Determinants and timings of withdrawal of life-sustaining therapies in patients with Status Epilepticus

<title>Abstract</title> <p>Status Epilepticus is a neurological emergency with high mortality that frequently requires hospitalization. A substantial proportion of patients require aggressive therapies, with uncertain outcomes. Withdrawal of life-sustaining therapies (WLST) is frequent in this setting. However, WLST in SE has been poorly described in the literature. Objective: To describe the types of WLST, the variables associated with their implementation, and the timing of these decisions in a cohort of patients with SE requiring hospital admission. Methods: We retrospectively analyzed data from medical records from our institutional SE database. Demographic characteristics, clinical course, and management variables, including information regarding WLST, were collected. Outcome was assessed at three months using the modified Rankin Scale (mRS). Time to WLST was analyzed using cumulative incidence functions and compared between groups. Results: A total of 100 patients were included in the analysis. WLST was implemented in 40.0% of patients. The median time to WLST was 72 hours. Variables associated with WLST included age, female sex, STESS and mSTESS scores, and super-refractoriness, whereas remote etiology was inversely related to WLST. In the logistic regression analysis, all variables except remote etiology remained significantly associated with WLST. Cumulative incidence of WLST differed markedly between patients who died and those who survived at three months (p &lt; 0.001), consistent with earlier implementation of WLST among the former. Conclusion: WLST was frequently implemented in patients with SE, and was earlier implemented in those patients who finally died at 3 months. The association between female sex and WLST warrants further investigation into possible sex differences in treatment limitation decisions in SE.</p>