Prediction of functional outcome in patients with convulsive status epilepticus: the END-IT score

Abstract

BackgroundPrediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge. The aim of this study was to characterize the prognostic factors and functional outcomes of patients after CSE in order to develop a practicable scoring system for outcome prediction.MethodsWe performed a retrospective explorative analysis on consecutive patients diagnosed with CSE between March, 2008 and November, 2014 in a tertiary academic medical center in northwest China. The modified Rankin Scale (mRS) was used to measure the functional outcome at three months post discharge.ResultsA total of 132 CSE patients was included, with a median age of 25.5 years and 60.6 % were male. Three months post discharge, an unfavorable outcome with mRS of 3–6 was seen in 62 (47.0 %) patients, 25 (18.9 %) of whom died. Logistic regression analysis revealed that encephalitis (p = 0.029), nonconvulsive SE (p = 0.018), diazepam resistance (p = 0.005), image abnormalities (unilateral lesions, p = 0.027; bilateral lesions or diffuse cerebral edema, p < 0.001) and tracheal intubation (p = 0.032) were significant independent predictors for unfavorable outcomes. Based on the coefficients in the model, these predictors were assigned a value of 1 point each, with the exception of the image, creating a 6-point scoring system, which we refer to as END-IT, for the outcome prediction of CSE. The area under the receiver operating characteristic curve for the END-IT score was 0.833 and using a cut-off point of 3 produced the highest sum sensitivity (83.9 %) and specificity (68.6 %). Compared with status epilepticus severity score (STESS) and Epidemiology-based Mortality score in SE (EMSE), END-IT score showed better discriminative power and predictive accuracy for the outcome prediction.ConclusionsWe developed an END-IT score with a strong discriminative power for predicting the functional outcome of CSE patients. External prospective validation in different cohorts is needed for END-IT score.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1221-9) contains supplementary material, which is available to authorized users.

Early Predictors of Drug-Resistant Epilepsy Development after Convulsive Status Epilepticus

“…First of all, there was no significant relationship between age (with median age of 25 [interquartile range 18-36] in our study) and DRE development, which might imply that age did not play a determinant role in DRE development among survivors who usually were younger. Second, the presence of NCSE in coma or generalized convulsive seizures at onset was reported to be independently associated with a high risk of death and poor functional outcome [5,17]. However, among survivors of SE, NCSE was not found to correlate pronouncedly with DRE development in our study.…”

“…Accordingly, many studies have investigated the risk factors of mortality and morbidity after SE, and found that age, etiology, seizure type, consciousness, and albumin level were early predictors [3][4][5]. SE is also often followed by unprovoked seizures, although whether epileptogenesis is associated with SE per se or with other underlying brain illness remains in dispute.…”

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

“…The median CBI in the GOS 1-3 group was significantly higher than in GOS >3 group (4 [3-6] and 3[2][3][4] [median, interquartile range], respectively, P = .006). For continuous CBI, the RR value is interpreted as a change in event probability for a one-level increase in CBI.…”

“…8 A few studies report that mortality in SE might be related to systemic complications in 12%-50% of the cases. [2][3][4] We lack tools to evaluate total complication burden and its effects on outcome. [2][3][4] We lack tools to evaluate total complication burden and its effects on outcome.…”

Prognostic scores in status epilepticus—a critical appraisal

“…10 Of the underlying etiologies of SE, encephalitis was chosen as an evaluating dimension in END-IT due to it being the most frequent underlying etiology, 21-23 as well as being determined to be an independent predictor in this study. Independent risk factors, that is, predictor variables, were identified using backward stepwise multivariate logistic regression.…”