Prediction of in-hospital mortality in status epilepticus: Evaluation of four scoring tools in younger and older adult patients.

OBJECTIVE: The goal of this study was to evaluate the predictive capacity of four scoring tools: the Status Epilepticus Severity Score (STESS), the Encephalitis-NCSE-Diazepam resistance-Image abnormalities-Tracheal intubation (END-IT) score, and two variable combinations of the Epidemiology-based Mortality Score in Status Epilepticus (EMSE) in younger and older adult patients with status epilepticus (SE). METHODS: We present a retrospective hospital-based analysis with a focus on adult patients with SE at three tertiary care hospitals in the Zhejiang province of China. Data were collected from January 2013 to December 2018. The patients were divided into two groups: younger adult patients (18-64 years old) and older adult patients (≥65 years old). Clinical outcomes (dead or alive) were assessed at hospital discharge. The four scoring tools were used to predict in-hospital mortality in both younger and older adult patients. RESULTS: The mortality rate in older adult patients (25.4%) was higher than in younger adult patients (12.9%). Compared with the elderly, the younger adult patients had a higher proportion of encephalitis, while acute cerebrovascular disease and Charlson Complications Index (CCI) were lower. For the younger adult patients, END-IT had the largest area under the curve (AUC) of 0.843 (95% CI, 0.772-0.899), which was higher than the EMSE-EAL value of 0.687 (95% CI, 0.603-0.763, p < 0.05) and EMSE-EAC of 0.646 (95% CI, 0.561-0.725, p < 0.05). For the older adult patients, EMSE-EAL had the largest AUC of 0.843 (95% CI, 0.738-0.919), which was significantly higher than STESS with an AUC of 0.676 (95% CI, 0.554-0.782, p < 0.05). Moreover, the AUC of EMSE-EAL in the elderly was larger than in younger adult patients. The cutoffs in younger adult patients were STESS ≥ 4 (sensitivity 0.444, specificity 0.951), END-IT ≥ 3 (sensitivity 0.833, specificity 0.672), EMSE-EAL ≥ 31 (sensitivity 0.778, specificity 0.566), and EMSE-EAC ≥ 33 (sensitivity 0.833, specificity 0.492). However, the cutoffs in older adult patients were STESS ≥ 5 (sensitivity 0.500, specificity 0.925), END-IT ≥ 2 (sensitivity 0.944, specificity 0.547), EMSE-EAL ≥ 30 (sensitivity 0.944, specificity 0.623), and EMSE-EAC ≥ 31 (sensitivity 0.944, specificity 0.415). CONCLUSION: Our results indicated that the STESS, END-IT, EMSE-EAC, and EMSE-EAL scores have excellent capacity to predict in-hospital mortality in both younger and older adult patients with SE. Our study supports the use of END-IT in patients under 65 years of age and suggests that EMSE-EAL is the most suitable scoring tool for patients over 65.

Improving the ability to predict hospital mortality among adults by combining two status epilepticus outcome scoring tools.

OBJECTIVE: The goal of this study was to compare the predictive ability of the Status Epilepticus Severity Score (STESS), the Encephalitis-nonconvulsive status epilepticus (NCSE)-Diazepam resistance-Image abnormalities-Tracheal intubation (END-IT), and the combination of these two scoring tools to predict mortality among inhospital patients with status epilepticus (SE). METHODS: A retrospective analysis was conducted of adult patients with SE who were admitted to the neurology department, the emergency department, and the intensive care unit from January 2013 to December 2017. The patients were divided into two groups: survivors and nonsurvivors. The STESS data were obtained when the patient arrived at the hospital, and the END-IT data were collected 24 h after patients were initially treated in the hospital. The ability of the scoring tools to predict death in patients with SE, alone or in combination, was evaluated. RESULTS: A total of 123 patients with SE were included in the study, of which 22 died, for a mortality rate of 17.9%. The STESS and END-IT scores of nonsurvivors were both significantly higher than those of survivors (median STESS 4 vs. 2, p = 0.003; median END-IT 3 vs. 1, p < 0.001). The area under the receiver operating characteristic curve (AUC) was 0.698 for the STESS and 0.852 for the END-IT, and the cutoff values were 4 and 3, respectively. The AUC of the END-IT with the optimal cutoff value was larger than that of the STESS (p = 0.024). The sensitivity and specificity of combining the STESS and END-IT by the serial method (STESS ≥ 4∩END-IT ≥ 3) were 0.50 and 0.95, respectively, and the specificity was significantly higher than the STESS or END-IT (both p's < 0.001). The sensitivity and specificity of combining the STESS and END-IT by the parallel method (STESS ≥ 4⋃END-IT ≥ 3) were 0.91 and 0.53, respectively, and the sensitivity was higher than the STESS was (p = 0.016). CONCLUSION: Our results indicated that the combined score of the STESS and END-IT systems was a better predictor of survival of patients with SE than the scores of either the STESS system or the END-IT system alone and that combining the scores may be considered to be a new method for early identification of patients for both good and bad outcomes.