ACARD Score Predicts Mortality in Status Epilepticus

TOPLINEA newly developed prognostic scoring system that combined five readily available clinical variables — Age, Consciousness, Aetiology, Refractoriness, Disability (ACARD) — demonstrated superior accuracy in predicting 30-day mortality after nonhypoxic status epilepticus (SE) compared with existing scoring systems.METHODOLOGYResearchers developed and validated a predictive model for 30-day mortality in adults with SE using data from two independent cohorts in Italy and Austria.The derivation cohort included 689 consecutive SE episodes in 611 participants (median age at SE onset, 73 years) admitted at a hospital in Ancona, Italy (September 2015 to December 2023), with 188 (27.3%) experiencing 30-day mortality.The validation cohort comprised 569 first-ever SE episodes in participants aged 18 years or older admitted at a hospital in Salzburg, Austria (February 2019 to December 2023), with 66 (11.6%) experiencing 30-day mortality.Discrimination was assessed using receiver operating characteristic (ROC) curves, and calibration was evaluated with calibration plots and the Hosmer-Lemeshow goodness-of-fit test.TAKEAWAYAge 75 or older (odds ratio [OR], 5.52), consciousness impairment before SE treatment (OR, 1.76), acute etiology due to primary central nervous system pathology (OR, 2.60), refractoriness to treatment (OR, 6.40), and disability before SE onset (OR, 3.53; P < .05 for all) were the independent risk factors for 30-day mortality.The ACARD score, which combines these variables, demonstrated good discrimination with an area under the ROC curve of 0.864 (95% CI, 0.836-0.891) and adequate calibration. The score maintained good discrimination in the validation cohort.Using a cutoff of ≥ 6 points, the ACARD score achieved 69.2% sensitivity, 84.4% specificity, and 80.3% accuracy for predicting 30-day mortality across all SE episodes, with a positive predictive value of 62.5% and a negative predictive value of 87.9%.The ACARD score outperformed the Status Epilepticus Severity Score (STESS), modified STESS, and Epidemiology-Based Mortality Score in Status Epilepticus in discriminating 30-day mortality.IN PRACTICE"The ACARD score is a user-friendly tool developed to predict 30-day mortality after SE, and it can outperform the performance of other available scoring systems," the authors of the study wrote.SOURCEThe study was led by Simona Lattanzi, Marche Polytechnic University in Ancona, Italy, and Eugen Trinka, Paracelsus Medical University in Salzburg, Austria. It was published online on July 21 in Neurology.LIMITATIONSThe score showed an imbalance between sensitivity and specificity, and the approximately 80% accuracy suggests it is more useful at the group level than for individual patient treatment decisions. The positive predictive value remained suboptimal. The score's complexity with up to 13 points and corresponding risk estimates may make it more challenging to use in routine clinical care compared with simpler scoring systems.DISCLOSURESThe study was supported by grants from the Italian Ministry of Health and the Austrian Science Fund. Multiple authors reported receiving consulting fees, honoraria, research support, or advisory board roles from various pharmaceutical companies and medical device manufacturers. Additional author disclosures are reported in the original article.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.