BACKGROUND: Status epilepticus (SE) is a severe acute condition in neurocritical care with high mortality. Searching for risk factors affecting the prognosis in SE remains a significant issue. The primary study's aim was to test the predictive values of the Clinical Frailty Scale (CFS) and the Modified 11-item Frailty Index (mFI-11), the biomarkers and basic biochemical parameters collected at ICU on the Glasgow Outcome Scale (GOS) assessed at hospital discharge (hosp), and three months later (3 M), in comatose patients with SE. The secondary aim was to focus on the association between the patient's state at admission and the duration of mechanical ventilation, the ICU, and hospital stay. METHODS: In two years single-centre prospective pilot study enrolling 30 adult neurocritical care patients with SE classified as Convulsive SE, A.1 category according to the International League Against Epilepsy (ILAE) Task Force without an-/hypoxic encephalopathy, we evaluated predictive powers of CFS, mFI-11, admission Status Epilepticus Severity Score (STESS), serum protein S100, serum Troponin T and basic biochemical parameters on prognosticating GOS using univariate linear regression, logistic regression and Receiver Operating Characteristic (ROC) analysis. RESULTS: Our study included 60% males, with a mean age of 57 ± 16 years (44-68) and a mean BMI of 27 ± 5.6. We found CFS, mFI-11, STESS, and age statistically associated with GOS at hospital discharge and three months later. Among the biomarkers, serum troponin T level affected GOS hosp (p = 0.027). Serum C-reactive protein significance in prognosticating GOS was found by logistic regression (hosp p = 0.008; 3 M p = 0.004), and serum calcium by linear regression (hosp p = 0.028; 3 M p = 0.015). In relation to secondary outcomes, we found associations between the length of hospital stay and each of the following: age (p = 0.03), STESS (p = 0.009), and serum troponin T (p = 0.029) parameters. CONCLUSIONS: This pilot study found promising predictive powers of two frailty scores, namely CFS and mFI-11, which were comparable to age and STESS predictors regarding the GOS at hospital discharge and three months later in ICU patients with SE. Among biomarkers and biochemical parameters, only serum troponin T level affected GOS at hospital discharge.

Centrum of Anaesthesiology Resuscitation and Intensive Care Regional Hospital Husova 357 10 Liberec 46001 Czech Republic

Department of Anaesthesiology and Resuscitation 3rd Faculty of Medicine Charles University Prague Ruska 10 Prague 100 00 Czechia

Department of Neurology 1st Faculty of Medicine Charles University Prague Katerinska 1660 32 Prague 2 121 08 Czech Republic

Emergency Medical Services Klasterni 954 5 Liberec 460 01 Czech Republic

Faculty of Health Studies Technical University in Liberec Studentska 1402 2 461 17 Liberec 1 Czech Republic

Institute of Physiology 1st Faculty of Medicine Charles University Prague Albertov 5 Prague 128 00 Czech Republic

Neurocenter Neurointensive Care Unit Regional Hospital Husova 357 10 Liberec 46001 Czech Republic

University Hospital Kralovske Vinohrady 110 34 Prague 10 Srobarova 1050 Czech Republic

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Shorvon S, Sen A. What is status epilepticus and what do we know about its epidemiology? Seizure. 2020;75:131–6. doi: 10.1016/j.seizure.2019.10.003. PubMed DOI

Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status Epilepticus Severity score (STESS): a tool to orient early treatment strategy. J Neurol. 2008;255:1561–6. doi: 10.1007/s00415-008-0989-1. PubMed DOI

Leitinger M, Kalss G, Rohracher A, Pilz G, Novak H, Höfler J, Deak I, Kuchukhidze G, Dobesberger J, Wakonig A, Trinka E. Predicting outcome of status epilepticus. Epilepsy Behav. 2015;49:126–30. doi: 10.1016/j.yebeh.2015.04.066. PubMed DOI

Yuan F, Damien C, Gaspard N. Severity scores for status epilepticus in the ICU: systemic illness also matters. Crit Care. 2023;27:19. doi: 10.1186/s13054-022-04276-7. PubMed DOI PMC

Jayalakshmi S, Vooturi S. Outcome scores in status epilepticus – predicting the complex clinical situation. Eur J Neurol. 2016;23(11):1591–2. doi: 10.1111/ene.13124. PubMed DOI

Kannan L, Rathore C. Predicting the unpredictable: utility of Outcome Prediction scores in Status Epilepticus. Ann Indian Acad Neurol. 2021 May-Jun;24(3):313–4. PubMed PMC

Huang TH, Lai MC, Chen YS, Huang CW. Status Epilepticus Mortality Risk factors and a correlation survey with the newly modified STESS. Healthc (Basel) 2021;9(11):1570. PubMed PMC

Reindl C, Knappe RU, Sprügel MI, Sembill JA, Mueller TM, Hamer HM, Huttner HB, Madžar D. Comparison of scoring tools for the prediction of in-hospital mortality in status epilepticus. Seizure. 2018;56:92–7. doi: 10.1016/j.seizure.2018.01.024. PubMed DOI

Huang TH, Chen TS, Huang CW. External validation of newly modified status epilepticus severity score for predicting mortality in patients with status epilepticus in a regional hospital in Taiwan. Epilepsy Behav. 2023;149:109495. doi: 10.1016/j.yebeh.2023.109495. PubMed DOI

Yuan F, Damien C, Gaspard N. Prognostic scores in status epilepticus: A systematic review and meta-analysis. Epilepsia. 2023;64(1):17–28. 10.1111/epi.17442. Epub 2022 Nov 11. PMID: 36271624. PubMed

Hanin A, Lambrecq V, Denis JA, et al. Cerebrospinal fluid and blood biomarkers of status epilepticus. Epilepsia. 2020;61:6–18. doi: 10.1111/epi.16405. PubMed DOI

Nardone R, Brigo F, Trinka E. Acute symptomatic seizures caused by Electrolyte disturbances. J Clin Neurol. 2016;12:21–33. doi: 10.3988/jcn.2016.12.1.21. PubMed DOI PMC

Hanin A, Demeret S, Denis JA, Nguyen-Michel VH, Rohaut B, Marois C, Imbert-Bismut F, Bonnefont-Rousselot D, Levy P, Navarro V, Lambrecq V. Serum neuron-specific enolase: a new tool for seizure risk monitoring after status epilepticus. Eur J Neurol. 2022;29:883–9. doi: 10.1111/ene.15154. PubMed DOI

Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, Sibley S, Rockwood K. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43:1105–22. doi: 10.1007/s00134-017-4867-0. PubMed DOI PMC

Jung C, Flaatten H, Fjølner J, Bruno RR, Wernly B, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Czuczwar M, Elhadi M, Joannidis M, Oeyen S, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, Boumendil A, De Lange DW, Guidet B, COVIP study group The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study. Crit Care. 2021;25:149. doi: 10.1186/s13054-021-03551-3. PubMed DOI PMC

Proietti M, Romiti GF, Raparelli V, Diemberger I, Boriani G, Dalla Vecchia LA, Bellelli G, Marzetti E, Lip GY, Cesari M. Frailty prevalence and impact on outcomes in patients with atrial fibrillation: a systematic review and meta-analysis of 1,187,000 patients. Ageing Res Rev. 2022;79:101652. doi: 10.1016/j.arr.2022.101652. PubMed DOI

Panayi AC, Orkaby AR, Sakthivel D, Endo Y, Varon D, Roh D, Orgill DP, Neppl RL, Javedan H, Bhasin S, Sinha I. Impact of frailty on outcomes in surgical patients: a systematic review and meta-analysis. Am J Surg. 2019;218:393–400. doi: 10.1016/j.amjsurg.2018.11.020. PubMed DOI PMC

Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, Shorvon S, Lowenstein DH. A definition and classification of status epilepticus – report of the ILAE Task Force on classification of Status Epilepticus. Epilepsia. 2015;56:1515–23. doi: 10.1111/epi.13121. PubMed DOI

Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183:104–10. doi: 10.1016/j.jss.2013.01.021. PubMed DOI

Team RC. R: A Language and Environment for Statistical Computing. Published online 2021. https://www.r-project.org/.

Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005;47:458–72. doi: 10.1002/bimj.200410135. PubMed DOI

Semmlack S, Kaplan PW, Spiegel R, De Marchis GM, Hunziker S, Tisljar K, Rüegg S, Marsch S, Sutter R. Illness severity scoring in status epilepticus-when STESS meets APACHE II, SAPS II, and SOFA. Epilepsia. 2019;60:189–200. doi: 10.1111/epi.14623. PubMed DOI

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56. doi: 10.1093/gerona/56.3.M146. PubMed DOI

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95. doi: 10.1503/cmaj.050051. PubMed DOI PMC

Madžar D, Reindl C, Mrochen A, Hamer HM, Huttner HB. Value of initial C-reactive protein levels in status epilepticus outcome prediction. Epilepsia. 2021;62(4):e48–e52. doi: 10.1111/epi.16842. PubMed DOI

Sutter R, Grize L, Fuhr P, Rüegg S, Marsch S. Acute-phase proteins and mortality in status epilepticus: a 5-year observational cohort study. Crit Care Med. 2013;41(6):1526–33. doi: 10.1097/CCM.0b013e318287f2ac. PubMed DOI

Walker MC. Pathophysiology of status epilepticus. Neurosci Lett. 2018;667:84–91. doi: 10.1016/j.neulet.2016.12.044. PubMed DOI

Hanin A, Denis JA, Frazzini V, Cousyn L, Imbert-Bismut F, Rucheton B, Bonnefont-Rousselot D, Marois C, Lambrecq V, Demeret S, Navarro V. Neuron Specific Enolase, S100-beta protein and progranulin as diagnostic biomarkers of status epilepticus. J Neurol. 2022;269:3752–60. doi: 10.1007/s00415-022-11004-2. PubMed DOI

Chatzikonstantinou A, Ebert AD, Hennerici MG. Temporal seizure focus and status epilepticus are associated with high-sensitive troponin I elevation after epileptic seizures. Epilepsy Res. 2015;115:77–80. doi: 10.1016/j.eplepsyres.2015.05.013. PubMed DOI

Giovannini G, Meletti S. Fluid biomarkers of Neuro-Glial Injury in Human Status Epilepticus: a systematic review. Int J Mol Sci. 2023;24(15):12519. doi: 10.3390/ijms241512519. PubMed DOI PMC

Hosseini S, Mofrad AME, Mokarian P, Nourigheimasi S, Azarhomayoun A, Khanzadeh S, Habibzadeh S, Ghaedi A. Neutrophil to lymphocyte ratio in Epilepsy: a systematic review. Mediators Inflamm. 2022;2022:4973996. doi: 10.1155/2022/4973996. PubMed DOI PMC

Olivo S, Buoite Stella A, Pavan S, Cegalin M, Furlanis G, Cheli M, Tomaselli M, Stokelj D, Manganotti P. Admission neutrophil-to-lymphocyte ratio predicts length of hospitalization and need for ICU admission in adults with Status Epilepticus. Seizure. 2023;106:80–4. doi: 10.1016/j.seizure.2023.02.001. PubMed DOI