One- to 10-year Status Epilepticus Mortality (SEM) score after 30 days of hospital discharge: development and validation using competing risks analysis

Abstract

BackgroundStatus epilepticus (SE) is an emergency neurological disorder that affects quality of life and is associated with high mortality risk. Three scores have been developed to predict the risk of in-hospital death, but these scores are poor discrimination of mortality after discharge. This study aimed to develop and validate a simple risk score for long-term mortality in SE patients.MethodsThis retrospective cohort study was conducted using SE patient data collected from Thailand’s Universal Coverage Scheme database between the fiscal years of 2005 and 2015 and followed-up to 2016. Patients who died in hospital or within 30 days after discharge were excluded. Data were divided at random into either a derivation or validation set. A proportional hazards model for the sub-distribution of competing risks was fitted with backward stepwise method. The coefficients from the model were used to develop a point-based scoring system. The discrimination ability of the model was evaluated using a time-dependent receiver operating characteristic (ROC) curve.ResultsA total of 20,792 SE patients (with ages ranging from the first day of life to 99 years at first admission) were randomly separated into two groups: 13,910 in the development group and 6882 in the validation group. A sub-distribution hazard model was used to determine nine predictors to be included in the final model, which was, in turn, used to develop the scoring system: age (0–19 points), male (two points), brain tumor (12 points), stroke (three points), cancer (11 points), diabetes (three points), chronic kidney disease (five points), pneumonia (five points), and urinary tract infection (four points). The possible total score ranged from zero to 64 and the cumulative incidence function was used to determine the probability of mortality associated with each total score within the first 10 years after the first admission. The area under the ROC curve (AUC) of the first to last time point ranged from 0.760 to 0.738.ConclusionA nine-factor risk score for predicting 10-year mortality in SE patients was developed. Further studies should focus on external validity and including a range seizure types and duration of seizure as the predictors.

Prognostic scores in status epilepticus: A systematic review and meta‐analysis

“…A total of 10 069 citations were generated in our search, and 137 were identified as potentially relevant articles and underwent full‐text review for AUC analysis (Figure 1, Table S1). There are nine reported scores: STESS (Status Epilepticus Severity Score), 8 EMSE (Epidemiology‐based Mortality Score in Status Epilepticus), 10 ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation) score, 11 mSTESS (modified STESS), 3 nSTESS (newly modified STESS), 9 the score combining STESS and ENDIT, 12 the risk score based on Thailand national database, 13 SEM (Status Epilepticus Mortality) score, 14 and ACD (Age, level of Consciousness, Duration of SE) score 15 . Parameters of these prognostic scores of SE were presented in Table 1.…”

“…A Thailand research team conducted two studies based on a national database of over 20 000 SE patients and developed two scores to predict short-term (death at discharge or within 30 days after discharge) and long-term (10year mortality) outcomes. 13,14 Both scores are similar in that they include age, comorbidity, and SE complications, except that the long-term outcome score includes gender, whereas the short-term outcome score does not, and there are also slight differences in the specific types of comorbidity and SE complications. However, these two studies did not investigate the predictive values of some parameters regarding the characteristics of SE itself, such as the type, duration, medication, and treatment response of SE, possibly due to the lack of relevant data in the national database.…”

“…In 2018, Tiamkao et al developed a new risk score including age, comorbidities, and complications of SE, based on a large national database of over 20 000 patients with SE 13 . One year later, the same research team developed the Status Epilepticus Mortality (SEM) score based on the national database to predict 10‐year mortality of SE patients 14 . The latest prognostic score developed for SE is Age Consciousness Duration (ACD) score, which was designed to predict 2‐year survival in patients with SE causes that were not in itself damaging to the brain, such as remote symptomatic etiologies, insufficient adherence to medication, and alcohol withdrawal 15 …”

“…13 One year later, the same research team developed the Status Epilepticus Mortality (SEM) score based on the national database to predict 10-year mortality of SE patients. 14 The latest lower discriminative power. STESS-3 has the highest sensitivity, and STESS-4 the highest specificity, but neither combines acceptable sensitivity and specificity.…”

Severity scores for status epilepticus in the ICU: systemic illness also matters

“…To date, as many as ten prognostic scores have been developed for adult patients with SE: STESS [ 12 ], two modified scores based on STESS (mSTESS [ 32 ] and nSTESS [ 33 ]), EMSE score [ 13 ], ENDIT score [ 34 ], a new score combining STESS and ENDIT [ 35 ], two Thailand scores predicting short- and long-term outcomes based on the national SE database [ 36 , 37 ], Complication Burden Index (CBI) [ 38 ], and Age Consciousness Duration (ACD) score [ 39 ]. STESS and EMSE scores are the most widely used scores for status epilepticus and include quite different parameters.…”