A Risk Predictiion Model Indentifying Those at High Risk of Epilepsy-related Death
Abstract number :
2.149
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2022
Submission ID :
2204764
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Gashirai Mbizvo, MBChB (Hons) MRes (Dis) MRCP PhD – University of Edinburgh ; Christian Schnier, Ph.D – Usher Institute – University of Edinburgh; Colin Simpson, BSc. MSc. Ph.D – Professor, School of Health, Wellington Faculty of Health., University of Wellington, New Zealand; Richard Chin, Ph.D FRCP(Uk) – Professor Paediatric Neurology and Clinical Epidemiology, Centre for Clinical Brain Sciences, University of Edinburgh; Susan Duncan, MD FRCP(UK) – Honorary Consultant Neurologist, Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh
Rationale: Epilepsy-related death (EPRD) is a global problem, with mortality rates unchanged since the first studies in the 1950s. Many of these deaths are potentially preventable with timely intervention. Using in depth analysis of routinely collected health care data we have developed a risk prediction model to identify those at high risk of EPRD.
Methods: An age/sex matched case-control study compared adults (aged ≥ 16 years) who had an EPRD the years 2009 to 2016 to living patients with epilepsy in Scotland. Cases of EPRD were captured from administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define EPRD. Controls were recruited from a research database and epilepsy clinics. Medical records were examined to capture clinical data. Univariable and multivariable conditional regression was used to develope a risk prediction model consisting of four variables chosen a priori. A sum of the factors present was taken to creak a risk index- the Scottish Epilepsy- Related Deaths Study score (SEDS). Odds ratios (ORs) and 95% CIs were estimated.
Results: A total of 224 deceased cases (114 male) were compared to 224 living controls (114 male) – mean age 48 years. In univariable analysis, variables predicting EPRD were recent epilepsy-related emergency department or hospital admission (OR 5.1, 95% CI 3.2–8.3), living in the two most deprived Scottish areas (OR 2.5, 95% CI 1.6–4.0), developmental epilepsy (OR 3.1, 95% CI 1.7–5.7), alcohol abuse (OR 4.4, 95% CI 2.2–9.2), absent recent neurology review (OR 3.8, 95% CI 2.4–6.1), generalised epilepsy (OR 1.9, 95% CI 1.2–3.0), and mental health problems (OR 1.6, 95% 1.0–2.6). The SEDS Score model variables consisted of the first three listed above, alongside the number of comorbidities (adjusting variable). Compared to having a SEDS Score of Zero, those with a SEDS Score of One, Two, and Three, had 3.6x (CI 1.9–6.8), 17.2x (CI 7.4–39.6), and 19.8x (CI 5.1–76.6) increased odds of death, respectively.
Conclusions: The Scottish Epilepsy Deaths Score (SEDS) may be a helpful tool for identifying adults at high risk of EPRD and requires external validation.
Funding: Epilepsy Research UK, The Juliet Bergqvist Memorial Fund
Clinical Epilepsy