Prediction of Mortality After Convulsive Status Epilepticus: The Status Epilepticus M 3 A 2 S 2 H Score

Abstract

Purpose

This study aimed to investigate in-patient mortality and predictors of death associated with convulsive status epilepticus (CSE) in a large nationwide cohort and create a simplified predictive score for in-hospital mortality.

Methods

Retrospective data from the National Inpatient Sample (NIS) database between 2007 and 2014 were analyzed, including 123,082 adults with CSE. Univariate logistic testing identified admission variables, neurological and medical complications associated with mortality. A simplified clinical prediction score, called M³A²S²H, was generated using variables that were frequent (>1%) and had a significant impact on mortality.

Results

The overall hospital mortality rate was 3.5%. Univariate analysis revealed that older age, female gender, past medical history, and acute hospital conditions were related to mortality. After reclassification, a final multivariable model with 27 clinical variables was constructed, and the eight strongest predictors were included in the M³A²S²H score: hypoxic-ischemic encephalopathy/cardiac arrest (2 points); age >60 years, acute symptomatic CSE, invasive mechanical ventilation, sepsis, metastases, and chronic liver failure (all 1 point); and medication nonadherence (−1 point). The mortality rate among patients with ≤0, 1, 2, 3, 4, or ≥5 of these risk factors progressively increased from 0.2%, 2.1%, 7.8%, 20.3%, 31.9%, to 50.0% (P < 0.0001). Additionally, a similar stepwise trend was observed regarding discharge to a facility versus home without services (P < 0.0001).

Conclusions

This study demonstrates that mortality in CSE cases occurs in 3.5% of adult hospital admissions. Identification of specific acute and chronic conditions using the standardized M³A²S²H score can help predict the risk of death or disability even in hospitals without advanced brain monitoring.