Kang Bong Su, Kim Dong Wook, Kim Kwang Ki, Moon Hye Jin, Kim Young-Soo, Kim Hyun Kyung, Lee Seo-Young, Koo Yong Seo, Shin Jung-Won, Moon Jangsup, Sunwoo Jun-Sang, Byun Jung-Ick, Cho Yong Won, Jung Ki-Young, Chu Kon, Lee Sang Kun
Department of Neurology, Korea University Anam Hospital, Seoul, South Korea.
Department of Neurology, Konkuk University School of Meidcine, Seoul, South Korea.
Crit Care. 2016 Jan 27;20:25. doi: 10.1186/s13054-016-1190-z.
Two clinical scoring systems, the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE), are used to predict mortality in patients with status epilepticus (SE). The aim of this study was to compare the outcome-prediction function of the two scoring systems regarding in-hospital mortality using a multicenter large cohort of adult patients with SE. Moreover, we studied the potential role of these two scoring systems in predicting the functional outcome in patients with SE.
The SE cohort consisted of patients from the epilepsy centers of eight academic tertiary medical centers in South Korea. The clinical and electroencephalography data for all adult patients with SE from January 2013 to December 2014 were derived from a prospective SE database. The primary outcome variable was defined as in-hospital death. The secondary outcome variable was defined as a poor functional outcome, i.e., a score of 1-3 on the Glasgow Outcome Scale, at discharge.
Among the 120 non-hypoxic patients with SE recruited into the study, 16 (13.3%) died in the hospital and 64 (53.3%) were discharged with a poor functional outcome. The receiver-operating characteristic (ROC) curve for prediction of in-hospital death based on the STESS had an area under the curve of 0.673 with an optimal cutoff value for discrimination (best match for both sensitivity (0.56) and specificity (0.70)) that was ≥ 4 points. The two combinations of elements of the EMSE system (EMSE-ALDEg and EMSE-ECLEg) predicted not only in-hospital mortality with the best match for sensitivity (more than 0.6) and specificity (more than 0.6), but also a poor functional outcome with the best match for both sensitivity (>0.7) and specificity (>0.6). STESS did not predict a poor functional outcome (area under the ROC, 0.581; P = 0.23).
Although the EMSE is a clinical scoring system that focuses on individual mortality, we did not find differences between the EMSE and STESS in the prediction of in-hospital death. The EMSE was useful in predicting poor functional outcome, as it was significantly better than STESS.
两种临床评分系统，即癫痫持续状态严重程度评分（STESS）和癫痫持续状态基于流行病学的死亡率评分（EMSE），用于预测癫痫持续状态（SE）患者的死亡率。本研究的目的是使用多中心大型成年SE患者队列，比较这两种评分系统在预测住院死亡率方面的预后预测功能。此外，我们研究了这两种评分系统在预测SE患者功能结局方面的潜在作用。
SE队列由韩国8家学术三级医疗中心癫痫中心的患者组成。2013年1月至2014年12月所有成年SE患者的临床和脑电图数据来自前瞻性SE数据库。主要结局变量定义为住院死亡。次要结局变量定义为出院时功能结局不良，即格拉斯哥结局量表评分为1 - 3分。
在纳入研究的120例非缺氧性SE患者中，16例（13.3%）在医院死亡，64例（53.3%）出院时功能结局不良。基于STESS预测住院死亡的受试者操作特征（ROC）曲线下面积为0.673，具有≥4分的最佳判别临界值（灵敏度（0.56）和特异度（0.70）的最佳匹配）。EMSE系统的两种要素组合（EMSE - ALDEg和EMSE - ECLEg）不仅以最佳匹配的灵敏度（超过0.6）和特异度（超过0.6）预测住院死亡率，而且以最佳匹配的灵敏度（>0.7）和特异度（>0.6）预测功能结局不良。STESS不能预测功能结局不良（ROC曲线下面积，0.581；P = 0.23）。
尽管EMSE是一个侧重于个体死亡率的临床评分系统，但我们未发现EMSE和STESS在预测住院死亡方面存在差异。EMSE在预测功能结局不良方面很有用，因为它明显优于STESS。
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