Risk Factors of Influenza-Associated Necrotizing Encephalopathy in Children

Guangming Liu,Weiqiang Xiao,Peiqing Li,Sida Yang,Suyun Li,Qinglian Chen

doi:10.4236/jbbs.2021.118015

Abstract

Objective: A case-control study of Influenza-Associated Necrotizing Encephalopathy (IANE) in children was conducted to explore the risk factors for the diagnosis of IANE, and to provide a predictive reference for the diagnosis of IANE. Methods: The children with IANE who received treatment in our hospital from January 2016 to December 2020 were selected as the study group, and the children with Influenza-Associated Encephalopathy (IAE) group who received treatment in the same period were selected as the control group. The blood biochemical, coagulation function and cerebrospinal fluid test results of the two groups were analyzed by univariate analysis. Receiver Operating Characteristic curve (ROC) analysis was used to determine the optimal threshold point of each index for the indicators with statistically significant differences in univariate analysis results, and multivariate Logistic stepwise regression analysis was performed according to the optimal threshold points. Results: In the IANE group, there were 32 children, including 20 males and 12 females, aged 60 (35, 84) months. There were 40 children in IAE group, including 26 males and 14 females, aged 58 (23, 97) months. Univariate results showed that serum Lactate Dehydrogenase (LDH), Cerebrospinal Fluid Lactate Dehydrogenase (CSF LDH) and Cerebrospinal Fluid Protein (CSF PRO) in the IANE group were significantly higher than those in the IAE group, and the difference between the two groups was statistically significant (P 535 U/L (OR = 31.264, 95% CI: 5.892 - 165.878, P 0.49 g/L (OR = 7.695, 95% CI: 1.052 - 56.305, P = 0.044) were independent risk factors for IANE. Conclusion: For children with influenza whose neurological symptoms appear rapidly and persist in the early stages of the disease, blood LDH > 535 U/L and CSF PRO > 0.49 g/L are independent risk factors for IANE.

Highlights

Influenza occurs frequently in winter and spring in southern China
Further Multivariate Logistic stepwise regression analysis showed that Lactate Dehydrogenase (LDH) > 535 U/L (OR = 31.264, 95% CI: 5.892 - 165.878, P < 0.001) and Cerebrospinal Fluid Protein (CSF PRO) > 0.49 g/L (OR = 7.695, 95% CI: 1.052 - 56.305, P = 0.044) were independent risk factors for Influenza-Associated Necrotizing Encephalopathy (IANE)
In the IANE group, there were 32 children, including 20 males and 12 females, aged 60 (35, 84) months, and all of them had an initial infection and persistent neurological symptoms following, such as Acute Disturbance of Consciousness (ADOC) or seizure occurred within three days after onset of the disease

Summary

Introduction

Influenza occurs frequently in winter and spring in southern China. Most infected children have a fever and respiratory symptoms. In addition to fever and respiratory symptoms, some children with influenza will have neurological symptoms, manifested as convulsions, disturbance of consciousness and coma. Some cases will die after rapid progress, and the survivors will have severe neurological sequelae [1] [2] [3]. Nervous system damage caused by influenza is one of the main causes of influenza death in children, among which IANE is the most serious, with a case fatality rate of up to 30% [4] [5]. There is currently a lack of indicators related to IANE risk factors, which delays the early identification of critical cases, leading to poor prognosis and death [6]

Methods

Results

Conclusion