Epilepsy Fellow Beth Israel Deaconess Medical Center Allston, Massachusetts
This abstract is recognized by Partners Against Mortality in Epilepsy for its contribution to improving the understanding of epilepsy-related mortality
Rationale: Acute respiratory failure (ARF) is a known risk factor associated with a higher morbidity and mortality in patients with status epilepticus (SE). We aimed: 1) to identify ARF rate in patients admitted for SE, 2) to identify independent risk factors of ARF (patient demographics, medical comorbidities and seizure types) and 3) to compare the outcomes of patients who experienced ARF with patients who did not in this patient population. Methods: Using Nationwide Inpatient Sample (NIS) database, we examined medical comorbidities and characteristics of patients admitted with diagnosis of SE from October 2015 to December 2016 in the United States. ICD-10 codes were used to identify patients who admitted for SE. Univariate and multivariate regression analyses were performed to identify independent risk factors for ARF Results: A total of 78,194 patients were identified. The mean age was 41 years (+/-27) with comparable gender distribution (Female; 50.55% vs. Male: 49.45%). Sixty percent of patients were Caucasian. The rate of ARF in the cohort with admission diagnosis of SE was 17.9% (13,965 patients). Using multivariate regression analysis showed that non-compliance with medication (adjusted odds ration [AOR], 3.42), history of CVA (AOR, 2.56), smoking (AOR, 2.37), history of brain tumor (AOR, 2.29), liver disease (AOR, 1.92), Asia race (AOR, 1.89), African-American race (AOR, 1.80), chronic renal failure (AOR, 1.34) and chronic lung disease (AOR, 1.30) were significant risk factors of ARF. There was no association between age, gender, other ethnicities (Hispanic and Native American), hypertension, diabetes mellitus, congestive heart failure, obesity, chronic anemia, alcohol abuse, type of seizure or CNS infection on ARF. Compared with SE patients who did not experience ARF, patients with ARF had a significantly higher mortality rate (5.0% vs. 1.40%), a longer mean length of hospital stay (8.46 days vs. 4.36 days; P< 0.01) and a higher total cost of hospitalization ($116,903 vs. $45,415; P< 0.01). Conclusions: The rate of ARF in SE is significant (17.9%). This study demonstrated that non-compliance with medication, history of CVA, smoking and history of brain tumor are major risk factors for ARF. Not surprisingly, patients who experienced ARF had a significantly worse outcomes compared with patients who did not have ARF. Addressing modifiable risk factors (e.g., being compliant with medications and smoking cessation) could lower the chance of ARF and associated morbidity and mortality. Funding: Please list any funding that was received in support of this abstract.: None
