Complication Burden Index-A tool for comprehensive evaluation of the effect of complications on functional outcome
Leena Kämppi1, Jaakko Ritvanen1, Daniel Strbian1
1Clinical Neurosciences, Neurology, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
Insights
A new Complication Burden Index (CBI) tool helps assess systemic complications in status epilepticus. A CBI score greater than 3 effectively predicts poor functional outcomes and worse-than-baseline conditions in patients.
Area of Science:
- Neurology
- Critical Care Medicine
- Clinical Research
Background:
- Systemic complications are frequent in status epilepticus, impacting patient outcomes.
- Currently, no standardized tool exists to quantify the total burden of these complications.
- Assessing complication burden is crucial for understanding and predicting the prognosis of status epilepticus.
Purpose of the Study:
- To introduce and internally validate the Complication Burden Index (CBI) as a novel tool.
- To evaluate the CBI's ability to predict functional outcomes in patients with generalized convulsive status epilepticus (GCSE).
- To establish an optimal cutoff value for the CBI in predicting poor functional outcomes.
Main Methods:
- The Complication Burden Index (CBI) assesses 13 categories of systemic complications.
- A retrospective cohort of 70 adult GCSE patients was analyzed.
- Functional outcomes were assessed using the Glasgow Outcome Scale (GOS), and statistical analyses including relative risks and ROC curves were performed.
Main Results:
- The average CBI was 3.8, with a median of 3.
- A CBI cutoff value greater than 3 was associated with poor functional outcomes (GOS 1-3) and worse-than-baseline conditions.
- The CBI demonstrated significant predictive value for both outcomes (ROC-AUC for poor outcome: 0.687; for worse-than-baseline: 0.662).
Conclusions:
- The Complication Burden Index (CBI) is a novel and effective tool for comprehensively assessing systemic complications in status epilepticus.
- The CBI, particularly with a cutoff >3, can predict poor functional outcomes and worse-than-baseline conditions.
- This index aids clinicians in evaluating the overall impact of complications on patient prognosis in status epilepticus.
Abstract:
Systemic complications are common in status epilepticus. We have no tools to evaluate total burden of complications and its effect on the outcome of status epilepticus. For Complication Burden Index (CBI) a patient is assessed for 13 complication categories: respiratory, cardiovascular, nervous, renal, hepatic, coagulation, gastrointestinal and musculoskeletal systems, electrolyte/acid-base balance, infection, hypo-/hyperglycemia, skin/allergic reactions, and mental condition. Maximum CBI is 13. CBI was internally validated in a retrospective cohort of 70 consecutive adult patients with generalized convulsive status epilepticus (GCSE) treated in a tertiary hospital over a period of 2 years. Functional outcome at discharge was defined Poor for Glascow Outcome Scale (GOS) 1-3 or worse-than-baseline condition and Good for GOS >3 or return to baseline condition. Relative risks (RRs) and receiver-operating characteristic (ROC) -curves were calculated to obtain optimal cutoff. Functional outcome was poor in 40% and worse-than-baseline in 59%. In-hospital mortality was 7%. Average CBI was 3.8 (range 0-10, median 3). Cutoff value predicting poor functional outcome was a CBI >3 (GOS 1-3 RR 1.84, P = .045, 95% confidence interval [CI 1.01-3.33; ROC-AUC [area under the curve] 0.687, P = .008, sensitivity 64%, specificity 61%; worse-than-baseline condition RR 1.52, P = .04, 95% CI 1.02-2.26; ROC-AUC 0.662, P = .022, sensitivity 56%, specificity 69%). CBI with cutoff >3 and as a continuous variable was associated with GOS1-3 (P = .046, P = .002) and with worse-than-baseline condition (P = .041, P = .004). CBI is a novel tool for comprehensive assessment of status epilepticus complications predicting poor/worse-than-baseline functional outcome with cutoff >3.
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