New ACARD Score Outperforms Existing Systems in Predicting Mortality After Status Epilepticus

Researchers have developed and validated a new prognostic scoring system called ACARD to predict 30-day mortality in patients suffering from nonhypoxic status epilepticus, according to a research article published in the August 11, 2026 issue of the peer-reviewed journal Neurology. The multicenter, multinational cohort study demonstrates that the integer-based risk tool outperforms existing scoring systems by evaluating five specific clinical variables recorded prior to or during treatment.

• The ACARD score assesses age, level of consciousness, etiology, treatment refractoriness, and baseline disability to predict 30-day mortality in status epilepticus.
• The study analyzed 689 episodes in an Italian derivation cohort and 569 episodes in an Austrian validation cohort.
• The tool achieved an area under the curve of 0.864 in the derivation cohort and 0.845 in the validation cohort, indicating strong predictive accuracy and calibration.

Clinical Predictors and Derivation of the ACARD Score

Status epilepticus remains a frequent neurological emergency characterized by high rates of morbidity and mortality. Investigators designed the study to address the limitations of current prognostic systems, which frequently lack generalizability or exhibit poor calibration. By analyzing registry data from consecutive episodes of status epilepticus, the research team identified independent risk factors associated with short-term mortality. In the Italian derivation cohort, which included patients aged 14 years or older from Modena, the 30-day mortality rate stood at 27.3 percent.

According to the published findings, five independent clinical variables emerged as significant risk factors. Age 75 years or older carried an odds ratio of 5.52. Pre-treatment consciousness impairment, defined as stuporous or comatose states, yielded an odds ratio of 1.76. Acute etiology due to primary central nervous system pathology presented an odds ratio of 2.60, while baseline disability before seizure onset showed an odds ratio of 3.53. Treatment refractoriness proved to be the strongest independent risk factor, with an odds ratio of 6.40. Conversely, remote etiology demonstrated an independent association with a lower likelihood of 30-day mortality, registering an odds ratio of 0.28.

Validation and Performance Metrics

To confirm the reliability of the findings, the researchers tested the integer-based scoring system—named ACARD for Age, Consciousness, Aetiology, Refractoriness, and Disability—in an independent validation cohort. Comprising 569 episodes of status epilepticus in patients aged 18 years or older from Salzburg, Austria, this validation group recorded a 30-day mortality rate of 11.6 percent. Calibration plots indicated a strong fit between predicted and observed outcomes across both cohorts.

Future Directions in Neuro-Intensive Care

The development of the ACARD score provides clinicians with a user-friendly stratification tool to identify patients at elevated risk of short-term mortality following nonhypoxic status epilepticus. As validation data confirms its utility across diverse European cohorts, future clinical applications may involve integrating the score into electronic health record systems within intensive care units.