Status epilepticus is one of the most common neurological critical illnesses, often leading to permanent neurological damage, with high morbidity and mortality [1, 12–15, 20–23]. The mortality rate of convulsive epilepsy in southwestern China is 15.4–15.8% . Of the 396 patients enrolled in the study, 43 were hospitalized, and the mortality rate was approximately 10.9%, which was consistent with the mortality rate of previous studies in Southwest China.
This study showed that the digestive system, respiratory system, immune system, kidney and urinary system, electrolyte/acid-base imbalance, and infection are the risk factors for hospitalization death in status epilepticus. The musculoskeletal system diseases, digestive system, thyroid function, respiratory system, immune system, kidney/urinary system, electrolyte/acid-base imbalance, hypoglycemia/hyperglycemia, infection, blood system, nervous system, and cardiovascular system diseases are risk factors for poor prognosis of patients with status epilepticus. Therefore, we improved the CBI scale and added three new complications: immune system diseases, thyroid function diseases and hypoproteinemia, because these three diseases also have certain influence on the prognosis of patients, such as hyperthyroidism/hypofunction, etc. In addition, the liver system and gastrointestinal diseases are combined into the digestive system to avoid double counting. Coagulation function should be expanded to include diseases of the blood system,such as anemia. The renal system and urinary system are combined into one item. This study did not consider tumor (excluding the cause of status epilepticus), which obviously affects the prognosis of patients, because it probably existed before status epilepticus.
The average total number of epileptic patients included in this study is 2.98, which is somewhat different from the average CBI of 3.8 obtained by Leena et al. The reasons may be as follows: 1. The patients with status epilepticus included in this study are included in the study according to the latest definition of status epilepticus , and the patients with status epilepticus lasting for 5–30 min, that is T1 time, are included in the study. The sample size and scope of patients included in the study are larger than those of previous studies, and the number of patients suffering from epilepsy in T1 time is less, the hospitalization time is shorter, and the prognosis is better. 2. Patients with non-convulsive status epilepticus were included in this study. 3. With the continuous development of medical technology, the awareness of medical personnel in the prevention and treatment of complications has continuously improved, and complications have generally decreased. 4. In this study, all factors that may be the cause of the status epilepticus, such as tumor, metabolic brain, autoimmune encephalitis and acute stroke, were excluded. 5. When complications involve multiple systems, the standard of only one calculation shall be strictly followed. For example, the calculation shall only be carried out once when patients suffer from urinary tract infection, lung infection, and blood system infection at the same time. This study shows that the cutoff point of RCBI scale for predicting hospital death and poor prognosis of patients with status epilepsy is 3, which is consistent with the results obtained by Leena et al.
For convulsive status epilepticus, the cut-off point for predicting hospital death and poor prognosis is 3, and for non-convulsive status epilepticus, the cut-off point for predicting hospital death and poor prognosis is also 3. In this study, patients with non-convulsive status epilepticus were analyzed separately, which proves that it has certain predictive value for hospital death and poor prognosis of patients with non-convulsive status epilepticus, and there is no significant difference compared with convulsive status epilepticus. The RCBI scale is simple to operate and can be completed in a short time, compared with the previous EMSE and STESS scores, the effect of complications on the prognosis of patients with epilepsy status during hospitalization is more focused, which enriches the scale for predicting the prognosis of the status epilepticus and fills the gap in the non-convulsive status epilepticus prediction scale.
This was a single-center study. The patients included in the study were all from a hospital in western China, which may have certain selection bias. This study was scaled by a doctor's own judgment, and there may be some deviation. In the subsequent study, it is expected that two doctors will scale at the same time to obtain more accurate scoring results. Therefore, more scales or indicators may be needed to evaluate the prognosis of patients with epilepsy, and large-scale multicenter studies are needed to further verify our findings.