Hypoalbuminemia excellent prognostic biomarker for mortality in status epilepticus unravels study
Researchers have established that hypoalbuminemia is an independent and strong predictor for both short- and long-term mortality in patients diagnosed with status epilepticus (SE). This accessible biomarker indicates the general condition of a patient and can greatly help improve the existing scoring models, such as the Status Epilepticus Severity Score (STESS). A recent study was conducted by Francesco and colleagues which was published in the European Journal of Neurology.
It was a prospective observational cohort study done at the University Hospital of Geneva, Switzerland, during 2015 to 2023, with an enrollment of 496 adults with non-hypoxic status epilepticus. The outcomes investigated were in-hospital and 6-month mortality. Hypoalbuminemia was correlated with demographic, comorbidities, and clinical outcomes. The association between hypoalbuminemia and mortality was established using binomial regression models. The study also conducted an exploratory analysis by replacing the age variable in STESS with hypoalbuminemia, creating the Albumin-STESS (A-STESS) score. The predictive performance of STESS and A-STESS was compared using the area under the curve (AUC).
Key Findings
Mortality Rates:
Among the 496 patients, 46 (9.3%) died during hospitalization.
Follow-up data at six months were available for 364 patients, and among them, 86 (23.6%) had died.
Hypoalbuminemia and Mortality:
Hypoalbuminemia independently correlated with in-hospital mortality (p=0.005, OR=3.35, 95% CI=1.43–7.86) and 6-month mortality (p=0.001, OR=3.59, 95% CI=1.75–7.35).
STESS vs. A-STESS:
The original STESS had an AUC of 0.754 (95% CI=0.656–0.836) for in-hospital mortality prediction and 0.684 (95% CI=0.613–0.755) for 6-month mortality.
A-STESS significantly improved predictive accuracy with an AUC of 0.837 (95% CI=0.760–0.916; p=0.002) for in-hospital mortality and 0.739 (95% CI=0.688–0.826; p=0.033) for 6-month mortality.
A-STESS Performance:
An A-STESS score of ≥3 showed optimal balance between sensitivity and specificity for mortality prediction:
In-hospital mortality: Sensitivity=0.88, Specificity=0.68, Accuracy=0.70
6-month mortality: Sensitivity=0.67, Specificity=0.73, Accuracy=0.72
This study demonstrates that hypoalbuminemia is an excellent prognostic biomarker for mortality in status epilepticus. It was found that the integration of hypoalbuminemia into the STESS scoring system significantly increases the predictive power of STESS for both short and long-term outcomes. It would be useful to find therapeutic interventions like albumin supplementation that improve patient outcome in future research by validation of the A-STESS model.
Reference:
Misirocchi F, Quintard H, Rossetti AO, Florindo I, Sarbu OE, Kleinschmidt A, Schaller K, Seeck M, De Stefano P. Hypoalbuminemia in status epilepticus is a biomarker of short- and long-term mortality: A 9-year cohort study. Eur J Neurol. 2025 Jan;32(1):e16573. doi: 10.1111/ene.16573. PMID: 39711115; PMCID: PMC11664120.
