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A Predictive Model for Short-Term Mortality After Status Epilepticus: The ACARD Score
Simona Lattanzi1, Eugen Trinka2,3,4, Pilar Bosque-Varela2,3
1Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
Neurology
|July 21, 2026
Summary
A new scoring system, the Age, Consciousness, Aetiology, Refractoriness, Disability (ACARD) score, accurately predicts 30-day mortality in nonhypoxic status epilepticus (SE). This tool helps identify high-risk patients, improving clinical decision-making for SE management.
Area of Science:
- Neurology
- Critical Care Medicine
- Epidemiology
Background:
- Status epilepticus (SE) poses a significant risk of short-term mortality.
- Existing prognostic systems for SE have limitations in accuracy, generalizability, and calibration.
- Predicting mortality in nonhypoxic SE is crucial for guiding clinical interventions.
Purpose of the Study:
- To identify clinical predictors of 30-day mortality in patients with nonhypoxic status epilepticus.
- To develop and validate a novel predictive scoring system for short-term mortality in SE.
Main Methods:
- A multicenter, multinational cohort study using registry data.
- Inclusion of consecutive SE episodes in adults (14+ years in Italy, 18+ years in Austria).
- Assessment of predictors including age, consciousness level, semiology, disability, etiology, and treatment refractoriness to develop the ACARD score.
Main Results:
- The ACARD score identified age (≥75 years), impaired consciousness, acute CNS pathology etiology, treatment refractoriness, and baseline disability as independent risk factors for 30-day mortality.
- Remote etiology was associated with lower mortality.
- The ACARD score demonstrated strong predictive performance (AUC 0.864 in derivation, 0.845 in validation) with good calibration.
Conclusions:
- The ACARD score is a user-friendly tool for predicting 30-day mortality in nonhypoxic SE.
- It shows potential to outperform existing scoring systems in identifying high-risk individuals.
- The ACARD score can aid in clinical decision-making for patients with SE.