Status Epilepticus, Gender Differences Identified With Worse Outcomes in Women

A study has identified sex-related disparities among women and men with adult status epilepticus (SE), with women being at a greater disadvantage regarding clinical features, treatment modalities, and patient outcomes.

The study suggests the significance of considering sex-based factors when identifying and managing patients with SE.

“While our study revealed an independent association of age with all primary outcomes, female sex was not independently associated with the primary outcomes after correcting for potential confounders in our multivariable models at first glance,” wrote the researchers of the study. “However, propensity score-matched analyses accounting for potential imbalances regarding age between men and women revealed that female sex was associated with decreased odds for return to premorbid neurologic outcome independently of potential confounders.”

The retrospective observational cohort study is published in BMC Critical Care.

The study was conducted at 2 Swiss tertiary medical care centers, and included clinical, laboratory, and electrophysiologic data of patients ages 18 and older from January 1, 2015, to December 31, 2021. Clinical characteristics collected were age, sex, presumed etiology of SE, and the Glasgow Coma Score at onset.

Additionally, SE was categorized into predetermined types using digital electroencephalogram (EEG), emergency service reports, and current guidelines of the International League Against Epilepsy, including focal nonconvulsive without coma (with or without altered consciousness and absences), with motor symptoms (myoclonic and convulsive), and nonconvulsive with coma.

Illness severity was measured by the Status Epilepticus Severity Score, the Charlson Comorbidity Index, and the Simplified Acute Physiological Score II.

The primary outcomes of the study were a return to premorbid neurologic function and death during hospital stay at 30 days, while secondary outcomes were characteristics of treatment and disease course.

Using multivariable logistic regression, the researchers evaluated primary and secondary outcomes, while propensity score matching was performed for age imbalances between men and women.

A total of 762 patients with SE were included in the analysis, in which 45.9% were female. The only sex-related differences observed between men and women were older age and lower frequency of intracranial hemorrhages in women.

Women had a higher median age (70 vs 66 years; P = .003), higher incidences of nonconvulsive SW without coma (34.9% vs 25.5%; P = .005), and less often had SE with motor symptoms (52.3% vs 63.6%; P = .002) compared with men.

Furthermore, women had longer SE duration (1 vs 0.5 days; P = .011) and a similar proportion of refractory SE compared with men (36.0% vs 36.4%; P = .898). However, women received anesthesia and mechanic ventilation less often than men (30.6% vs 42%; P = .001).

Although age was associated with all primary outcomes in the unmatched analyses and not female sex, propensity score-matched analyses showed a decreased odds for return to premorbid neurologic function for women was independent of potential cofounders. At the time of hospital discharge, women were sent home less often than men (29.7% vs 43.7%; P < .001) but sent to nursing homes more often than men (17.1% vs 10%; P = .004).

The researchers acknowledged some limitations to the study, including only being conducted at 2 academic tertiary care centers, which reduced generalizability. Additionally, the study was observational in design, may have been influenced by several biases, and used an approximation of SE duration, especially when there were cases of missing EEG data due to recording issues.

Despite these limitations, the researchers believe the study has shown a connection between sex-related disparities in the clinical characteristics, therapeutic interventions, and outcomes of patients with SE, with women experiencing a relative disadvantage compared with men.

“To what extent these results are explained by undetected and unexplored sex-specific differences in a systemic response to SE remains unclear,” wrote the researchers. “Nevertheless, this does not make them any less concerning.”

Reference

Baumann SM, De Stefano P, Kliem PSC, et al. Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation. Crit Care. 2023;27(1):308. Published 2023 Aug 5. doi:10.1186/s13054-023-04592-6