Refractory status epilepticus: Impact of baseline comorbidity and usefulness of STESS and EMSE scoring systems in predicting mortality and functional outcome.

Purpose: Little has been published on the prognostic value of the Status Epilepticus Severity Score (STESS) or the Epidemiology-based Mortality score in Status Epilepticus (EMSE) in refractory status epilepticus (RSE). We sought to analyze the prognostic value of STESS and EMSE and the impact of baseline comorbidities in mortality and functional outcome in RSE.

Methods: We designed an observational retrospective study of patients diagnosed with RSE between August 2013 and September 2017. For each patient, we analyzed prospectively recorded demographic, clinical, comorbidity, electroencephalographic, treatment, and hospital stay-related data and calculated STESS and EMSE. All variables were compared statistically between patients with good and poor functional outcome at discharge and between patients who died in hospital and those who were alive at discharge.

Results: Fourty-nine patients had RSE; 35.4% died in hospital and 88% showed functional decline at discharge. Mortality was associated with baseline chronic kidney disease (CKD) (OR 19.25, p = 0.006), baseline modified Rankin scale score (mRS) (OR 3.38, p = 0.005), non-convulsive status epilepticus (NCSE) with coma (OR 11.9, p = 0.04), STESS (OR 2, p = 0.04), and EMSE (OR 1.3, p = 0.02). Functional outcome was associated with baseline mRS (OR 13.9, p = 0.02), and EMSE (OR 1.3, p = 0.02). The optimal cutoff scores for predicting mortality were 4 for STESS and 60 for EMSE. EMSE predicted functional outcome with an optimal cutoff of 40.

Conclusions: CKD, NCSE with coma and STESS were associated with mortality. mRS and EMSE were associated with mortality and functional outcome. EMSE was useful for predicting functional outcome, while EMSE and STESS were useful for predicting in-hospital mortality.