Factors related to in-hospital mortality in patients with refractory Status Epilepticus

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-06 DOI:10.1016/j.jocn.2025.111301

Miriam Paul-Arias , Daniel Vázquez-Justes , Javier Trujillano , Alejandro Quílez

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引用次数: 0

Abstract

Background

Status Epilepticus (SE) is a neurological emergency characterized by prolonged or recurrent seizures without recovery between episodes. SE is associated with high morbidity and mortality, especially when it becomes refractory.

SE is refractory (RSE) when it persists despite first-line and second-line antiseizure treatment. The factors related to mortality remain poorly understood.

Objective

Our objective was to analyze the factors related to in-hospital mortality in patients with RSE at our center.

Methods

We retrospectively reviewed patients with RSE who required hospitalization between 2019 and 2024. Patients with post-anoxic SE were excluded. Demographics, semiology, etiology and management data were obtained. We analyzed the relationship between different variables and in-hospital mortality. Variables related to mortality in the bivariate analysis were included in logistic regression analysis.

Results

Ninety-four patients with suspected RSE were hospitalized. Five were excluded due to post-anoxic SE and nine were not refractory SE. Finally, 80 patients were included.

The mean age was 60 (range 20–90). Forty-three (53.8%) were female. Thirty-two (40.0%) patients had previous diagnosis of epilepsy. Twenty-nine (36.3%) patients died during hospitalization.

In the bivariate analysis, factors related to mortality were older age, a history of cancer and chronic kidney disease, hemodynamic instability, renal failure, electrolyte disturbances, seizure recurrence, a history of previous epilepsy, acute symptomatic etiology and Status Epilepticus Severity Score (STESS) (all p < 0.05).

In multivariate analysis, age [OR 7.763 (CI 1.11–54.40)], hemodynamic instability [OR 23.41 (3.91–140.20)] and seizure recurrence [OR 20.97 (2.25–195.68)] were associated with in-hospital mortality. A past history of epilepsy was inversely related to mortality [OR 0.014 CI 95 % (0.005–0.550)]. A simple scoring system incorporating these variables predicted mortality better than STESS.

Conclusion

Complications during hospitalization, such as hemodynamic instability and seizure recurrence, appear to be important variables related to in-hospital mortality in patients with RSE. A previous history of epilepsy appears to be inversely related to mortality.

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难治性癫痫持续状态患者住院死亡率的相关因素

背景：癫痫持续状态（SE）是一种神经系统急症，其特征是长时间或反复发作，发作之间无恢复。SE的发病率和死亡率都很高，尤其是难治性SE。当SE在一线和二线抗癫痫治疗后仍然存在时，它是难治性的（RSE）。与死亡率有关的因素仍然知之甚少。目的分析本中心RSE患者住院死亡率的相关因素。方法回顾性分析2019 - 2024年间需要住院治疗的RSE患者。排除缺氧后SE患者。获得了人口统计学、符号学、病因学和管理数据。我们分析了不同变量与住院死亡率之间的关系。双变量分析中与死亡率相关的变量纳入逻辑回归分析。结果94例疑似RSE患者住院治疗。5例排除缺氧后SE， 9例排除非难治性SE。最终纳入80例患者。平均年龄60岁（20-90岁）。女性43例（53.8%）。32例（40.0%）患者既往有癫痫诊断。29例（36.3%）患者在住院期间死亡。在双变量分析中，与死亡率相关的因素是年龄较大、癌症和慢性肾脏疾病史、血液动力学不稳定、肾功能衰竭、电解质紊乱、癫痫复发、既往癫痫史、急性症状病因学和癫痫持续状态严重程度评分（ess）(所有p <；0.05)。在多因素分析中，年龄[OR 7.763 (CI 1.11-54.40)]、血流动力学不稳定[OR 23.41 (CI 3.91-140.20)]和癫痫发作复发[OR 20.97 (CI 2.25-195.68)]与住院死亡率相关。既往癫痫史与死亡率呈负相关[OR 0.014 CI 95%(0.005-0.550)]。一个包含这些变量的简单评分系统比压力更能预测死亡率。结论住院期间血流动力学不稳定、癫痫复发等并发症是影响RSE患者住院死亡率的重要因素。既往癫痫史似乎与死亡率呈负相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.