Potentially Surgical Digestive Complications in Patients With Status Epilepticus: Insights From the ICTAL Registry

To report the prevalence of potentially surgical digestive complications in critically ill patients with status epilepticus (SE), identify the associated factors, and study the association between digestive complications and mortality at hospital discharge.

Retrospective analysis of prospectively collected data.

Twenty-three ICUs.

Adults prospectively included in the ICTAL Registry between February 2018 and July 2025. Inclusion criteria were age 18 years or older and ICU admission for SE. Digestive complications were defined by severe clinical and/or radiologic findings suggestive of a need for surgical intervention, including bowel ileus, colonic dilatation, and/or gut ischemia. A propensity score identified factors associated with digestive complications. Logistic multivariable regression assessed predictors of hospital mortality.

None.

Among 1007 patients, 16 patients (1.6%) developed digestive complications (median age, 58 yr; 37.5% male) at a median of 5 days (interquartile range, 3-9 d) after SE onset. Surgery was required in six patients (37.5%). Paralytic ileus or colonic dilatation occurred in 13 patients (81.3%), and bowel or colonic ischemia in 7 (43.8%). Refractory SE (RSE) and its treatment (propofol, midazolam, thiopental, and ketamine) were significantly associated with digestive complications. In-hospital mortality was higher in patients with digestive complications (50.0% vs. 18.4%; p = 0.005). Digestive complications independently predicted mortality (odds ratio, 3.43; 95% CI, 1.13-10.21; p = 0.03).

Potentially surgical digestive complications in SE were rare but strongly associated with RSE and its treatment. These complications independently predicted hospital mortality.