Highlights
- •SRSE is a SE that continues or recurs ≥24 h after the onset of anesthesia.
- •Machine learning prediction of progression to SRSE and 30-day mortality.
- •Acute hypoxic etiology and younger age are major predictors of progression to SRSE.
- •In patients SRSE, older age is associated with increased risk of 30-day mortality.
Abstract
Aim
Super-refractory status epilepticus (SRSE) is a status epilepticus (SE) that continues
or recurs ≥24 h after the onset of anesthesia. We aimed to identify the predictors
of progression to SRSE and the risk of 30-day mortality in patients with SRSE by using
a machine learning technique.
Methods
We reviewed consecutive SE episodes in patients aged ≥14 years at Baggiovara Civil
Hospital (Modena, Italy) from 2013 to 2021. A classification and regression tree analysis
was performed to develop a predictive model of progression to SRSE in SE patients.
In SRSE patients, a multivariate analysis was conducted to identify predictors of
30-day mortality.
Results
We included 705 patients, 16% of whom (113/705) progressed to SRSE. Acute symptomatic
hypoxic etiology and age ≤ 68.5 years predicted the highest risk (87.1%) of progression
to SRSE. Etiology other than acute symptomatic hypoxic and absence of NCSE predicted
the lowest risk (3.6%) of progression to SRSE. The predictive model was accurate in
96.1% of patients not evolving to SRSE and in 48.7% of those evolving to SRSE. Among
patients with SRSE, 46.9% (53/113) died within 30 days compared to 25.2% (149/592)
of patients without SRSE (p < 0.001). Among patients with SRSE, older age was associated with increased 30-day
mortality (odds ratio 1.075; 95% confidence interval: 1.031–1.112; p = 0.001).
Conclusions
Acute symptomatic hypoxic etiology and younger age are major predictors of progression
to SRSE. In patients with SRSE, older age is associated with increased risk of short-term
mortality.
Keywords
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Article info
Publication history
Published online: October 27, 2022
Accepted:
October 24,
2022
Received in revised form:
October 20,
2022
Received:
July 23,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
