Abstracts

Rationale: Status epilepticus (SE) refractory to first- and second-line antiepileptic drugs carries high mortality. Little is known on early prediction of refractory SE (RSE) an essential tool for planning an appropriate level of therapy. The aim of this study was to identify and validate independent early predictors for RSE in adult patients with SE. Methods: Clinical data on all ICU patients in SE from the University Hospital of Basel, Switzerland (derivation data set from 2005-2011) were assessed. Multivariable logistic regression analysis was performed to identify independent RSE predictors at SE onset. Their external validity was evaluated in an independent data set from the Johns Hopkins Bayview Medical Center, Baltimore, USA (validation data set from 2005-2012). Measures of calibration and discrimination were assessed. Results: 302 patients were analyzed (138 with and 164 without RSE), 171 in the derivation data set and 131 in the validation data set. Acute SE etiology, coma/stupor and serum albumin levels <35 g/L at SE onset were independent predictors for RSE in the derivation data set (OR=2.02, 95%CI 1.01-4.07; OR=4.83, 95%CI 2.42-9.68; OR=2.45, 95%CI 1.16-5.16, respectively). The prediction model showed good measures of calibration (Hosmer-Lemeshow goodness-of-fit test p=0.994) and discrimination (area under the receiver operating characteristics [ROC] curve 0.75) on the derivation set. This result was similar in the validation data set (Hosmer-Lemeshow p=0.24; area under ROC curve 0.72).Conclusions: This clinical prediction model confirms the independent prognostic value of readily available clinical parameters for early RSE prediction. Prospective studies are needed to further validate and weight these variables in order to propose a reliable prediction scoring system.