Does the ACD score predict long-term survival after status epilepticus?

Given the high mortality rate in the years following status epilepticus diagnosis, early prediction of long-term mortality in status epilepticus is important
.

To improve prediction of long-term mortality after status epilepticus diagnosis, a new scoring system, called the ACD score, was developed in Denmark to predict 2-year (long-term) mortality after discharge for status epilepticus
.

The ACD score represents age at onset, level of consciousness on admission, and duration of status epilepticus
.

We recently conducted a retrospective cohort study to assess whether the ACD score could predict long-term survival after status epilepticus
.

Compiled and organized by Yimaitong, please do not reprint without authorization
.

STUDY DESCRIPTION This retrospective, multicenter, multinational cohort study analyzed status epilepticus diagnosed and treated at Odense University Hospital, Denmark, and Oslo, Norway, and Germany between January 1, 2008, and December 31, 2017.
of adult patients
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The patient was 18 years of age or older and presented for the first time with nonconvulsive status epilepticus
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Data analysis was conducted between September 1, 2019 and March 31, 2020
.

  The predefined outcome was 2-year survival for all patients and a group of patients with status epilepticus (no or less damage to the brain)
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Neurological deficits, demographic characteristics, etiological categories of status epilepticus, complications, survival rates, time points, treatments, and prognostic scores for different indicators were assessed before and after onset
.

 Results ➤ A total of 261 patients (mean [SD] age, 67.
2 [14.
8] years; 132 women [50.
6%]) were included in the study, of whom 145 patients (mean [SD] age, 66.
3 [15.
0] years; 78 women [ 53.
8%]) had no or less damage to the brain
.

The validation cohort included patients from Norway (n = 139) and Germany (n = 906)
.

At discharge, 29.
8% of patients (64 of 215) developed new moderate-to-severe neurological deficits compared with baseline
.

New neurological deficit was the main predictor of 2-year survival after discharge (OR, 5.
1; 95% CI, 2.
2-11.
8); this association was independent of etiology category
.

 ➤ Nonconvulsive status epilepticus and duration of status epilepticus in coma were associated with the development of new neurological deficits, and we combined these two risk factors with age at onset to create a simple 3-factor score (ACD).
score) to assess survival after a diagnosis of status epilepticus
.

ACD score was linearly associated with 2-year survival (Pearson r2 = 0.
848), especially in patients with a low likelihood of brain injury
.

 CONCLUSIONS: The study found that age, duration, and nonconvulsive status epilepticus in a coma were associated with the development of new neurological deficits that were predictors of long-term mortality
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Using the ACD score to account for risk factors for new neurological deficits is a reliable method for predicting long-term outcomes in patients with status epilepticus (no or less damage to the brain)
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 Compiled by: Roberg LE, Monsson O, Kristensen SB, Dahl SM, Ulvin LB, Heuser K, Taubøll E, Strzelczyk A, Knake S, Bechert L, Rosenow F, Beier D, Beniczky S, Krøigård T, Beier CP .
Prediction of Long-term Survival After Status Epilepticus Using the ACD Score.
JAMA Neurol.
2022 Apr 11.
doi: 10.
1001/jamaneurol.
2022.
0609.
Epub ahead of print.
PMID: 35404392.