Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus

Harald Settergren Møller, Emmely Rodin, Preben Aukland, Martin Lando, Elsebeth Bruun Christiansen, Christoph Patrick Beier

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background/Objective: Status epilepticus (SE) is a life-threatening condition with a high long-term mortality. The correct prediction of the individual patient’s outcome is crucial for stratifying treatment. Status epilepticus severity score (STESS) and the epidemiology-based mortality score (EMSE) are well established for predicting in-hospital mortality; however, scores indicating long-term mortality are lacking. We here studied the association of both scores with mortality after discharge and long-term mortality. Methods: In this retrospective cohort study of adult patients with incident, non-anoxic, first-time SE (from 01/2008 to 12/2014), STESS, EMSE-EACE (etiology-age-comorbidity-EEG), demographic data, modified Rankin Scale at discharge, treatment, date of diagnosis, and date of death were determined based on electronic patients charts. Results: A total of 129 patients with a median follow-up of 24.8 months were included. We found no significant difference between STESS and EMSE-EACE in predicting in-hospital and 3 months mortality. At end-of-study, EMSE-EACE with a cutoff of ≥ 64 showed the best association with overall survival. At last follow-up, only 15.7% (8 out of 51) of the patients with EMSE ≥ 64 were alive as compared to 32.4% (24 out of 74) of the patients with STESS ≥ 3. Median survival of patients with EMSE-EACE ≥ 64 and EMSE-EACE < 64 was 6.4 months (95% confidence interval (CI) 2.3–15.3 months) and 35.8 months (CI 32.8–37.9 months), respectively. In the subgroup of patients that were discharged alive from the hospital, EMSE-EACE was highly significantly associated with mortality (p < 0.001) after discharge. In the same patients, STESS with a cutoff of STESS ≥ 3 reached only borderline significance (p = 0.04), STESS with a cutoff of STESS ≥ 4 did not reach statistical significance (p = 0.23). Exploratory analyses of different EMSE components unveiled a strong association of etiology with in-house mortality but not with long-term survival. In patients discharged alive from the hospital, only comorbidity and age remained significantly associated with long-term mortality. Conclusions: In our cohort, EMSE-EACE was significantly associated with long-term survival after discharge.

OriginalsprogEngelsk
TidsskriftNeurocritical Care
Vol/bind31
Udgave nummer1
Sider (fra-til)135-141
ISSN1556-0961
DOI
StatusUdgivet - 15. aug. 2019

Fingeraftryk

Epidemiology
Hospital Mortality
Comorbidity
Confidence Intervals
Electroencephalography
Cohort Studies
Retrospective Studies

Citer dette

Møller, Harald Settergren ; Rodin, Emmely ; Aukland, Preben ; Lando, Martin ; Christiansen, Elsebeth Bruun ; Beier, Christoph Patrick. / Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus. I: Neurocritical Care. 2019 ; Bind 31, Nr. 1. s. 135-141.
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title = "Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus",
abstract = "Background/Objective: Status epilepticus (SE) is a life-threatening condition with a high long-term mortality. The correct prediction of the individual patient’s outcome is crucial for stratifying treatment. Status epilepticus severity score (STESS) and the epidemiology-based mortality score (EMSE) are well established for predicting in-hospital mortality; however, scores indicating long-term mortality are lacking. We here studied the association of both scores with mortality after discharge and long-term mortality. Methods: In this retrospective cohort study of adult patients with incident, non-anoxic, first-time SE (from 01/2008 to 12/2014), STESS, EMSE-EACE (etiology-age-comorbidity-EEG), demographic data, modified Rankin Scale at discharge, treatment, date of diagnosis, and date of death were determined based on electronic patients charts. Results: A total of 129 patients with a median follow-up of 24.8 months were included. We found no significant difference between STESS and EMSE-EACE in predicting in-hospital and 3 months mortality. At end-of-study, EMSE-EACE with a cutoff of ≥ 64 showed the best association with overall survival. At last follow-up, only 15.7{\%} (8 out of 51) of the patients with EMSE ≥ 64 were alive as compared to 32.4{\%} (24 out of 74) of the patients with STESS ≥ 3. Median survival of patients with EMSE-EACE ≥ 64 and EMSE-EACE < 64 was 6.4 months (95{\%} confidence interval (CI) 2.3–15.3 months) and 35.8 months (CI 32.8–37.9 months), respectively. In the subgroup of patients that were discharged alive from the hospital, EMSE-EACE was highly significantly associated with mortality (p < 0.001) after discharge. In the same patients, STESS with a cutoff of STESS ≥ 3 reached only borderline significance (p = 0.04), STESS with a cutoff of STESS ≥ 4 did not reach statistical significance (p = 0.23). Exploratory analyses of different EMSE components unveiled a strong association of etiology with in-house mortality but not with long-term survival. In patients discharged alive from the hospital, only comorbidity and age remained significantly associated with long-term mortality. Conclusions: In our cohort, EMSE-EACE was significantly associated with long-term survival after discharge.",
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Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus. / Møller, Harald Settergren; Rodin, Emmely; Aukland, Preben; Lando, Martin; Christiansen, Elsebeth Bruun; Beier, Christoph Patrick.

I: Neurocritical Care, Bind 31, Nr. 1, 15.08.2019, s. 135-141.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus

AU - Møller, Harald Settergren

AU - Rodin, Emmely

AU - Aukland, Preben

AU - Lando, Martin

AU - Christiansen, Elsebeth Bruun

AU - Beier, Christoph Patrick

PY - 2019/8/15

Y1 - 2019/8/15

N2 - Background/Objective: Status epilepticus (SE) is a life-threatening condition with a high long-term mortality. The correct prediction of the individual patient’s outcome is crucial for stratifying treatment. Status epilepticus severity score (STESS) and the epidemiology-based mortality score (EMSE) are well established for predicting in-hospital mortality; however, scores indicating long-term mortality are lacking. We here studied the association of both scores with mortality after discharge and long-term mortality. Methods: In this retrospective cohort study of adult patients with incident, non-anoxic, first-time SE (from 01/2008 to 12/2014), STESS, EMSE-EACE (etiology-age-comorbidity-EEG), demographic data, modified Rankin Scale at discharge, treatment, date of diagnosis, and date of death were determined based on electronic patients charts. Results: A total of 129 patients with a median follow-up of 24.8 months were included. We found no significant difference between STESS and EMSE-EACE in predicting in-hospital and 3 months mortality. At end-of-study, EMSE-EACE with a cutoff of ≥ 64 showed the best association with overall survival. At last follow-up, only 15.7% (8 out of 51) of the patients with EMSE ≥ 64 were alive as compared to 32.4% (24 out of 74) of the patients with STESS ≥ 3. Median survival of patients with EMSE-EACE ≥ 64 and EMSE-EACE < 64 was 6.4 months (95% confidence interval (CI) 2.3–15.3 months) and 35.8 months (CI 32.8–37.9 months), respectively. In the subgroup of patients that were discharged alive from the hospital, EMSE-EACE was highly significantly associated with mortality (p < 0.001) after discharge. In the same patients, STESS with a cutoff of STESS ≥ 3 reached only borderline significance (p = 0.04), STESS with a cutoff of STESS ≥ 4 did not reach statistical significance (p = 0.23). Exploratory analyses of different EMSE components unveiled a strong association of etiology with in-house mortality but not with long-term survival. In patients discharged alive from the hospital, only comorbidity and age remained significantly associated with long-term mortality. Conclusions: In our cohort, EMSE-EACE was significantly associated with long-term survival after discharge.

AB - Background/Objective: Status epilepticus (SE) is a life-threatening condition with a high long-term mortality. The correct prediction of the individual patient’s outcome is crucial for stratifying treatment. Status epilepticus severity score (STESS) and the epidemiology-based mortality score (EMSE) are well established for predicting in-hospital mortality; however, scores indicating long-term mortality are lacking. We here studied the association of both scores with mortality after discharge and long-term mortality. Methods: In this retrospective cohort study of adult patients with incident, non-anoxic, first-time SE (from 01/2008 to 12/2014), STESS, EMSE-EACE (etiology-age-comorbidity-EEG), demographic data, modified Rankin Scale at discharge, treatment, date of diagnosis, and date of death were determined based on electronic patients charts. Results: A total of 129 patients with a median follow-up of 24.8 months were included. We found no significant difference between STESS and EMSE-EACE in predicting in-hospital and 3 months mortality. At end-of-study, EMSE-EACE with a cutoff of ≥ 64 showed the best association with overall survival. At last follow-up, only 15.7% (8 out of 51) of the patients with EMSE ≥ 64 were alive as compared to 32.4% (24 out of 74) of the patients with STESS ≥ 3. Median survival of patients with EMSE-EACE ≥ 64 and EMSE-EACE < 64 was 6.4 months (95% confidence interval (CI) 2.3–15.3 months) and 35.8 months (CI 32.8–37.9 months), respectively. In the subgroup of patients that were discharged alive from the hospital, EMSE-EACE was highly significantly associated with mortality (p < 0.001) after discharge. In the same patients, STESS with a cutoff of STESS ≥ 3 reached only borderline significance (p = 0.04), STESS with a cutoff of STESS ≥ 4 did not reach statistical significance (p = 0.23). Exploratory analyses of different EMSE components unveiled a strong association of etiology with in-house mortality but not with long-term survival. In patients discharged alive from the hospital, only comorbidity and age remained significantly associated with long-term mortality. Conclusions: In our cohort, EMSE-EACE was significantly associated with long-term survival after discharge.

KW - EMSE

KW - Long-term mortality

KW - STESS

KW - Status epilepticus

U2 - 10.1007/s12028-018-0663-0

DO - 10.1007/s12028-018-0663-0

M3 - Journal article

VL - 31

SP - 135

EP - 141

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 1

ER -