Hypoalbuminemia in status epilepticus is a biomarker of short- and long-term mortality: A 9-year cohort study

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2024-12-22 DOI:10.1111/ene.16573

Francesco Misirocchi, Hervé Quintard, Andrea O. Rossetti, Irene Florindo, Oana E. Sarbu, Andreas Kleinschmidt, Karl Schaller, Margitta Seeck, Pia De Stefano

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Abstract

Background

Outcome prediction in Status epilepticus (SE) aids in clinical decision-making, yet existing scores have limitations due to SE heterogeneity. Serum albumin is emerging as a readily available prognostic biomarker in various clinical conditions. This study evaluates hypoalbuminemia in predicting short- and long-term mortality.

Methods

Observational cohort study including non-hypoxic SE adult patients admitted to the University Hospital of Geneva (Switzerland) between 2015 and 2023. Primary outcomes were in-hospital and 6-month mortality.

Results

Four hundred and ninety-six patients were included, 46 (9.3%) died in hospital; 6-month outcome was available for 364 patients, 86 (23.6%) were not alive at follow-up.

Hypoalbuminemia was associated with older age and patients' comorbidities. Binomial regression showed an independent correlation between hypoalbuminemia and short- (p = 0.005, OR = 3.35, 95% CI = 1.43–7.86) and long-term mortality (p = 0.001, OR = 3.59,95% CI = 1.75–7.35).

The Status Epilepticus Severity Score (STESS) had an overall AUC of 0.754 (95% CI = 0.656–0.836) for predicting in-hospital mortality and of 0.684 (95% CI = 0.613–0.755) for 6-month mortality. Through an exploratory analysis, we replaced age with hypoalbuminemia in the STESS, creating the Albumin-STESS (A-STESS) score (0–6). The global A-STESS AUC significantly improved for both in-hospital (0.837, 95% CI = 0.760–0.916, p = 0.002) and 6-month (0.739, 95% CI = 0.688–0.826; p = 0.033) mortality prediction. A-STESS-3 cutoff demonstrated a strong sensitivity-specificity balance for both in-hospital (sensitivity = 0.88, specificity = 0.68, accuracy = 0.70) and 6-month (sensitivity = 0.67, specificity = 0.73, accuracy = 0.72) mortality.

Conclusions

Hypoalbuminemia is an easily measurable biomarker reflecting the overall patient's condition and is independently related to short- and long-term SE mortality. Integrating hypoalbuminemia into the STESS (A-STESS) significantly enhances mortality prediction. Future studies are needed to externally validate the A-STESS and evaluate the benefits of albumin supplementation in SE patient prognosis.

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癫痫持续状态低白蛋白血症是短期和长期死亡率的生物标志物：一项为期9年的队列研究

背景：癫痫持续状态（SE）的预后预测有助于临床决策，但由于SE的异质性，现有评分存在局限性。血清白蛋白正在成为各种临床条件下易于获得的预后生物标志物。本研究评估了低白蛋白血症在预测短期和长期死亡率方面的作用。方法：观察性队列研究，纳入2015年至2023年瑞士日内瓦大学医院收治的非缺氧SE成年患者。主要结局是住院和6个月死亡率。结果：共纳入496例患者，其中46例（9.3%）在医院死亡；364例患者有6个月的结果，86例（23.6%）在随访时不存活。低白蛋白血症与年龄和患者合并症有关。二项回归显示低白蛋白血症与短期（p = 0.005, OR = 3.35, 95% CI = 1.43-7.86）和长期死亡率（p = 0.001, OR = 3.59,95% CI = 1.75-7.35）之间存在独立相关性。癫痫持续状态严重程度评分（ess）预测住院死亡率的总AUC为0.754 (95% CI = 0.656-0.836)，预测6个月死亡率的总AUC为0.684 （95% CI = 0.613-0.755）。通过探索性分析，我们用低白蛋白血症代替年龄，创建白蛋白-白蛋白评分（A-STESS）（0-6）。总体a - ess AUC在住院（0.837,95% CI = 0.76 -0.916, p = 0.002）和6个月(0.739,95% CI = 0.688-0.826；P = 0.033)死亡率预测。a - ess -3截止值对住院死亡率（敏感性= 0.88，特异性= 0.68，准确性= 0.70）和6个月死亡率（敏感性= 0.67，特异性= 0.73，准确性= 0.72）均显示出较强的敏感性-特异性平衡。结论：低白蛋白血症是一种容易测量的生物标志物，反映了患者的整体状况，并与短期和长期SE死亡率独立相关。将低白蛋白血症纳入ess （a - ess）可显著提高死亡率预测。未来的研究需要从外部验证a - ess，并评估补充白蛋白对SE患者预后的益处。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).