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Prognostic Factors Among Children With Acute Encephalitis/Encephalopathy Associated With Viral and Other Pathogens
Takeshi Hatachi1, Nobuaki Michihata2, Yu Inata1
1Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
Insights
Identifying early prognostic factors in children with acute encephalitis/encephalopathy (AE) is crucial for timely treatment. Older age, congenital anomalies, and epilepsy indicate poor outcomes, while certain viral infections suggest a better prognosis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute encephalitis/encephalopathy (AE) poses significant risks of neurological damage and death.
- Identifying early prognostic factors is vital for prompt medical interventions in pediatric AE cases.
- This study investigates early unfavorable prognostic factors in children diagnosed with AE.
Purpose of the Study:
- To examine early-phase unfavorable prognostic factors in children hospitalized for acute encephalitis/encephalopathy.
- To utilize a nationwide database for a comprehensive analysis of prognostic indicators.
- To inform immediate therapeutic strategies by understanding key predictive factors.
Main Methods:
- A retrospective cohort study was conducted using Japan's Diagnosis Procedure Combination database.
- Children aged 18 years or younger hospitalized for AE between April 2010 and March 2018 were included.
- Unfavorable outcomes (in-hospital death, tracheostomy, enteral feeding, rehabilitation) were assessed using multivariable Poisson regression within 2 days of admission.
Main Results:
- The study included 9386 children with AE; 2.6% experienced in-hospital death, and 21.6% had a composite unfavorable outcome.
- Significant unfavorable prognostic factors identified were older age (12-18 years), congenital anomalies, epilepsy, and lower Japan Coma Scale scores.
- Herpes simplex virus and influenza virus infections were associated with more favorable outcomes.
Conclusions:
- Early unfavorable prognostic factors within 2 days of admission for pediatric AE have been identified.
- These findings can aid in identifying children who would benefit from early, aggressive treatment interventions.
- Understanding these factors is key to improving outcomes for children with AE.
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 9386 children with AE (median age, 3 years). A total of 241 (2.6%) in-hospital deaths occurred, and 2027 (21.6%) patients had the composite unfavorable outcome. Significant unfavorable prognostic factors were age 12-18 years, congenital anomalies, epilepsy, and Japan Coma Scale score of 100-300 at admission (ie, 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.
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