Department of Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China; Department of Medical Record Management, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Clinics (Sao Paulo). 2024 Aug 2;79:100475. doi: 10.1016/j.clinsp.2024.100475. eCollection 2024.
Influenza-Associated Encephalopathy/Encephalitis (IAE) is characterized by high incidence and poor prognosis. The aim of this study is to describe the clinical features and outcomes of IAE in pediatric patients.
We performed a retrospective review of hospitalized cases of laboratory-confirmed influenza infection between January 2018 and December 2021. Demographic, clinical, imaging, treatment and outcome data were collected. Statistical analysis was performed using SPSS software.
Of 446 children hospitalized with influenza, 71 cases were identified with a diagnosis of IAE. The median age was 3 years and 46 (64.8 %) were younger than 5 years. Only one patient was vaccinated for seasonal influenza. 46 (64.8 %) patients had abnormal electroencephalogram examination and 47 (66.2 %) had abnormal brain MRI or CT findings. 68 (95.8 %) patients were treated with oseltamivir/peramivir. 12 (16.9 %) patients suffered mortality. Non-survivors were more likely to have lower Glasgow coma score (median 7), longer duration of fever (median 3 days), with underlying medical conditions (P = 0.006), and complications including sepsis (P = 0.003), shock (P < 0.001), respiratory failure (P = 0.006), acute renal failure (P = 0.001), myocardial damage (P < 0.001), coagulation disorders (P = 0.03), electrolyte disturbance (P = 0.001) and hyperlactacidemia (P = 0.003). Non-survivors had higher percentages of corticosteroids (P = 0.003) and immunoglobulin (P = 0.003) treatments compared to survivors.
Children with IAE have a high mortality rate. Lower Glasgow coma score, longer duration of fever, with underlying medical conditions and complications pose a great risk to poor prognosis. Influenza vaccination is recommended to all eligible children.
流感相关脑病/脑炎（IAE）具有发病率高和预后差的特点。本研究旨在描述儿科患者 IAE 的临床特征和结局。
我们对 2018 年 1 月至 2021 年 12 月期间住院的实验室确诊流感感染病例进行了回顾性分析。收集了人口统计学、临床、影像学、治疗和结局数据。使用 SPSS 软件进行了统计分析。
在因流感住院的 446 名儿童中，有 71 例被诊断为 IAE。中位年龄为 3 岁，46 例（64.8%）年龄小于 5 岁。仅有 1 例患者接种了季节性流感疫苗。46 例（64.8%）患者的脑电图检查异常，47 例（66.2%）患者的脑 MRI 或 CT 检查异常。68 例（95.8%）患者接受了奥司他韦/帕拉米韦治疗。12 例（16.9%）患者死亡。非幸存者更有可能出现较低的格拉斯哥昏迷评分（中位数为 7）、较长的发热持续时间（中位数为 3 天）、存在基础疾病（P=0.006），以及合并感染性休克（P=0.003）、脓毒症（P=0.003）、呼吸衰竭（P=0.006）、急性肾损伤（P=0.001）、心肌损伤（P＜0.001）、凝血功能障碍（P=0.03）、电解质紊乱（P=0.001）和高乳酸血症（P=0.003）等并发症。与幸存者相比，非幸存者使用皮质类固醇（P=0.003）和免疫球蛋白（P=0.003）治疗的比例更高。
IAE 患儿死亡率高。较低的格拉斯哥昏迷评分、较长的发热持续时间、存在基础疾病和并发症是预后不良的危险因素。建议所有符合条件的儿童接种流感疫苗。
