Huang Lilin, Yang Xiaole, Li Jing, Peng Shumei
Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.
BMC Pediatr. 2024 Dec 23;24(1):831. doi: 10.1186/s12887-024-05335-4.
Fulminant virus-associated encephalopathy (VAE) is a rare complication of viral infection that presents as acute brain dysfunction and requires respiratory support and/or vasoactive agents. However, the mechanism of VAE is undetermined. The mortality rate is high since there is no specific treatment for fulminant VAE. The aim of this study was to identify risk factors for children with fulminant VAE on the basis of clinical data since timely recognition and treatment might be needed to improve the poor prognosis.
This retrospective study included children with fulminant VAE who were diagnosed between June 2018 and October 2023 in the PICU of Guangdong Women and Children Hospital. Clinical data were analyzed, and receiver operating characteristic (ROC) curve analysis was performed to determine the prognostic value of the selected variables.
Twenty-three children with fulminant VAE were included and divided into a survival group (n = 16) and a nonsurvival group (n = 7). The mortality rate of patients with fulminant VAE was 30.8%. Compared with the survival group, the nonsurvival group had higher incidences of shock 48 h after onset, a higher acute necrotizing encephalopathy severity score (ANE-SS), higher procalcitonin (PCT) levels, and lower platelet counts (p < 0.05). The serum PCT level was significantly higher in the children with shock than in those without shock (p = 0.015). The serum PCT concentration was positively correlated with the ANE-SS (correlation coefficient 0.544, p < 0.039). Combined immunotherapies might help to decrease PCT levels in some children. Low PCT levels might be related to a good outcome. The area under the curve (AUC) for PCT used to predict death in patients with fulminant VAEs was 0.821 (95% CI 0.626-1.00). The sensitivity and specificity of PCT > 101.58 ng/ml for predicting death in patients with fulminant VAE were 57.1% and 100.0%, respectively.
Patients with fulminant VAE deteriorate rapidly and are at high risk of death if they develop shock within 48 h after onset, exhibit extremely elevated serum PCT levels, or have decreased platelet counts. The serum PCT level might predict the death outcome of patients with fulminant VAE.
暴发性病毒相关性脑病（VAE）是病毒感染的一种罕见并发症，表现为急性脑功能障碍，需要呼吸支持和/或血管活性药物治疗。然而，VAE的发病机制尚不清楚。由于暴发性VAE没有特异性治疗方法，其死亡率很高。本研究的目的是根据临床数据确定暴发性VAE患儿的危险因素，因为可能需要及时识别和治疗以改善不良预后。
这项回顾性研究纳入了2018年6月至2023年10月在广东省妇幼保健院重症监护病房（PICU）诊断为暴发性VAE的患儿。对临床数据进行分析，并进行受试者操作特征（ROC）曲线分析以确定所选变量的预后价值。
纳入23例暴发性VAE患儿，分为存活组（n = 16）和非存活组（n = 7）。暴发性VAE患者的死亡率为30.8%。与存活组相比，非存活组在发病后48小时休克发生率更高、急性坏死性脑病严重程度评分（ANE-SS）更高、降钙素原（PCT）水平更高且血小板计数更低（p < 0.05）。休克患儿的血清PCT水平显著高于无休克患儿（p = 0.015）。血清PCT浓度与ANE-SS呈正相关（相关系数0.544，p < 0.039）。联合免疫疗法可能有助于降低部分患儿的PCT水平。低PCT水平可能与良好预后相关。用于预测暴发性VAE患者死亡的PCT曲线下面积（AUC）为0.821（95%CI 0.626 - 1.00）。PCT > 101.58 ng/ml预测暴发性VAE患者死亡的敏感性和特异性分别为57.1%和100.0%。
暴发性VAE患者病情迅速恶化，如果在发病后48小时内发生休克、血清PCT水平极度升高或血小板计数降低，则死亡风险很高。血清PCT水平可能预测暴发性VAE患者的死亡结局。
