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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Prediction of functional outcome in patients with convulsive status epilepticus: the END-IT score

Authors: Qiong Gao, Tang-peng Ou-Yang, Xiao-long Sun, Feng Yang, Chen Wu, Tao Kang, Xiao-gang Kang, Wen Jiang

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Prediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge. The aim of this study was to characterize the prognostic factors and functional outcomes of patients after CSE in order to develop a practicable scoring system for outcome prediction.

Methods

We performed a retrospective explorative analysis on consecutive patients diagnosed with CSE between March, 2008 and November, 2014 in a tertiary academic medical center in northwest China. The modified Rankin Scale (mRS) was used to measure the functional outcome at three months post discharge.

Results

A total of 132 CSE patients was included, with a median age of 25.5 years and 60.6 % were male. Three months post discharge, an unfavorable outcome with mRS of 3–6 was seen in 62 (47.0 %) patients, 25 (18.9 %) of whom died. Logistic regression analysis revealed that encephalitis (p = 0.029), nonconvulsive SE (p = 0.018), diazepam resistance (p = 0.005), image abnormalities (unilateral lesions, p = 0.027; bilateral lesions or diffuse cerebral edema, p < 0.001) and tracheal intubation (p = 0.032) were significant independent predictors for unfavorable outcomes. Based on the coefficients in the model, these predictors were assigned a value of 1 point each, with the exception of the image, creating a 6-point scoring system, which we refer to as END-IT, for the outcome prediction of CSE. The area under the receiver operating characteristic curve for the END-IT score was 0.833 and using a cut-off point of 3 produced the highest sum sensitivity (83.9 %) and specificity (68.6 %). Compared with status epilepticus severity score (STESS) and Epidemiology-based Mortality score in SE (EMSE), END-IT score showed better discriminative power and predictive accuracy for the outcome prediction.

Conclusions

We developed an END-IT score with a strong discriminative power for predicting the functional outcome of CSE patients. External prospective validation in different cohorts is needed for END-IT score.
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Literature
1.
2.
Neligan A, Shorvon SD. Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol. 2010;67:931–40.PubMed
3.
Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology. 1993;43:483–8.CrossRefPubMed
4.
Aminoff MJ, Simon RP. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980;69:657–66.CrossRefPubMed
5.
Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status epilepticus severity score (STESS): A tool to orient early treatment strategy. J Neurol. 2008;255:1561–6.CrossRefPubMed
6.
Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adults. Neurology. 2006;66:1736–8.CrossRefPubMed
7.
Leitinger M, Holler Y, Kalss G, Rohracher A, Novak HF, Hofler J, et al. Epidemiology-based mortality score in status epilepticus (EMSE). Neurocrit Care. 2015;22:273–82.CrossRefPubMed
8.
Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia. 1993;34:592–6.
9.
Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia. 1994;35:27–34.CrossRefPubMed
10.
Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3–23.CrossRefPubMed
11.
Kalviainen R. Status epilepticus treatment guidelines. Epilepsia. 2007;48(8 Suppl):S99–S102.CrossRef
12.
Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013;54(6 Suppl):S28–9.CrossRef
13.
Chen L, Zhou B, Li JM, Zhu Y, Wang JH, Sander JW, et al. Clinical features of convulsive status epilepticus: a study of 220 cases in western China. Eur J Neurol. 2009;16:444–9.CrossRefPubMed
14.
Jayalakshmi S, Ruikar D, Vooturi S, Alladi S, Sahu S, Kaul S, et al. Determinants and predictors of outcome in super refractory status epilepticus--a developing country perspective. Epilepsy Res. 2014;108:1609–17.CrossRefPubMed
15.
Li Y, Tian L, Zeng T, Chen J, Chen L, Zhou D. Clinical features and outcome of super-refractory status epilepticus: a retrospective analysis in West China. Seizure. 2014;23:722–7.CrossRefPubMed
16.
Zhou B, Huang Y, Wang J, Zou Z, Chen L, Li J, et al. The aetiology of convulsive status epilepticus: a study of 258 cases in Western China. Seizure. 2014;23:717–21.CrossRefPubMed
17.
Kariuki SM, Kakooza-Mwesige A, Wagner RG, Chengo E, White S, Kamuyu G, et al. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology. 2015;84:1838–45.PubMedCentralCrossRefPubMed
18.
Prasad A, Worrall BB, Bertram EH, Bleck TP. Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia. 2001;42:380–6.CrossRefPubMed
19.
Stecker MM, Kramer TH, Raps EC, O'Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia. 1998;39:18–26.CrossRefPubMed
20.
Logroscino G, Hesdorffer DC, Cascino GD, Annegers JF, Bagiella E, Hauser WA. Long-term mortality after a first episode of status epilepticus. Neurology. 2002;58:537–41.CrossRefPubMed
21.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
22.
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.CrossRefPubMed
23.
24.
Rossetti AO, Hurwitz S, Logroscino G, Bromfield EB. Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry. 2006;77:611–5.PubMedCentralCrossRefPubMed
25.
Chin RF, Nevillea BG, Scotta RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11:800–10.CrossRefPubMed
26.
Koubeissi M, Alshekhlee A. In-hospital mortality of generalized convulsive status epilepticus: a large US sample. Neurology. 2007;69:886–93.CrossRefPubMed
27.
Maganti R, Gerber P, Drees C, Chung S. Nonconvulsive status epilepticus. Epilepsy Behav. 2008;12:572–86.CrossRefPubMed
28.
Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007;6:329–39.CrossRefPubMed
29.
DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39:833–40.CrossRefPubMed
30.
Sutter R, Kaplan PW, Ruegg S. Outcome predictors for status epilepticus--what really counts. Nat Rev Neurol. 2013;9:525–34.CrossRefPubMed
31.
Legriel S, Mourvillier B, Bele N, Amaro J, Fouet P, Manet P, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34:476–80.CrossRefPubMed
32.
33.
Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012;135:2314–28.CrossRefPubMed
34.
Legriel S, Azoulay E, Resche-Rigon M, Lemiale V, Mourvillier B, Kouatchet A, et al. Functional outcome after convulsive status epilepticus. Crit Care Med. 2010;38:2295–303.CrossRefPubMed
35.
36.
Hocker S, Wijdicks EF, Rabinstein AA. Refractory status epilepticus: new insights in presentation, treatment, and outcome. Neurol Res. 2013;35:163–8.CrossRefPubMed
37.
Sutter R, Tschudin-Sutter S, Grize L, Fuhr P, Bonten MJ, Widmer AF, et al. Associations between infections and clinical outcome parameters in status epilepticus: a retrospective 5-year cohort study. Epilepsia. 2012;53:1489–97.CrossRefPubMed
38.
Kilbride RD, Reynolds AS, Szaflarski JP, Hirsch LJ. Clinical outcomes following prolonged refractory status epilepticus (PRSE). Neurocrit Care. 2013;18:374–85.CrossRefPubMed
39.
Correale J, Rabinowicz AL, Heck CN, Smith TD, Loskota WJ, DeGiorgio CM. Status epilepticus increases CSF levels of neuron-specific enolase and alters the blood–brain barrier. Neurology. 1998;50:1388–91.CrossRefPubMed
40.
DeGiorgio CM, Correale JD, Gott PS, Ginsburg DL, Bracht KA, Smith T, et al. Serum neuron-specific enolase in human status epilepticus. Neurology. 1995;45:1134–7.CrossRefPubMed
41.
DeGiorgio CM, Gott PS, Rabinowicz AL, Heck CN, Smith TD, Correale JD. Neuron-specific enolase, a marker of acute neuronal injury, is increased in complex partial status epilepticus. Epilepsia. 1996;37:606–9.CrossRefPubMed
42.
DeGiorgio CM, Heck CN, Rabinowicz AL, Gott PS, Smith T, Correale J. Serum neuron-specific enolase in the major subtypes of status epilepticus. Neurology. 1999;52:746–9.CrossRefPubMed
Metadata
Title
Prediction of functional outcome in patients with convulsive status epilepticus: the END-IT score
Authors
Qiong Gao
Tang-peng Ou-Yang
Xiao-long Sun
Feng Yang
Chen Wu
Tao Kang
Xiao-gang Kang
Wen Jiang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1221-9

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