BACKGROUND: As a debilitating and severe repercussion, the clinical and economic impact of Status epilepticus (SE) has not been thoroughly explored in various regions around the world, especially those with limited resources. Therefore, we aimed to identify the predictors of mortality and healthcare costs associated with SE in one tertiary care center with limited resources. METHODS: This retrospective single-center cohort study, carried out at Namazi Hospital, Shiraz, Iran, included 130 SE cases from March 21, 2021, to March 20, 2022. Patient data were extracted from medical records, including demographics, clinical presentations, hospital course, treatment modalities, and costs. Multivariable regression models were used to identify factors associated with mortality and hospital stay costs. RESULTS: Patients were aged 1 month to 92 years (mean 20.36 years, median 7), with a male predominance of 59.23 %. Pre-existing epilepsy was found to be associated with lower mortality (p <
0.05), while cardiovascular complications (p <
0.05) and cerebrovascular disease (p <
0.002) were significantly associated with increased mortality risks. In addition, Intensive Care Unit (ICU) admission, necessitated by complex treatment regimens, was linked to significantly higher healthcare costs (p <
0.002). Older age and the use of sedatives were also associated with higher costs, while psychiatric disorders were linked to lower costs. CONCLUSION: SE imposes a substantial clinical and economic burden in resource-limited settings, as limited availability of ICU beds is common. Thus, screening SE cases based on clinical characteristics (e.g., comorbidities) is paramount. Therefore, targeted strategies are essential for optimizing care and reducing costs.