Comparative analysis of APACHE II, STESS, and nSTESS scores, and a novel scale for mortality prediction in status...

Status epilepticus (SE) is a neurological emergency with high morbidity and mortality. While various clinical scales exist to predict mortality in SE, there is no consensus on their accuracy. The Acute Physiology and Chronic Health Evaluation (APACHE) II assesses general disease severity in intensive care units (ICU). Currently, no score combines this critical care assessment and current scales for mortality prediction.

We retrospectively analyzed SE patients admitted to our ICU between January 2016 and December 2023. Data included Status Epilepticus Severity Score (STESS), Newly Modified STESS (nSTESS), and APACHE II scores, with patients categorized into survivor and non-survivor groups. Variables identified through univariate analysis and clinical relevance from nSTESS and APACHE II were entered into logistic regression to develop the novel SPAA2 score.

Of 93 identified patients, 66 were included (mean age 58.1 ± 16.2 years; 54.5 % male). In-hospital mortality was 21.2 %, with generalized convulsive seizures being most common (51.5 %). APACHE II score, nSTESS, and SPAA2 revealed significant differences between survival and non-survival group (p < 0.001, p = 0.048, p < 0.001), while STESS did not (p = 0.189). APACHE II score, previous seizure history and anti-seizure medication use were independently associated with mortality (p = 0.001, p = 0.006 and p = 0.019). Receiver operating characteristic analysis revealed an area under the curve of 0.798 (APACHE II), 0.657 (nSTESS), 0.563 (STESS) and 0.879 (SPAA2). A SPAA2 cut-off ≥4 was identified for mortality prediction.

The SPAA2 score outperformed APACHE II, STESS, and nSTESS in predicting in-hospital mortality for ICU patients with SE, combining both critical care and SE-specific parameters. Further external validation is warranted.