Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after 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.

Long‐term prognosis related to deep sedation in refractory status Epilepticus

“…We also analyzed other factors that have been reported to be involved in prognosis. Surprisingly, our results show no significant difference in the etiology in contrast with previous studies, 14 as well as myopathy, respiratory failure, and hemodynamic instability in the acute-subacute phase. These findings remark once more the importance of DS in affecting the long-term prognosis, since complications do not play a major role there.…”

“…All new‐onset complications during hospital and ICU stay were collected separately. We further recoded them into the Complication Burden Index (CBI), 14 a 13‐item scale, in which each category scores 1 point if present up to a maximum of 13, being 3 the cutoff value, proposed by the authors, predicting poor prognosis.…”

Impact of co-morbidities on the mortality of patients with status epilepticus and the utility of RCBI score in evaluating the mortality of status epilepticus

“…In recent years, there have been many studies on the prognosis of status epilepticus, including a variety of scales and biological markers [3-5, 8, 11]. At present, five commonly used international scoring scales for predicting the prognosis of patients with status epilepticus include the epidemiology-based mortality scale in status epilepticus EMSE [3][4] ENDtracheal intubation scale END-IT [8] status epilepticus severity scale STESS [2,4] modified Rankin scale-status epilepticus severity scale mSTESS [11] and Complication Burden Index CBI [5].…”

“…Systemic complications are very common in patients with status epilepticus, and the types and number of complications may influence the prognosis of patients [5,[9][10][16][17][18][19]24]. In 2018, Leena et al [5] proposed the CBI and evaluated patients for 13 types of complications: respiratory system, cardiovascular system, nervous system, kidney, liver, coagulation function, gastrointestinal and musculoskeletal system, and electrolyte/acid-base balance, infection, hypoglycemia/hyperglycemia, skin/allergic reaction, and mental disorders. Using the receiver operating characteristic (ROC) curve, the maximum CBI scale was 13 points, the average CBI was 3.8 points, and the cutoff point for poor prediction function was 3 points [5].…”

“…In 2018, Leena et al [5] proposed the CBI and evaluated patients for 13 types of complications: respiratory system, cardiovascular system, nervous system, kidney, liver, coagulation function, gastrointestinal and musculoskeletal system, and electrolyte/acid-base balance, infection, hypoglycemia/hyperglycemia, skin/allergic reaction, and mental disorders. Using the receiver operating characteristic (ROC) curve, the maximum CBI scale was 13 points, the average CBI was 3.8 points, and the cutoff point for poor prediction function was 3 points [5]. The CBI scale established by Leena et al included a small number of patients, and only included convulsive epileptic patients with seizure time > 30 min.…”