Analysis of clinical features and prognosis in 258 patients with CNSC of HFMD

Abstract

Objective To investigate the clinical features and prognosis in the patients with central nervous system complications (CNSC) of hand,foot,and mouth disease (HFMD).Methods The clinical data of 258 hospitalized children with CNSC of HFMD during 2008-2012 were reviewed.The possible factors of the prognosis were analyzed by the Logistic regression,which included age,duration of fever(DOF),blood glucose (BG),severe impaired consciousness (SIC),neurogenic pulmonary edema (NPE) and limb muscle strength obstacles(LMSO).Results ①There was no significant difference of Age,DOF,LS,CRP,CFPro,CFWBC or positive rate of EV71 among patients with different CNSC of HFMD.Peripheral blood WBC,BG and CFP of the brain stem encephalitis group were at levels higher than those of the other groups,and the significant differences were observed.② The incidences of SIC,NPE (respectively 52.63％,57.89％) in brain stem encephalitis group were detected to be the highest,but was zero for aseptic meningitis and acute flaccid paralysis.③ Positive rate of imaging MRI was low (only 5.91％) for aseptic meningitis,but was much higher for encephalitis,brainstem encephalitis and acute flaccid paralysis (81.81％,100％ and 100％ respectively).④ EEG test results were normal for aseptic meningitis and acute flaccid paralysis,but positive rates of EEG were 80.00％,66.7％ for encephalitis,brainstem encephalitis respectively.⑤ Rate of mortality was the highest (up to 36.8％) for brainstem encephalitis,but was zero for the other three groups.The incidence of sequelae for brainstem encephalitis (up to 21.05％) was higher than those for the other three groups,i.e.for acute flaccid paralysis (15.38％),encephalitis (4.5％) and aseptic meningitis (0).⑥ NPE,LMSO and SIC were the three significant high-risk factors for prognosis of neurological outcome in patients with CNSC of HFMD,and NPE was the most significant one of the three.(odds ratio 0.099,P =0.008).The linear predictor in the model was Z =12.68-2.314 (NPE)-3.089 (LMSO)-3.491 (SIC),and positive forecast (poor prognosis) accuracy rate of the three factors was 70.6％,and the negative forecast (good prognosis) one reached up to 97.5％.Conclusions Once NPE,SIC,LMSO or brainstem encephalitis appears in patients with HFMD,the active intervention measures are highly recommended to be taken to improve the prognosis at an early phase. Key words: Hand, foot, and mouth disease ; Central nervous system/Complications ; Clinical features ; Prognosis