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Research Snapshot Theater: Epidemiology - Outcomes/Quality and Patient Safety, Adult

Cerebrovascular Disease Among Critically Ill Status Epilepticus Patients: Population-Level Analyses

Tuesday, March 24, 2026
10:00 AM - 11:00 AM Central Time
Location: Connections Central - RST 01
Introduction: Status epilepticus (SE) is a neurologic emergency marked by prolonged seizures that cause neuronal injury, organ failure, or death. It often results from stroke, trauma, hypoxia, or metabolic disturbances. Cerebrovascular disease (CVD), or impaired cerebral perfusion, is both a cause and comorbidity of SE. Although SE often requires intensive care, mortality risk across comorbid profiles remains poorly defined. This study assesses mortality in SE patients by CVD and stroke status.


Methods: We conducted a population-based cohort study of publicly available data from adult intensive care admissions in Texas acute care hospitals (2016–2022) with SE to assess in-hospital mortality. We excluded transfers, elective admissions, and discharges against medical advice. Cases were identified using International Classification of Diseases, Tenth Revisions, Clinical Modification (ICD-10-CM) codes selected from Clinical Classification Software Refined (CCSR) category NVS009: Epilepsy; convulsions. CVD was identified using ICD-10-CM codes G45x, G46x, I60x-I69X, and H340x. Stroke was identified with CCSR categories CIR020: Cerebral infarction and CIR021: Acute hemorrhagic cerebrovascular disease. Overlap propensity score weighting was expressed as adjusted risk ratio and 95% confidence interval (aRR [95% CI]).


Results: Of 23,338 hospitalizations, 3,212 (14%) had CVD without stroke and 2,597 (11%) CVD with stroke. Non-CVD patients were younger (28% aged ≥65 years vs 54% for CVD without stroke and 52% with stroke) and had lower Deyo comorbidity index (mean[SD] 1.6[2.2] vs 2.0[2.1] vs 2.4[2.3]). Crude mortality was 11% for non-CVD, 6% for CVD without stroke, and 19% for CVD with stroke. In the overlap population, adjusted mortality was 14%, 8%, and 15% respectively. CVD without stroke was associated with lower mortality versus non-CVD (0.6 [0.5 to 0.7]). Sensitivity analyses in older mechanically ventilated, and severely ill had the same pattern.


Conclusions: Despite older age and comorbidity burden, CVD without stroke patients had significantly lower crude mortality. After adjustment, their risk of death remained 42% lower than non-CVD patients. We hypothesize that CVD may induce adaptive mechanisms protective against seizure-related injury—benefits not observed in acute stroke due to its high lethality.