Mortality prediction in status epilepticus with the APACHE II score

Area of Science:

• Critical Care Medicine
• Neurology
• Medical Statistics

Background:

• Status epilepticus (SE) is a neurological emergency requiring intensive care.
• Accurate prediction of in-hospital mortality is crucial for managing SE patients.
• The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is commonly used to assess severity but its utility in SE is unclear.

Purpose of the Study:

• To evaluate the predictive performance of the APACHE II score for in-hospital mortality in non-cardiac status epilepticus patients.
• To identify factors associated with mortality in this cohort.

Main Methods:

• Retrospective study of 104 adult ICU patients with non-cardiac status epilepticus.
• Assessment of four APACHE II scoring models: numerical, adjusted mortality, category, and category mortality.
• Multivariate analysis to identify independent predictors of mortality.

Main Results:

• The APACHE II score demonstrated poor calibration and discrimination for predicting mortality.
• Seizure etiology (toxic-metabolic) and seizure type (myoclonic) were initially associated with mortality.
• Only toxic-metabolic seizure etiology remained an independent predictor after multivariate adjustment.

Conclusions:

• The APACHE II score is not a reliable predictor of mortality in intensive care unit patients with status epilepticus.
• Further research is needed to develop improved measures of disease severity for status epilepticus.
• Toxic-metabolic etiologies are significantly associated with mortality in SE patients.