied, with each marker as the dependent variable, propofol exposure (including patients who did not receive propofol as the reference group) or dose of propofol as the fixed-effect predictor, and patient as a random effect. A secondary objective was to determine the incidence of PRIS in this tertiary referral center for the management of refractory and super-refractory status epilepticus.

A total of 235 patients were enrolled, of whom 51% received propofol for at least 1 day. We collected biological data over 2,407 patient-days, including 1,086 (45%) under propofol infusion. Propofol use was associated with lipid dysregulation, characterized by increased triglycerides, decreased LDL-cholesterol and HDL-cholesterol, along with impaired renal function, and mild acute respiratory acidosis, reflected by elevated pCO2, and reduced pH and phosphate levels. Propofol exposure was also associated with a pro-inflammatory profile, characterized by elevated CRP, procalcitonin, leukocyte counts, and an altered neutrophil-to-lymphocyte ratio, independent of the patient’s clinical inflammatory status. Over the past 10 years, only four cases of likely or most likely PRIS cases were identified.

Prolonged propofol infusions warrant routine monitoring of specific biological markers. Our study identifies key parameters to follow and confirms that PRIS remains rare in specialized centers where patients are closely monitored and risk factors are carefully considered.