Predictors of long-term mortality in status epilepticus

Tiamkao, Somsak; Saybungkla, Pawinee; Sirikarn, Prapassara; Sawanyawisuth, Kittisak

doi:10.1016/j.yebeh.2018.04.027

Cited by 7 publications

(11 citation statements)

References 24 publications

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“…The rate of long‐term mortality at 65% in this study is considerably higher than in prior studies with a follow‐up of at least 10 years, with mortality rates ranging from 17% to 43% [5-7, 13]. This difference might be partly due to the fact that most of these studies also included children, whose overall estimated mortality after CSE is substantially lower than in adults [25].…”

Section: Mortality and Life Expectancycontrasting

confidence: 60%

Long‐term outcome of convulsive status epilepticus: a 10‐year follow‐up

Kling¹,

Ritvanen²,

Mustonen³

et al. 2022

Epileptic Disorders

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Objective. This study aimed to determine the mortality, causes of death and factors affecting the outcome of convulsive status epilepticus (CSE) at 10 years. Method. This retrospective study consisted of 62 consecutive adult patients diagnosed with CSE at the Helsinki University Hospital (HUS) emergency department during 2002‐2003. Patients were followed for up to 10 years or up to the time of death. Data on patient demographics, CSE characteristics, treatment, complications, and outcome from the time of CSE were collected. The Official Statistics of Finland provided the information on mortality and causes of death. Survival analysis was conducted using Cox proportional hazards regression analysis. Results. In‐hospital mortality was 8.1%, and mortality was 25.8% at one year, 51.6% at five years and 64.5% at 10 years. Estimated standardized mortality ratio (SMR) was 5.3 and the deceased patients lost 20.9 potential years of life, on average. The leading causes of death were disorders of the brain or the circulatory system, epilepsy‐related conditions or intracranial tumours. The univariable survival analysis demonstrated that age ≥65 (HR=2.8, p=0.001), Charlson Comorbidity Index (CCI)>0 (CCI=1‐3: HR=3.0, p=0.009; CCI>3: HR=8.4, p<0.001), Status Epilepticus Severity Score (STESS)>4 (HR=5.3, p<0.001) and Epidemiology‐Based Mortality Score (EMSE‐EAC)>15 (HR=2.2, p=0.036) were risk factors and a Glasgow outcome scale (GOS) of 5 at discharge (HR=0.14, p=0.025) was a protective factor for survival. The multivariable analysis established STESS>4 (HR=5.0, p=0.002) and CCI>0 (CCI=1‐3: HR=2.9, p=0.015; CCI>3: HR=6.3, p=0.006) as independent risk factors and GOS>3 (time‐dependent) (GOS=4: HR=0.33, p=0.048; GOS=5: HR=0.13, p=0.019) as a protective factor for survival. Significance. The rate of long‐term mortality and number of potential years of life lost were high. Factors demonstrative of the overall situation of the patients, such as comorbidities, functional state after CSE and age, were significant predictors for long‐term outcome.

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Section: Mortality and Life Expectancycontrasting

confidence: 60%

Long‐term outcome of convulsive status epilepticus: a 10‐year follow‐up

Kling¹,

Ritvanen²,

Mustonen³

et al. 2022

Epileptic Disorders

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“…Because this study focused on long-term mortality in SE patients, gender, cancer, pneumonia, and urinary tract infection scores differed from those found in previous studies. However, prior articles have found clear associations between these predictors and mortality in SE patients [4, 6, 7, 24], except the urinary tract infection which shown as a protective factor in previous study [7]. This is due to the difference group of patients – inpatients and after discharge within 30 days, and the outcome – all-cause mortality in SE.…”

Section: Discussionmentioning

confidence: 83%

“…There are several factors that contribute to the risk of death in SE patients, but the key factors are age, duration of SE, and etiology [2, 3]. Moreover, previous studies found that comorbidities and complications were also major factors associated with mortality, for example, brain tumors, central nervous system (CNS) infection, septicemia, pneumonia, and shock [4–7]. Because death is a crucial outcome in SE, identifying the risk of death in patients with this condition can allow physicians to optimally manage their patients’ care on an individual basis.…”

Section: Introductionmentioning

confidence: 99%

One- to 10-year Status Epilepticus Mortality (SEM) score after 30 days of hospital discharge: development and validation using competing risks analysis

2019

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BackgroundStatus epilepticus (SE) is an emergency neurological disorder that affects quality of life and is associated with high mortality risk. Three scores have been developed to predict the risk of in-hospital death, but these scores are poor discrimination of mortality after discharge. This study aimed to develop and validate a simple risk score for long-term mortality in SE patients.MethodsThis retrospective cohort study was conducted using SE patient data collected from Thailand’s Universal Coverage Scheme database between the fiscal years of 2005 and 2015 and followed-up to 2016. Patients who died in hospital or within 30 days after discharge were excluded. Data were divided at random into either a derivation or validation set. A proportional hazards model for the sub-distribution of competing risks was fitted with backward stepwise method. The coefficients from the model were used to develop a point-based scoring system. The discrimination ability of the model was evaluated using a time-dependent receiver operating characteristic (ROC) curve.ResultsA total of 20,792 SE patients (with ages ranging from the first day of life to 99 years at first admission) were randomly separated into two groups: 13,910 in the development group and 6882 in the validation group. A sub-distribution hazard model was used to determine nine predictors to be included in the final model, which was, in turn, used to develop the scoring system: age (0–19 points), male (two points), brain tumor (12 points), stroke (three points), cancer (11 points), diabetes (three points), chronic kidney disease (five points), pneumonia (five points), and urinary tract infection (four points). The possible total score ranged from zero to 64 and the cumulative incidence function was used to determine the probability of mortality associated with each total score within the first 10 years after the first admission. The area under the ROC curve (AUC) of the first to last time point ranged from 0.760 to 0.738.ConclusionA nine-factor risk score for predicting 10-year mortality in SE patients was developed. Further studies should focus on external validity and including a range seizure types and duration of seizure as the predictors.

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“…By including information about this group, the present study complements previous prospective and retrospective trials on the treatment of SE. So far, we have identified only a few studies that considered the impact of comorbidities in the prognosis of SE [ 4 , 19 – 23 ].…”

Section: Discussionmentioning

confidence: 99%

Does diabetes mellitus affect the safety profile of valproic acid for the treatment of status epilepticus? A retrospective cohort study

Müller

Hofen-Hohloch

Awissus

et al. 2022

Neurol. Res. Pract.

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Background In the treatment of status epilepticus less is known about the influence of comorbidities on the safety profile of anticonvulsive drugs. Especially patients with diabetes mellitus may be predisposed to certain adverse events that have been related to therapy with valproic acid. In this single-center retrospective cohort study we examined if the complications of the intravenous treatment with valproic acid is different in patients with or without diabetes. Methods Patients who were treated for status epilepticus with intravenous valproic acid between 2008 and 2020 were identified. Primary endpoint was the discontinuation of therapy with valproic acid due to adverse events. Relevant secondary endpoints were the functional status at the time of discharge from hospital in comparison to the premorbid state and the in-hospital mortality. Both groups (patients with or without diabetes) were compared by Mann–Whitney U-Test or Pearson´s Chi2 test. To identify therapy with valproic acid as a risk factor of in-hospital mortality, a binary regression model was used. Results During the study period 408 patients and 482 episodes of status epilepticus were treated with intravenous valproic acid. Group comparisons did not reveal a significant difference in the rates of discontinuation of therapy. A difference was found in the rate of thrombocytopenia (p = 0.015), which occurred more often in patients with diabetes. In total, 36 hypoglycemic episodes could be identified, two occurred spontaneously under intravenous valproic acid. After correction for potential confounders, continuous therapy with valproic acid could not be confirmed as an independent risk factor for in-hospital mortality (p = 0.079). In patients with diabetes, the proportion of patients with a good functional state, indicated by the modified Rankin Scale, was significantly lower in both times (premorbid: 55% vs. 69%, p = 0.008; at discharge: 22% vs. 36%, p = 0.004). Conclusions Tolerability of the treatment with valproic acid was similar in patients with or without diabetes. Diabetes as a relevant comorbidity can signal a potentially increased risk of a poor outcome after status epilepticus. Trial registration: The study was registered at the German Clinical Trials Register on 8 April 2022 (DRKS 00,027,836).

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Predictors of long-term mortality in status epilepticus

Cited by 7 publications

References 24 publications

Long‐term outcome of convulsive status epilepticus: a 10‐year follow‐up

Long‐term outcome of convulsive status epilepticus: a 10‐year follow‐up

One- to 10-year Status Epilepticus Mortality (SEM) score after 30 days of hospital discharge: development and validation using competing risks analysis

Does diabetes mellitus affect the safety profile of valproic acid for the treatment of status epilepticus? A retrospective cohort study

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