Recurrence and Mortality After a First Status Epilepticus

Status epilepticus (SE) is associated with high short-term mortality, but data on long-term outcomes, including recurrence and mortality, are limited. The aim of this study was to describe recurrence and postdischarge mortality rates up to 3 years after an initial SE and identify the associated risk factors. We conducted a retrospective cohort study involving all patients, infants and adults, who survived their first hospitalization with an ICD-10 code of SE from January 1, 2011, to December 31, 2016, using the French National Health Data System, with a 3-year follow-up. Outcomes included SE recurrence, death, and cause of death from death certificates. Measures included patient characteristics, comorbidities, SE causes, intensive care unit admissions, and mechanical ventilation at the first SE. Multivariable Cox models assessed the relationships between these factors and recurrence or mortality. Among 37,930 patients (46.4% female, median age 55 years [interquartile range (IQR) 30-71]), the 3-year recurrence rate was 16.7% (95% CI 16.3-17.1) and the mortality rate was 25% (95% CI 24.5-25.4). Factors present at first SE associated with 3-year recurrence were younger age (hazard ratio [HR] 2.21, 95% CI 1.90-2.58, for age group <1 compared with 10-19 years), history of epilepsy before first SE (HR 1.73, IQR 1.63-1.84), alcohol consumption (HR 1.37, 95% CI 1.27-1.48), remote and progressive causes, comorbidities, and prolonged mechanical ventilation (HR 1.21, 95% CI 1.11-1.32). Progressive causes and higher number of comorbidities were also associated with mortality, but male sex (HR 1.24, 95% CI 1.19-1.30) and older age were specifically associated with mortality and not recurrence. Main causes of death at 3 years were tumors (32.1%), cardiovascular diseases (20.2%), and infectious or respiratory diseases (8.3%). Our study highlights a high risk of recurrence or death within 3 years after a first SE. We identified factors associated with increased risk of both recurrence and mortality and factors specifically associated with recurrence or mortality. A better understanding of these factors, which are mostly nonmodifiable at the time of discharge, could assist clinicians in better planning patient follow-up.