title: Early predictors of status epilepticus-associated mortality and morbidity in children.
abstract: BACKGROUND
  Early predictors of status epilepticus (SE)-associated mortality and morbidity have not been systematically studied in children, considerably impeding the identification of patients at risk.
  
  
  OBJECTIVE
  To determine reliable early predictors of SE-associated mortality and morbidity and identify the etiology of SE-associated sequelae in Japanese children.
  
  
  METHODS
  We conducted a prospective multicenter study of clinical findings and initial laboratory data acquired at SE onset, and assessed outcomes at the last follow-up examination. In-hospital death during the acute period and neurological sequelae were classified as poor outcomes.
  
  
  RESULTS
  Of the 201 children who experienced their first SE episode, 16 exhibited poor outcome that was most commonly associated with acute encephalopathy. Univariate analysis revealed that the following were associated with poor outcomes: young age (⩽24 months); seizure duration >90 min; seizure intractability (failure of the second anticonvulsive drug); biphasic seizures; abnormal blood glucose levels (<61 or >250 mg/dL); serum aspartate aminotransferase (AST) ⩾56 U/L; and C-reactive protein (CRP) levels >2.00 mg/dL. Multivariate analysis revealed that young age, seizure intractability, abnormal blood glucose levels, and elevated AST and CRP levels were statistically significant.
  
  
  CONCLUSIONS
  Young age and seizure intractability were highly predictive of poor outcomes in pediatric SE. Moreover, abnormal blood glucose levels and elevated AST and CRP levels were predictors that might be closely associated with the etiology, especially acute encephalopathy and severe bacterial infection (sepsis and meningitis) in Japanese children.
authors.affiliation: Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan. Electronic address: maegaki@med.tottori-u.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maegaki
authors.affiliation: Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kurozawa
authors.affiliation: Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamasaki
authors.affiliation: Tottori Prefecture Central Hospital, Tottori, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Togawa
authors.affiliation: Tottori Prefecture Central Hospital, Tottori, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamura
authors.affiliation: Tottori Red Cross Hospital, Tottori, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Hirao
authors.affiliation: Tottori Seikyo Hospital, Tottori, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Nagao
authors.affiliation: Tottori Municipal Hospital, Tottori, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kouda
authors.affiliation: Tottori Prefecture Kousei Hospital, Kurayoshi, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Okada
authors.affiliation: Yonago Medical Center, Yonago, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hayashibara
authors.affiliation: Hakuai Hospital, Yonago, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Harada
authors.affiliation: Tottori Prefecture Saiseikai Sakaiminato General Hospital, Sakaiminato, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Urushibara
authors.affiliation: Tottori Prefectural Rehabilitation Center for Disabled Children, Yonago, Japan.
authors.forename: Chitose
authors.initials: C
authors.lastname: Sugiura
authors.affiliation: Matsue Red Cross Hospital, Matsue, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sejima
authors.affiliation: Matsue City Hospital, Matsue, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Yasugi Municipal Hospital, Yasugi, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Matsuda-Ohtahara
authors.affiliation: Unnan City Hospital, Unnan, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Shimane University School of Medicine, Izumo, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Kishi
authors.affiliation: Tsuyama Chuo Hospital, Tsuyama, Japan.
authors.forename: Syunsaku
authors.initials: S
authors.lastname: Kaji
authors.affiliation: Kagoshima University, Kagoshima, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Toyoshima
authors.affiliation: Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanzaki
authors.affiliation: Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Kousaku
authors.initials: K
authors.lastname: Ohno
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013226:Status Epilepticus / Q000401:mortality* / Q000503:physiopathology
keywords: Acute encephalopathy; Predictors; Prognosis; Status epilepticus