Background: Status Epilepticus (SE) is a neurological emergency characterized by prolonged or recurrent seizures without recovery between episodes. SE is associated with high morbidity and mortality, especially when it becomes refractory. SE is refractory (RSE) when it persists despite first-line and second-line antiseizure treatment. The factors related to mortality remain poorly understood.

Objective: Our objective was to analyze the factors related to in-hospital mortality in patients with RSE at our center.

Methods: We retrospectively reviewed patients with RSE who required hospitalization between 2019 and 2024. Patients with post-anoxic SE were excluded. Demographics, semiology, etiology and management data were obtained. We analyzed the relationship between different variables and in-hospital mortality. Variables related to mortality in the bivariate analysis were included in logistic regression analysis.

Results: Ninety-four patients with suspected RSE were hospitalized. Five were excluded due to post-anoxic SE and nine were not refractory SE. Finally, 80 patients were included. The mean age was 60 (range 20-90). Forty-three (53.8%) were female. Thirty-two (40.0%) patients had previous diagnosis of epilepsy. Twenty-nine (36.3%) patients died during hospitalization. In the bivariate analysis, factors related to mortality were older age, a history of cancer and chronic kidney disease, hemodynamic instability, renal failure, electrolyte disturbances, seizure recurrence, a history of previous epilepsy, acute symptomatic etiology and Status Epilepticus Severity Score (STESS) (all p < 0.05). In multivariate analysis, age [OR 7.763 (CI 1.11-54.40)], hemodynamic instability [OR 23.41 (3.91-140.20)] and seizure recurrence [OR 20.97 (2.25-195.68)] were associated with in-hospital mortality. A past history of epilepsy was inversely related to mortality [OR 0.014 CI 95 % (0.005-0.550)]. A simple scoring system incorporating these variables predicted mortality better than STESS.

Conclusions: Complications during hospitalization, such as hemodynamic instability and seizure recurrence, appear to be important variables related to in-hospital mortality in patients with RSE. A previous history of epilepsy appears to be inversely related to mortality.