Predictive value of the serum procalcitonin level for fulminant virus-associated encephalopathy

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.