Blood pressure variability and blood pressure rhythm phenotypes in children with severe encephalitis complicated by...

This study aimed to assess the effects of comorbid paroxysmal sympathetic hyperactivity (PSH) on disease severity, resource utilization, and the prognosis, thereby providing a basis for the identification and management of severe encephalitis with PSH in children.

A retrospective analysis was conducted on the general clinical data, PSH-related manifestations, and resource utilization of children with severe encephalitis complicated by PSH who were admitted to the Pediatric Intensive Care Unit (PICU) of Hunan Children's Hospital from January 2020 to December 2025.

A total of 28 children with severe encephalitis complicated by PSH were included. The distribution of blood pressure rhythm phenotypes was as follows: a nondipper pattern in 16 patients (57.1%) and a reverse-dipper pattern in 12 patients (42.9%), with no dipper or extreme-dipper patterns observed. A poor prognosis was observed in 16 patients (57.1%), including 5 fatalities. Furthermore, the PSH group had a significantly longer PICU length of stay, an increased duration of ventilator-assisted ventilation, a higher rate of mechanical ventilation use, and greater total hospitalization costs (all P < 0.001). Within the PSH-complicated group, the subgroup with a poor prognosis demonstrated a significantly higher coefficient of variation for diastolic blood pressure (P = 0.030) and a significantly lower GCS score at admission (P = 0.011).

The majority of children with severe encephalitis complicated by PSH exhibited a nondipper or reverse-dipper blood pressure rhythm phenotype. Diastolic blood pressure variability and the GCS score at admission were associated with the prognosis. Compared with those in the control group, the children in the PSH-complicated group were older, experienced prolonged PICU stays, required more mechanical ventilation, and incurred significantly higher hospitalization costs.