tetano
Editor, Senior Moderator
Clin Infect Dis. 2020 May 7. pii: ciaa536. doi: 10.1093/cid/ciaa536. [Epub ahead of print]
Prognostic factors among children with acute encephalitis/encephalopathy associated with viral and other pathogens.
Hatachi T[SUP]1[/SUP], Michihata N[SUP]2[/SUP], Inata Y[SUP]1[/SUP], Takeuchi M[SUP]1[/SUP], Matsui H[SUP]3[/SUP], Fushimi K[SUP]4[/SUP], Yasunaga H[SUP]3[/SUP].
Author information
Abstract
BACKGROUND:
Acute encephalitis/encephalopathy (AE) associated with viral and other pathogens leads to neurological sequelae and mortality. Knowing the prognostic factors is therefore important for immediate interventions. We examined early-phase unfavorable prognostic factors among children with AE using a nationwide database.
METHODS:
We performed a retrospective cohort study using the Diagnosis Procedure Combination database, which includes approximately half of acute-care inpatients across Japan. We enrolled children aged ≤18 years who were hospitalized for AE and discharged from April 2010 to March 2018. The composite unfavorable outcome included the following at discharge: in-hospital death, tracheostomy, enteral tube feeding, and physical rehabilitation. Unfavorable prognostic factors were assessed using a multivariable Poisson regression model including patient characteristics, associated pathogens, and interventions within 2 days of admission adjusting for within-hospital clustering.
RESULTS:
This study included 9,386 children with AE (median age of 3 years). A total of 241 (2.6%) in-hospital deaths occurred, and 2,027 (21.6%) patients had the composite unfavorable outcome. Significant unfavorable prognostic factors were age of 12 to 18 years, congenital anomalies, epilepsy, and Japan Coma Scale score of 100 to 300 at admission (i.e., worse levels of consciousness). In contrast, herpes simplex virus infection and influenza virus infection were associated with favorable outcomes.
CONCLUSIONS:
We identified early-phase (within 2 days of admission) unfavorable prognostic factors among children with AE. These findings will help identify patients who may benefit from early aggressive therapeutic interventions.
? The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
KEYWORDS:
Encephalitis; Encephalopathy; Pediatrics; Prognosis; Viral
PMID:32379862DOI:10.1093/cid/ciaa536
Prognostic factors among children with acute encephalitis/encephalopathy associated with viral and other pathogens.
Hatachi T[SUP]1[/SUP], Michihata N[SUP]2[/SUP], Inata Y[SUP]1[/SUP], Takeuchi M[SUP]1[/SUP], Matsui H[SUP]3[/SUP], Fushimi K[SUP]4[/SUP], Yasunaga H[SUP]3[/SUP].
Author information
Abstract
BACKGROUND:
Acute encephalitis/encephalopathy (AE) associated with viral and other pathogens leads to neurological sequelae and mortality. Knowing the prognostic factors is therefore important for immediate interventions. We examined early-phase unfavorable prognostic factors among children with AE using a nationwide database.
METHODS:
We performed a retrospective cohort study using the Diagnosis Procedure Combination database, which includes approximately half of acute-care inpatients across Japan. We enrolled children aged ≤18 years who were hospitalized for AE and discharged from April 2010 to March 2018. The composite unfavorable outcome included the following at discharge: in-hospital death, tracheostomy, enteral tube feeding, and physical rehabilitation. Unfavorable prognostic factors were assessed using a multivariable Poisson regression model including patient characteristics, associated pathogens, and interventions within 2 days of admission adjusting for within-hospital clustering.
RESULTS:
This study included 9,386 children with AE (median age of 3 years). A total of 241 (2.6%) in-hospital deaths occurred, and 2,027 (21.6%) patients had the composite unfavorable outcome. Significant unfavorable prognostic factors were age of 12 to 18 years, congenital anomalies, epilepsy, and Japan Coma Scale score of 100 to 300 at admission (i.e., worse levels of consciousness). In contrast, herpes simplex virus infection and influenza virus infection were associated with favorable outcomes.
CONCLUSIONS:
We identified early-phase (within 2 days of admission) unfavorable prognostic factors among children with AE. These findings will help identify patients who may benefit from early aggressive therapeutic interventions.
? The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
KEYWORDS:
Encephalitis; Encephalopathy; Pediatrics; Prognosis; Viral
PMID:32379862DOI:10.1093/cid/ciaa536