Association of the 2HELPS2B Score With Impaired Recovery of Consciousness and In-Hospital Mortality in Critically Ill Patients: A Multicenter Retrospective Study

Background: Persistent impairment of consciousness after sedation withdrawal represents a diagnostic and prognostic challenge in critically ill patients, particularly in the absence of major structural brain injury.The 2HELPS2B score is an established electroencephalographic tool for seizure-risk stratification; however, its association with neurological improvement and mortality remains insufficiently investigated.Methods: We conducted an exploratory multicenter retrospective observational study, including 33 critically ill adults with persistent impairment of consciousness, defined as a Full Outline of UnResponsiveness (FOUR) score <7 persisting for more than 72 hours after sedation withdrawal.Patients with major structural brain injury, severe metabolic abnormalities, or incomplete clinical or electroencephalographic records were excluded.All patients underwent clinically indicated 40-minute video-electroencephalography between the fourth and fifth day after sedation withdrawal.Patients were categorized according to their 2HELPS2B score (≥2 versus <2).The primary outcome was failure to demonstrate any increase in FOUR score during ICU follow-up, and the secondary outcome was in-hospital mortality.Crude risk ratios (RRs) were calculated, and comparisons were performed using two-sided Fisher's exact tests.Results: Nine (27.3%) patients had a 2HELPS2B score ≥2.Failure to improve FOUR score occurred in four of nine (44.4%) patients with scores ≥2 compared with one of 24 (4.2%) patients with scores <2 (crude RR: 10.67; 95% confidence interval (CI): 1.37-83.11;Fisher's exact p=0.013).In-hospital mortality occurred in five of nine (55.6%) patients versus five of 24 (20.8%)patients, respectively (crude RR: 2.67; 95% CI: 1.01-7.07;Fisher's exact p=0.090).CIs were calculated using the approximate logarithmic method.Both estimates were unadjusted and based on a limited number of events.Conclusions: In this small, selected retrospective cohort, a 2HELPS2B score ≥2 was associated with failure to demonstrate improvement in FOUR score during ICU follow-up.Although mortality was numerically higher in the high-score group, the difference was not statistically significant using Fisher's exact test.These preliminary findings do not establish independent prognostic utility or incremental value beyond clinical assessment.Larger prospective studies are required to validate these exploratory associations.