New neurological deficits increased the risk for long-term mortality among patients with status epilepticus (SE), according to study findings published in JAMA Neurology.
Among patients with SE, mortality after hospital discharge is substantially higher than inpatient mortality, however, risk factors for long-term mortality remain unclear. The researchers sought to evaluate risk factors for long-term mortality and to develop a prediction tool.
This retrospective, multicenter, multinational cohort study sourced data from university hospitals in Denmark, Norway, and Germany between 2008 and 2017. Patients with first-time, nonanoxic SE were evaluated for clinical characteristics and outcomes. Data from Denmark (n=261) were used to develop the ACD score and data from Norway (n=139) and Germany (n=906) were used to validate the score.
The Danish patient population was comprised 50.6% women, aged mean 67.2 (standard deviation [SD], 14.8) years, 48.7% had nonconvulsive epilepticus, 34.1% convulsive epilepticus, 17.2% had mixed epilepticus, the duration of SE was 5.7 (SD, 10.0) hours, 17.6% had in-hospital mortality, and 47.1% 2-year mortality.
Mortality at 2 years was associated with new neurological deficit (adjusted odds ratio [aOR], 3.9; 95% CI, 1.4-11.3; P =.03), older than age 65 years (aOR, 3.2; 95% CI, 1.2-8.6; P =.02), and Charlson comorbidity index (aOR, 1.2; 95% CI, 1.0-1.4; P =.04). Among only the subset of patients without defined electroclinical syndrome, 2-year mortality was associated with progressive central nervous system disorder (aOR, 20.1; 95% CI, 4.5-89.4; P <.001), new neurological deficit (aOR, 5.1; 95% CI, 2.2-11.8; P <.001), and older than 65 years (aOR, 3.8; 95% CI, 1.7-8.3; P =.001).
On the basis of these risk factors, the ACD (Age, Consciousness, Duration) score was based on patient characteristics and had a maximum score of 15, calculated as the sum of:
|Patient characteristics||ACD points|
|Age >40 years at diagnosis||2|
|Age >60 years at diagnosis||4|
|Age >80 years at diagnosis||6|
|Stuporous or comatose at presentation||2|
|SE lasting 1-2 hours||1|
|SE lasting 3-6 hours||2|
|SE lasting 7-19 hours||3|
|SE lasting 20-54 hours||4|
|SE lasting 55-149 hours||5|
|SE lasting 150-399 hours||6|
|SE lasting 400 hours||7|
Patients with an ACD score of 10 points had a significantly lower survival probability than patients with a score of 5-10 or less than 5 points (P <.001). Survival was also lower among patients with new neurological deficits (P =.007).
With a cutoff score of 10 points, the ACD score had a sensitivity of 0.63 and specificity of 0.82 for predicting 2-year mortality.
Among the validation cohorts, the ACD score had an area under the curve (AUC) for predicting long-term mortality of 0.700 and 0.689 among patients with mixed etiological SE and 0.763 and 0.733 among patients with SE that was not damaging or less damaging to the brain among the Norwegian and German cohorts, respectively.
Using a subset of patients from all three cohorts (n=792), cumulative survival was decreased among patients with ACD more than 10 points (both P <.001) and ACD score was related with mortality (R2, 0.848).
This study developed a novel predictive tool for long-term mortality among patients with SE.
“Accounting for risk factors for new neurological deficits using the ACD score is a reliable method of prediction of long-term outcome in patients with status epilepticus causes that were not damaging or were less damaging to the brain,” the researchers concluded.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Roberg LE, Monsson O, Kristensen SB, et al. Prediction of Long-term Survival After Status Epilepticus Using the ACD Score. JAMA Neurol. Published online April 11, 2022. doi:10.1001/jamaneurol.2022.0609