Mortality risk factors in children with influenza-associated encephalopathy admitted to the paediatric intensive care unit between 2009 and 2021.

Abstract

The purpose of this study was to determine the risk factors for death in children with influenza-associated encephalopathy (IAE) in the paediatric intensive care unit (PICU). Forty-six paediatric patients with IAE admitted to the PICU at shenzhen Children's Hospital between December 2009 and December 2021 were evaluated. Their clinical characteristics were retrospectively analysed. A total of 46 patients were diagnosed with influenza A virus infection and encephalopathy. The cases were concentrated in children <5 years of age (27/46, 58.7%). Twenty-nine patients (63.0%) survived and 17 patients (37.0%) died, of which 70.6% (12/17) of the patients died within 1 week of hospitalisation. Thirty-two patients (69.6%) developed neurological symptoms within 1-2 days of fever onset. Common symptoms included fever (45/46, 97.8%), loss of consciousness (39/46, 84.8%), seizures (31/46, 67.4%), cough (19/46, 41.3%), and vomiting (16/46, 34.8%). Multivariate logistic regression analysis indicated that vomiting (odds ratio [OR], 11.005), loss of consciousness (AVPU score: P; OR, 15.871), lymphopenia (OR, 8.964), alanine aminotransferase (>80 IU/L; OR, 32.060) and serum sodium concentration (>145 mmol/L or <135 mmol/L; OR, 16.264) were related to mortality. The mortality in this study population was 37.0%. Children with IAE who have corresponding clinical manifestations and abnormal examination results in PICU should be warned of the high mortality rate.