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Predicting Mortality in Status Epilepticus: Elixhauser Comorbidity Index and SOFA in ICU
Dilek Agircan1, Adalet Gocmen21Department of Neurology, Harran Faculty of Medicine, Harran University, Sanliurfa, Turkey.2Department of Neurology, Sanliurfa Training And Research Hospital, Sanliurfa, Turkey.
INTRODUCTION: High mortality rates in status epilepticus (SE) within intensive care units (ICU) underscore the need for effective predictive scores to improve patient outcomes. While SE-specific scoring systems are commonly used, the role of comorbidity indices in mortality prediction is less explored. This study assesses the prognostic efficacy of various scoring systems in predicting hospital mortality among critically ill SE patients in the ICU.
METHODS: We conducted a retrospective analysis of 103 SE patients treated in the ICU at XXX University Medical Faculty Hospital from 2013 to 2023. Patients with myoclonic seizures due to cardiac arrest were excluded. The key scoring systems analyzed included the Elixhauser Comorbidity Index (ECI), Status Epilepticus Severity Score (STESS), Encephalitis, Non-convulsive SE, Diazepam resistance, Image abnormalities, and Time to first treatment (END-IT), Acute Physiology and Chronic Health Evaluation-II (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA), Modified Rankin scale (mRS) and Glasgow coma scale (GCS). Univariate and multivariate logistic regression, along with ROC curve analysis, were used to identify mortality predictors.
RESULTS: Out of 103 patients, 54 met the study criteria, with 29 (54%) hospital deaths. Univariate analysis identified ECI, mRS, GCS, STESS, END-IT, APACHE II, and SOFA as significant mortality predictors. Multivariate analysis showed that ECI and SOFA were strong independent predictors. SOFA had an AUC of 0.848, close to ECI's 0.875 in predicting mortality.
DISCUSSION AND CONCLUSION: ECI and SOFA scores emerged as superior predictors of mortality in ICU patients with SE, suggesting that a broader approach considering systemic illness and comorbidities is crucial for prognosis, beyond SE-specific scoring systems.
Manuscript Language: English