The ACARD score is a user-friendly tool developed to predict 30-day mortality after nonhypoxic SE and has the potential to identify participants at high risk of short-term mortality and outperform the performance of other available scoring systems.
Abstract
Background and Objectives Reliable prediction of short-term mortality in status epilepticus (SE) can contribute to guide clinical decisions. Current prognostic systems achieve only acceptable predictive power and show lack of generalizability or poor calibration. We aimed to identify clinical predictors of short-term mortality in patients with nonhypoxic SE and develop a predictive score. Methods This was a multicenter, multinational cohort study based on registry data. Participants were consecutive episodes of SE in participants aged 14 years or older from Modena (Italy) (derivation cohort) and in participants aged 18 years or older from Salzburg (Austria) (validation cohort). The predefined outcome was 30-day mortality after the onset of SE. Age, sex, level of consciousness before treatment, semiology of SE, level of disability at baseline before SE, etiology, and treatment refractoriness were assessed. Adjusted regression coefficients of each independent predictor were transformed to produce a points-based risk scoring system. Results The Italian cohort included 689 episodes, and the Austrian cohort comprised 569 episodes of SE. In the derivation cohort, the 30-day mortality rate was 27.3%. The independent risk factors were aged 75 years or older (odds ratio [OR] 5.52, 95% CI 3.45–8.83; p < 0.001), consciousness impairment (stuporous or comatose) before SE treatment (OR 1.76, 95% CI 1.09–2.82; p = 0.020), acute etiology due to primary CNS pathology (OR 2.60, 95% CI 1.60–4.23; p < 0.001), refractoriness to treatment (OR 6.40, 95% CI 3.91–10.46; p < 0.001), and disability before SE onset (OR 3.53, 95% CI 2.22–5.61; p < 0.001); remote etiology was independently associated with a lower likelihood of 30-day mortality (OR 0.28, 95% 0.13–0.61; p = 0.001). An integer-based scoring system termed Age, Consciousness, Aetiology, Refractoriness, Disability (ACARD) was developed by combining these independent predictors. In the validation cohort, the 30-day mortality rate was 11.6%. The area under the curve of the ACARD score was 0.864 (95% CI 0.836–0.891) in the derivation cohort and 0.845 (95% CI 0.801–0.888) in the validation cohort. Calibration plot indicated good fit of predicted and observed data in both cohorts. Discussion The ACARD score is a user-friendly tool developed to predict 30-day mortality after nonhypoxic SE. It has the potential to identify participants at high risk of short-term mortality and outperform the performance of other available scoring systems.
BACKGROUND & OBJECTIVES
Status epilepticus (SE) poses high risks of death and disability, yet most prognostic tools focus solely on mortality. The END-IT score is the only scale specifically developed to predict 3-month functional outcomes of SE. Hence, this study evaluated the performance of END-IT in adults with SE and explored additional predictors of 3-month functional outcomes.
METHODS
This prospective cohort study was conducted at a tertiary hospital in Egypt (August 2024-August 2025). Data collected included demographics, the Charlson Comorbidity Index (CCI), initial level of consciousness (as measured by the Glasgow Coma Scale [GCS] and FOUR score), seizure semiology, SE refractoriness, Status Epilepticus Severity Score (STESS), and all END-IT components. An unfavourable outcome was defined as a Modified Rankin Scale (mRS) score of 3-6 at the 3-month follow-up.
RESULTS
A total of 114 patients were enrolled (median age 33 years [IQR 17.75-54.25]). Most episodes were convulsive SE, while non-convulsive SE accounted for 4.4%. At 3 months, 55.3% had unfavourable outcomes, including 36.8% deaths. The sensitivity and specificity for unfavourable outcome prediction after 3 months for END-IT (≥3) = 0.524 and 0.843, respectively (Area under the curve = 0.747). The regression model revealed that higher CCI scores (OR = 2.06, 95% CI: 1.31-3.23, P = 0.002) and higher END-IT scores (OR = 1.67, 95% CI: 1.12-2.49, P = 0.013) were independently associated with unfavourable outcomes.
CONCLUSION
In this SE cohort, END-IT showed moderate prognostic performance for predicting 3-month functional outcomes. Incorporating comorbidity burden may enhance future prognostic models.
R. Magdy, N. Kishk, Ehab Shaker et al.· Epilepsy & Behavior· 0 citations
The STEPSS >2 shows a moderate predictive performance of functional outcomes in children with SE at discharge and at 3-month follow-up, with clinically useful sensitivity and specificity.
Sai Anjali Kambala, S. Sindgikar· International Journal of Epi...· 0 citations
Objectives To explore the risk factors impacting control of seizures in status epilepticus (SE) and to construct a valid nomogram for predicting the prognosis. Methods In this retrospective study, we analyzed the patients with SE who were hospitalized in Fujian Medical University Union Hospital from January 2017 to December 2022. Two separate groups of data are created: one for model development and the other for model validation. Results A total of 272 patients with SE were enrolled in this study, of which 89 had poorly-controlled seizures at discharge. Six potential risk predictors were identified through LASSO regression. After validation by univariate logistic regression (p < 0.01) and multivariate logistic regression (p < 0.05), four of the predictors: the classification of SE, the seizure type, respiratory complications, and circulatory complications, were confirmed as independent risk factors affecting seizure control in SE patients. The AUC of the predictive model was 0.829, that of validation was 0.710. Conclusion The proposed nomogram, constructed based on four independent risk factors, exhibits acceptable discriminative ability and clinical benefit. The risk of poorly-controlled seizures in individual SE patients can be predicted through the nomogram. The model may facilitate the early and timely identification of high-risk patients.
Zhenglin Huang, Shenggen Chen, Han-Bing Lin et al.· Frontiers in Neurology· 0 citations
PURPOSE
To evaluate clinical determinants of refractoriness and outcome in status epilepticus (SE) in a prospective low- and middle-income country (LMIC) cohort.
METHODS
In this single-centre prospective cohort study, 97 consecutive SE patients were classified as non-refractory status (NRSE, n = 50), refractory (RSE, n = 31), or super-refractory SE (SRSE, n = 16). A single 21 channel video-EEG was done within 24 h of presentation to the hospital. Clinical context, preexisting epilepsy history, etiology, Status Epilepticus Severity Score (STESS) and EEG findings were recorded, and outcome was assessed through in-hospital mortality.
RESULTS
The median age of our cohort was 32 years; most common etiologies were remote symptomatic (68%), acute symptomatic (19%) and progressive symptomatic (5%). Patients with drug-sensitive epilepsy (DSE) showed low refractoriness and mortality (29%, 6%), whereas drug-resistant epilepsy and new-onset status epilepticus (NOSE) were more likely to be refractory (68% and 70% respectively) and had higher mortality (26% and 30% respectively). Overall mortality was 16.5%, increasing stepwise from 4% (NRSE) to 13% (RSE) to 63% (SRSE; p < 0.001). STESS discriminated between non-survivors and survivors (median 3 vs 0; p < 0.001). Among 85 patients with available EEG, periodic discharges (PDs) were associated with 71% mortality (p < 0.001).
CONCLUSION
Status Epilepticus in the setting of DSE carries a favourable prognosis, while DRE and NOSE confer refractoriness. A short-term early EEG performed in the first 24 h is associated with refractoriness and its exact role warrants further studies.
S. Lodha, Babu Rao Challepalle, Shubho Acharya et al.· Epilepsy & Behavior· 0 citations
AIM
To investigate the determinants of physicians' therapeutic decision-making in status epilepticus (SE), with a focus on factors influencing the choice between therapeutic coma (TC) and less aggressive antiseizure medication (ASM) approaches, and to assess the impact of treatment intensity on clinical outcomes.
PRINCIPAL RESULTS
In this prospective multicenter study including 145 adult SE cases, refractory SE (RSE) occurred in 55%. TC was used in 47% of RSE patients and was preferentially applied to individuals with acute or potentially fatal etiologies, higher severity (STESS score), and intensive care unit admission at SE onset. Conversely, vascular and tumor-related SE were more often managed conservatively with multiple ASMs. Although TC-treated patients showed worse functional outcomes and higher mortality, these differences were not significant after adjustment for confounders, indicating that baseline disease severity largely accounted for outcome disparities. Etiology was the main factor influencing decisions to withdraw TC in RSE, whereas comorbidities and premorbid functional status guided decisions to withhold aggressive treatment. Semiology emerged as the primary determinant of treatment intensity, with less aggressive approaches involving multiple ASMs - still proving effective in a substantial proportion of cases - being reserved for patients with clinical presentations considered less harmful. EEG correlates were seldom cited as influential in treatment decisions and, when reported, were almost exclusively associated with decisions to withdraw therapy.
CONCLUSIONS
Treatment decisions in RSE are primarily driven by etiology, semiology, and premorbid functional status, rather than electrographic findings. TC is reserved for the most severe cases, and outcome differences between treatment strategies reflect underlying disease severity rather than treatment-related harm. Conservative ASM escalation remains effective in a substantial proportion of RSE patients.
M. Ferlisi, E. Greco, M. Casartelli-Liviero et al.· Epilepsy & Behavior· 0 citations
Background: Status Epilepticus (SE) is a neurological emergency with high morbidity and mortality. Accurate early predictions of death are essential to guide clinical management, especially in resource-constrained settings. STESS and m-STESS are assessment systems developed to stratify the severity of SE and predict short- and medium-term mortality.
Objective: This study aimed to compare the performance of STESS and m-STESS in predicting 7-day and 30-day mortality among SE patients and to evaluate their clinical utility in the emergency department.
Methods: A retrospective cohort study was conducted at Prof. Dr. R. D. Kandou Hospital Manado, Indonesia, including 90 patients diagnosed with SE. Clinical and demographic data were collected from medical records, including levels of consciousness, seizure type, previous history, and mRS scores. Predictive performance was analyzed using ROC curves, calculating sensitivity, specificity, positive and negative predictive values, and total accuracy. Comparisons between STESS and m-STESS were conducted for 7-day and 30-day mortality outcomes.
Results: The 7-day mortality rate was 35.6% and increased to 56.7% at 30 days. m-STESS showed higher sensitivity and accuracy (90.6%) (83.3% at 30 days) compared to STESS (82.2% at 30 days). ROC analysis showed m-STESS had superior predictive performance, especially for 30-day mortality, although the difference at 7 days was not statistically significant. Both scores correlated significantly with mortality, and higher scores were observed among patients who died.
Conclusion: m-STESS provides a more accurate tool for predicting SE mortality and can improve clinical decision-making in emergency settings. Further multicenter studies are recommended to validate and optimize the scoring system.
Patricia Tedja Hermanto, H. Khosama, Rizal Tumewah et al.· Glosains Jurnal Sains Global...· 0 citations
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