Evaluation and comparison of mortality scores in status epilepticus patients

TL;DR

This study compares different scoring systems to predict mortality in patients with status epilepticus, finding that general systemic scores perform better than epilepsy-specific ones.

Contribution

The study evaluates and compares the effectiveness of SE-specific and systemic severity scores in predicting mortality in status epilepticus patients.

Findings

The SOFA score had the highest performance in predicting mortality with an AUC of 0.81.

Systemic severity scores outperformed SE-specific scores like STESS and EMSE in mortality prediction.

None of the scoring systems alone or in combination could fully predict mortality in SE patients.

Abstract

Status epilepticus (SE) is a common neurological emergency associated with significant morbidity and mortality, with approximately one-third of patients demonstrating resistance to first-line treatment. Electroencephalography (EEG) plays a critical role not only in the diagnosis of SE but also in its monitoring and prognostication. This study aims to evaluate the performance of SE-specific severity scoring systems—Status Epilepticus Severity Score (STESS) and Epidemiology-Based Mortality Score in Status Epilepticus (EMSE)—in predicting mortality, in comparison with four widely used systemic severity scores: Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and the Inflammation, Nutrition, Consciousness, Neurologic function, and Systemic condition (INCNS) score. Furthermore, the effects on mortality of the Glasgow Coma Scale (GCS) for assessing level of consciousness, the age-adjusted Charlson Comorbidity Index (ACCI) for evaluating comorbidities, and the pre-SE Modified Rankin Scale (mRS) for measuring pre-existing morbidity will also be investigated.

A total of 200 status epilepticus (SE) episodes in 188 patients with available EEG data, followed over a four-year period, were included in the study. The sensitivity, specificity, accuracy, and area under the curve (AUC) of each scoring system were calculated and compared.

The SOFA score demonstrated the highest performance in predicting mortality (AUC = 0.81). Systemic severity scores such as SAPS II, SOFA, APACHE II, and INCNS were found to be more effective in predicting mortality than the SE-specific scores STESS and EMSE.

The evaluated scoring systems accounted for approximately 48% of mortality among adult SE patients; however, none were sufficient to predict mortality either alone or in combination. Therefore, there is a need for more specific prognostic scoring systems.

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