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Using characteristic changes in laboratory values to assist in the diagnosis of hemorrhagic shock and encephalopathy
1Department of Anesthesiology, Children's Hospital and Medical Center, University of Washington, Seattle 98105, USA.
Insights
Laboratory abnormalities in hemorrhagic shock encephalopathy syndrome (HSES) evolve predictably, aiding diagnosis. This pattern, along with clinical features, helps understand HSES in children.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Biochemistry
Background:
- Hemorrhagic shock encephalopathy syndrome (HSES) is a severe condition in children.
- Understanding the diagnostic patterns and clinical course of HSES is crucial for effective management.
Purpose of the Study:
- To identify a characteristic pattern of laboratory abnormalities in HSES.
- To describe the clinical features and outcomes of pediatric patients diagnosed with HSES.
Main Methods:
- Retrospective review of hospital records from a pediatric intensive care unit.
- Analysis of laboratory tests including creatine phosphokinase, liver enzymes, renal function, blood counts, coagulation, and acid-base status.
- Recording of patient demographics, clinical presentation, and outcomes.
Main Results:
- Laboratory abnormalities in HSES typically peaked between 1.2 to 1.4 days and then normalized.
- All patients presented with coma and seizures; 71% experienced respiratory failure.
- Survival rate was 64%, with no correlation between laboratory abnormality severity and mortality.
Conclusions:
- The evolution of laboratory abnormalities in HSES follows a distinct pattern, potentially aiding in diagnosis.
- Viral infections are frequently associated with HSES.
- The clinical severity and mortality observed are consistent with previous HSES literature.
Objectives:
(1) To determine whether the laboratory abnormalities in hemorrhagic shock encephalopathy syndrome (HSES) follow a characteristic pattern of evolution; and (2) to describe the clinical characteristics and outcome of this group of children.
Design:
Retrospective review of hospital records.
Setting:
Pediatric intensive care unit in an academic children's hospital.
Patients:
Seventeen children who received the diagnosis of HSES.
Measurements:
(1) To support the diagnosis of HSES, the following laboratory tests were obtained: creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, anemia, thrombocytopenia, coagulation abnormalities, and a metabolic acidosis; and (2) patient characteristics at the time of admission and during the illness and patient outcome were recorded.
Results:
The median time for laboratory abnormalities in HSES to reach the most aberrant levels was 1.2 to 1.4 days. After reaching maximal deviation, the laboratory values gradually returned to normal. The severity of laboratory abnormalities was not predictive of mortality. All patients were comatose, had seizures, and required fluid resuscitation. Respiratory failure occurred in 12 (71%) of 17 patients. Vasopressor infusions were used for 8 (47%). Viral cultures were performed in 15 patients and were positive in 8 (53%). Eleven (64%) patients survived.
Conclusions:
The laboratory abnormalities that are characteristic of HSES follow a distinctive pattern of evolution during the course of the illness. Although the sensitivity, specificity, and predictive value of this pattern of laboratory abnormalities are not known, it might provide a useful tool in diagnosing HSES and excluding other illnesses. Viral illness is common in HSES. The severity of illness and mortality in this group of patients is similar to other descriptions of HSES.