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Influenza-Associated Encephalopathy and Acute Necrotizing Encephalopathy in Children: A Retrospective Single-Center
Yongling Song1, Suyun Li1, Weiqiang Xiao2
1Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).
Insights
High cerebrospinal fluid (CSF) protein and serum procalcitonin levels may indicate acute necrotizing encephalopathy (ANE) in children with influenza. Early evaluation for influenza-related neurological complications is crucial for timely diagnosis and treatment.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Clinical Biochemistry
Background:
- Influenza, primarily a respiratory illness, can cause severe neurological complications in children.
- Early indicators for acute necrotizing encephalopathy (ANE), a severe influenza complication, are not well-established.
- Understanding these indicators is critical for timely intervention and improved outcomes in pediatric patients.
Purpose of the Study:
- To summarize clinical characteristics, diagnosis, and treatment of influenza-related neurological complications in children.
- To identify specific factors associated with the development of acute necrotizing encephalopathy (ANE).
- To evaluate the prognostic value of certain biomarkers in differentiating ANE from other influenza-related encephalopathies.
Main Methods:
- Retrospective study of children with confirmed influenza and neurological complications (01/2014-12/2019).
- Comparison of clinical and laboratory findings between influenza-induced encephalopathy (IAE) and ANE groups.
- Receiver operating characteristic (ROC) curve analysis to assess the diagnostic accuracy of procalcitonin and CSF protein.
Main Results:
- Sixty-three children (33 IAE, 30 ANE) were analyzed.
- ANE group showed higher fever, consciousness disturbance, liver enzymes, creatinine kinase, procalcitonin, and CSF protein, with lower CSF white blood cells.
- Procalcitonin (AUC=0.790) and CSF protein (AUC=0.736) effectively differentiated ANE; high procalcitonin (>4.25 ng/ml) and CSF protein (>0.48 g/L) showed high sensitivity and specificity for ANE prediction. ANE had a significantly higher mortality rate (43.3% vs 0%).
Conclusions:
- Elevated serum procalcitonin and cerebrospinal fluid (CSF) protein levels may serve as early indicators for acute necrotizing encephalopathy (ANE) in children.
- Prompt evaluation for influenza-related neurological complications is recommended for all children presenting with neurological symptoms during influenza season.
- Timely diagnosis and management of ANE are critical due to its high mortality rate.
Abstract:
BACKGROUND Although influenza primarily affects the respiratory system, it can cause severe neurological complications, especially in younger children, but knowledge about the early indicators of acute necrotizing encephalopathy (ANE) is limited. The main purpose of this article is to summarize the clinical characteristics, diagnosis, and treatment of neurological complications of influenza in children, and to identify factors associated with ANE. MATERIAL AND METHODS This was a retrospective study of children with confirmed influenza with neurological complications treated between 01/2014 and 12/2019 at Guangzhou Women and Children's Medical Center. A receiver operating characteristics curve analysis was performed to determine the prognostic value of selected variables. RESULTS Sixty-three children with IAE (n=33) and ANE (n=30) were included. Compared with the IAE group, the ANE group showed higher proportions of fever and acute disturbance of consciousness, higher alanine aminotransferase, higher aspartate aminotransferase, higher creatinine kinase, higher procalcitonin, higher cerebrospinal fluid (CSF) protein, and lower CSF white blood cells (all P<0.05). The areas under the curve (AUCs) for procalcitonin and CSF proteins, used to differentiate IAE and ANE, were 0.790 and 0.736, respectively. The sensitivity and specificity of PCT >4.25 ng/ml to predict ANE were 73.3% and 100.0%, respectively. The sensitivity and specificity of CSF protein >0.48 g/L to predict ANE were 76.7% and 69.7%, respectively. Thirteen (43.3%) children with ANE and none with IAE died (P<0.0001). CONCLUSIONS High levels of CSF protein and serum procalcitonin might be used as early indicators for ANE. All children admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications.
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