Predictors of hospital and one-year mortality in intensive care patients with refractory status epilepticus: a population-based study.
The aim was to determine predictors of hospital and 1-year mortality in patients with intensive care unit (ICU)-treated refractory status epilepticus (RSE) in a population-based study.



This was a retrospective study of the Finnish Intensive Care Consortium (FICC) database of adult patients (16 years of age or older) with ICU-treated RSE in Finland during a 3-year period (2010-2012). The database consists of admissions to all 20 Finnish hospitals treating RSE in the ICU. All five university hospitals and 11 out of 15 central hospitals participated in the present study. The total adult referral population in the study hospitals was 3.92 million, representing 91% of the adult population of Finland. Patients whose condition had a post-anoxic aetiological basis were excluded.



We identified 395 patients with ICU-treated RSE, corresponding to an annual incidence of 3.4/100,000 (95% confidence interval (CI) 3.04-3.71). Hospital mortality was 7.4% (95% CI 0-16.9%), and 1-year mortality was 25.4% (95% CI 21.2-29.8%). Mortality at hospital discharge was associated with severity of organ dysfunction. Mortality at 1 year was associated with older age (adjusted odds ratio (aOR) 1.033, 95% CI 1.104-1.051, p = 0.001), sequential organ failure assessment (SOFA) score (aOR 1.156, CI 1.051-1.271, p = 0.003), super-refractory status epilepticus (SRSE) (aOR 2.215, 95% CI 1.20-3.84, p = 0.010) and dependence in activities of daily living (ADL) (aOR 2.553, 95% CI 1.537-4.243, p < 0.0001).



Despite low hospital mortality, 25% of ICU-treated RSE patients die within a year. Super-refractoriness, dependence in ADL functions, severity of organ dysfunction at ICU admission and older age predict long-term mortality.



Retrospective registry study; no interventions on human participants.
Epilepsy Center, Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland. anne-mari.kantanen@kuh.fi.
Anne-Mari
AM
Kantanen
Epilepsy Center, Neurocenter, Department of Neurology, Kuopio University Hospital and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Box 100, Kuopio, 70029, KYS, Finland.
Reetta
R
Kälviäinen
Department of Intensive Care, Kuopio University Hospital and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Ilkka
I
Parviainen
Division of Intensive Care, Tampere University Hospital, Tampere, Finland.
Marika
M
Ala-Peijari
Departments of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.
Tom
T
Bäcklund
Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.
Juha
J
Koskenkari
Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Ruut
R
Laitio
Department of Intensive Care, North Karelia Central Hospital and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Joensuu, Finland.
Matti
M
Reinikainen
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005387:Finland; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D063305:Organ Dysfunction Scores; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013226:Status Epilepticus / Q000401:mortality*; D013997:Time Factors
ICU treatment; Incidence; Mortality; Outcome; Refractory status epilepticus; Status epilepticus; Super-refractory status epilepticus