From the Clinic for Intensive Care Medicine (R. Sutter, S.S., P.O., R. Spiegel, S.M.), Department of Neurology (R. Sutter, G.M.D.M., S.R.), and Medical Communication and Psychosomatic Medicine (S.H.), University Hospital Basel; Medical Faculty of the University of Basel (R. Sutter, G.M.D.M., S.H., S.R., S.M.), Switzerland; and Department of Neurology (P.W.K.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
Neurology. 2019 Apr 23;92(17):e1948-e1956. doi: 10.1212/WNL.0000000000007365. Epub 2019 Mar 27.
To uncover clinical characteristics leading to false outcome prediction of the Status Epilepticus Severity Score (STESS), a validated and broadly used clinical scoring system for outcome prediction in status epilepticus (SE).
From 2005 to 2016, adult patients with SE treated at the University Hospital Basel, Switzerland, were included. To assess independent associations of variables differing between patients with false and correct prediction of death (STESS ≥ 3), multivariable logistic regression models were computed using automated selection.
Among 467 patients, 12% died. The median STESS was 3 (interquartile range 2-4). Regarding prediction of death, the STESS was false-positive in 51% and false-negative in 1%. Patients surviving despite having a STESS ≥3 had less fatal etiologies, less nonconvulsive SE with coma, and lower Charlson Comorbidity Index, Simplified Acute Physiology Score II, and Acute Physiology and Chronic Health Evaluation II scores. In multivariable analyses, odds for survival were high with SE types other than nonconvulsive status with coma and low with an increasing Charlson Comorbidity Index in patients with a STESS ≥ 3 (odds ratio [OR] 4.23, 95% confidence interval [CI] 2.33-9.60; and OR 0.86, 95% CI 0.75-0.98). In patients with SE types other than nonconvulsive with coma, the STESS was mainly increased because they were frequently older than 65 years and had no seizure history.
The STESS frequently and inadequately predicts death especially in patients with SE other than nonconvulsive with coma and few comorbidities. Clinicians are urged to interpret a STESS ≥3 with caution in such patients.
揭示导致癫痫持续状态严重程度评分（STESS）错误预后预测的临床特征，STESS 是一种经过验证并广泛用于预测癫痫持续状态（SE）结局的临床评分系统。
2005 年至 2016 年，纳入瑞士巴塞尔大学医院治疗的成年 SE 患者。使用自动选择方法计算多变量逻辑回归模型，以评估患者之间的变量差异与死亡（STESS≥3）的预测的独立关联。
在 467 名患者中，有 12%死亡。STESS 的中位数为 3（四分位距 2-4）。关于死亡预测，STESS 的假阳性率为 51%，假阴性率为 1%。尽管 STESS≥3，但存活的患者具有较少的致命病因、较少的伴有昏迷的非惊厥性 SE，且Charlson 合并症指数、简化急性生理学评分 II 和急性生理学和慢性健康评估 II 评分较低。在多变量分析中，SE 类型为非惊厥性伴昏迷以外的患者存活的可能性较高，而 STESS≥3 的患者Charlson 合并症指数增加时存活的可能性较低（优势比[OR]4.23，95%置信区间[CI]2.33-9.60；和 OR 0.86，95% CI 0.75-0.98）。在 SE 类型为非惊厥性伴昏迷以外的患者中，STESS 增加主要是因为他们年龄常常超过 65 岁且没有癫痫发作史。
STESS 经常且不充分地预测死亡，尤其是在非惊厥性伴昏迷和合并症较少的 SE 患者中。临床医生在这些患者中解读 STESS≥3 时应谨慎。
