Predictors of mortality at one year after generalized convulsive status epilepticus

Abstract

Background: Status epilepticus (SE) is a life-threatening neurologic emergency, which requires prompt medical treatment. Little is known of the long-term survival of SE. The aim of this study was to investigate which factors influence 90 days and 1-year mortality after SE. Materials and methods: This retrospective study includes all consecutive adult (N16 years) patients (N = 70) diagnosed with generalized convulsive SE (GCSE) in Helsinki University Central Hospital (HUCH) emergency department (ED) over 2 years. We defined specific factors including patient demographics, GCSE characteristics, treatment, complications, delays in treatment, and outcome at hospital discharge and determined their relation to 90 days and 1-year mortality after GCSE by using logistic regression models. Survival analyses at 1 year after GCSE were performed with Cox proportional hazards regression analysis. Results: In-hospital mortality was 7.1%. Mortality rate was 14.3% at 90 days and 24.3% at 1 year after GCSE. In the univariate logistic regression analysis, Status Epilepticus Severity Score N 4 (STESS) (ODDS = 7.30, p = 0.012), worse-than-baseline condition at hospital discharge (ODDS = 3.5, p = 0.006), long delays in attaining seizure freedom (ODDS = 2.2, p = 0.041), and consciousness (ODDS = 3.4, p = 0.014) were risk factors for mortality at 90 days whereas epilepsy (ODDS = 0.2, p = 0.014) and Glasgow Outcome Scale (GOS) N3 at hospital discharge (ODDS = 0.05, p = 0.006) were protective factors. Risk factors for mortality at 1 year were STESS N4 (ODDS = 5.1, p = 0.028), use of vasopressors (ODDS = 8.2, p = 0.049), and worse-than-baseline condition at discharge (ODDS = 7.8, p = 0.010) while GOS N3 (ODDS = 0.2, p = 0.005) was protective. The univariate survival analysis at 1 year confirmed the significant findings regarding parameters STESS N4 (Hazard ratio (HR) = 4.1, p = 0.009), worse-than-baseline condition (HR = 6.2, p = 0.015), GOS N 3 (HR = 0.2, p = 0.004) at hospital discharge and epilepsy (HR = 0.4, p = 0.044). Additionally, diagnostic delay over 6 h (HR = 3.8, p = 0.022) and Complication Burden Index (CBI) as an ordinal variable (0-2, 3-6, N6) (HR = 2.7, p = 0.027) were predictive for mortality. In the multivariate survival analysis, STESS N 4 (HR = 5.1, p = 0.007), CBI (HR = 3.2, p = 0.025, ordinal variable), diagnostic delay over 6 h (HR = 7.2, p = 0.003), and worse-than-baseline condition at hospital discharge (HR = 5.8, p = 0.027) were all independent risk factors for mortality at 1 year. Conclusions: Severe form of SE, delayed recognition of GCSE, high number of complications during treatment period, and poor condition at hospital discharge are all independent predictors of long-term mortality. Most of these factors are also associated with mortality at 90 days, though at that point, delays in treatment seem to have a greater impact on prognosis than at 1 year. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures

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

“…Studies on shortterm mortality after SE show mainly the same factors [12,[17][18][19][20]. However, a prior study, based on some of the patients of the present cohort, compared factors associated with mortality at 90 days and at one year after SE and showed that some predictive factors change over time, especially regarding delays in treatment [14]. This raises the question of how the predictive factors may alter further as more time passes.…”

“…Regarding previous research, the relevance of STESS on longterm mortality seems somewhat contradictory. STESS, with a cut‐off of 3 and 4, has been associated with poor long‐term outcome [11, 12, 14]. However, in one study, STESS was not a risk factor for mortality but some of its components were [10], and a few studies did not find any significance at all [8, 9, 36].…”

Recognition and treatment of status epilepticus in the prehospital setting

“…It has to be stressed that patients in treatment episodes of missed SE were more often discharged from hospital with a new deficit. Additionally we were not able to analyse the 1 year mortality, which may be increased, when patients are discharged with a new deficit [20]. Recently a new scale (ADAN scale) for the identification of SE in the prehospital setting was introduced that may be useful in the future.…”

Seizures, Status Epilepticus, and Continuous EEG in the Intensive Care Unit

“…Patients for whom these therapies fail because of continued seizures are commonly treated with anesthetic seizure suppression or burst suppression; however, no randomized controlled trials are available to guide drug selection or dose. Trends embracing therapies other than traditional anesthetics include increasing use of IV ketamine 25 and ketogenic or low-glycemic diet therapy, 28 in addition to rational polytherapy aimed at avoiding the complications of status epilepticus that are independently associated with mortality at 1 year 29 . In the absence of comparative effectiveness studies, the selection of antiseizure medications in refractory and super-refractory status epilepticus remains focused on rational polytherapy targeting different mechanisms of action while managing and preventing complications ( table 6-2 ).…”