Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus
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Status epilepticus (SE) is a life-threatening condition with a high long-term mortality. The correct prediction of the individual patient’s outcome is crucial for stratifying treatment. Status epilepticus severity score (STESS) and the epidemiology-based mortality score (EMSE) are well established for predicting in-hospital mortality; however, scores indicating long-term mortality are lacking. We here studied the association of both scores with mortality after discharge and long-term mortality.
In this retrospective cohort study of adult patients with incident, non-anoxic, first-time SE (from 01/2008 to 12/2014), STESS, EMSE-EACE (etiology-age-comorbidity-EEG), demographic data, modified Rankin Scale at discharge, treatment, date of diagnosis, and date of death were determined based on electronic patients charts.
A total of 129 patients with a median follow-up of 24.8 months were included. We found no significant difference between STESS and EMSE-EACE in predicting in-hospital and 3 months mortality. At end-of-study, EMSE-EACE with a cutoff of ≥ 64 showed the best association with overall survival. At last follow-up, only 15.7% (8 out of 51) of the patients with EMSE ≥ 64 were alive as compared to 32.4% (24 out of 74) of the patients with STESS ≥ 3. Median survival of patients with EMSE-EACE ≥ 64 and EMSE-EACE < 64 was 6.4 months (95% confidence interval (CI) 2.3–15.3 months) and 35.8 months (CI 32.8–37.9 months), respectively. In the subgroup of patients that were discharged alive from the hospital, EMSE-EACE was highly significantly associated with mortality (p < 0.001) after discharge. In the same patients, STESS with a cutoff of STESS ≥ 3 reached only borderline significance (p = 0.04), STESS with a cutoff of STESS ≥ 4 did not reach statistical significance (p = 0.23). Exploratory analyses of different EMSE components unveiled a strong association of etiology with in-house mortality but not with long-term survival. In patients discharged alive from the hospital, only comorbidity and age remained significantly associated with long-term mortality.
In our cohort, EMSE-EACE was significantly associated with long-term survival after discharge.
KeywordsStatus epilepticus Long-term mortality STESS EMSE
HSM assessed EMSE in the cohort, statistical analyses, wrote, and approved the manuscript. ER analyzed patients from 2014 and approved the manuscript. PA analyzed patients diagnosed from 2008 to 2013 and approved the manuscript. ML analyzed patients diagnosed from 2008 to 2013 and approved the manuscript. EBC helped with the analysis of patients diagnosed from 2008 to 2013 and approved the manuscript. CPB designed the study, statistical analyses, wrote, and approved the manuscript.
This study was supported by a Grant of the Region of Southern Denmark to CPB (17/18517).
Compliance with Ethical Standards
Conflicts of Interest
Harald S. Møller received research support from UCB. Emmely Rodin, Preben Aukland Martin Lando, and Elsebeth B. Christiansen report no disclosures. Christoph P. Beier served as an advisory board member for UCB and EISAI, received speakers honoraries from UCB, EISAI, and the Danish Epilepsy Association, and research support from UCB, EISAI, Novartis, and Pfizer.
The study was evaluated and approved by the Ethic Committee of the Region of Southern Denmark.
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