Li Fei, Li Kechun, Wang Quan, Qian Suyun, Fan Chaonan
Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Transl Pediatr. 2025 Jan 24;14(1):42-51. doi: 10.21037/tp-24-416. Epub 2025 Jan 21.
Acute necrotizing encephalopathy (ANE) is a para-infectious neurological disorder with high mortality in children. There are limited studies evaluating predictive factors for mortality in ANE patients. This study aims to investigate the predictive value of independent risk factors and the ANE Severity Score (ANE-SS), combined with ferritin levels and Disseminated Intravascular Coagulation (DIC) scores, in assessing mortality risk in children with ANE.
We conducted a retrospective study of children with ANE in the pediatric intensive care unit of Beijing Children's Hospital from January 2016 to May 2024. The patients were divided into survival and non-survival groups, and clinical data were collected within 12 hours after admission. The predictive value of clinical indicators and a joint model for mortality in ANE patients was evaluated using receiver operating characteristic (ROC) curve analysis.
Of 56 patients enrolled, the overall mortality rate was 51.8%. In the non-survival group, the levels of ANE-SS, DIC scores, ferritin, procalcitonin, interleukin-6, activated partial thromboplastin time, prothrombin time, D-dimer, and cerebrospinal fluid protein at admission were significantly higher than those in the survival group. Multivariate analysis identified ferritin, ANE-SS, and DIC scores as independent risk factors for mortality. Ferritin exhibited an area under the curve (AUC) of 0.827, with sensitivity of 84.6% and specificity of 87.5%, which were superior to those of ANE-SS (AUC 0.782, sensitivity 75.9%, specificity 66.7%) and the DIC scores (AUC 0.773, sensitivity 60.7%, specificity 81.5%). In combined analysis, ANE-SS, ferritin, and DIC scores demonstrated the strongest predictive performance, with an AUC of 0.99 (95% CI: 0.965-1.000), sensitivity and specificity of 92.3% and 100%, respectively.
This study indicates that the combination of ANE-SS with ferritin and DIC scores provides a superior predictive value for 28-day mortality in ANE patients.
急性坏死性脑病（ANE）是一种儿童期具有高死亡率的感染后神经系统疾病。评估ANE患者死亡率预测因素的研究有限。本研究旨在探讨独立危险因素及ANE严重程度评分（ANE-SS），联合铁蛋白水平和弥散性血管内凝血（DIC）评分，在评估ANE患儿死亡风险中的预测价值。
我们对2016年1月至2024年5月在北京儿童医院儿科重症监护病房收治的ANE患儿进行了一项回顾性研究。将患者分为存活组和非存活组，并在入院后12小时内收集临床数据。采用受试者工作特征（ROC）曲线分析评估临床指标及联合模型对ANE患者死亡率 的预测价值。
在纳入的56例患者中，总死亡率为51.8%。在非存活组中，入院时ANE-SS、DIC评分、铁蛋白、降钙素原、白细胞介素-6、活化部分凝血活酶时间、凝血酶原时间、D-二聚体和脑脊液蛋白水平显著高于存活组。多因素分析确定铁蛋白、ANE-SS和DIC评分是死亡率的独立危险因素。铁蛋白的曲线下面积（AUC）为0.827，敏感性为84.6%，特异性为87.5%，优于ANE-SS（AUC 0.782，敏感性75.9%，特异性66.7%）和DIC评分（AUC 0.773，敏感性60.7%，特异性81.5%）。联合分析显示，ANE-SS、铁蛋白和DIC评分具有最强的预测性能，AUC为0.99（95%CI：0.965 - 1.000），敏感性和特异性分别为92.3%和100%。
本研究表明，ANE-SS联合铁蛋白和DIC评分对ANE患者28天死亡率具有更高的预测价值。
