Early risk factors for mortality in children with seizure and/or impaired consciousness accompanied by fever without known etiology
Early risk factors for mortality in children with seizure and/or impaired consciousness accompanied by fever without known etiology
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DOI：
10.1016/j.braindev.2018.02.015
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发表时间：
2018-08-01
影响因子：
1.7
通讯作者：
Iijima, Kazumoto
中科院分区：
文献类型：
--
作者：
Tomioka, Kazumi;Nagase, Hiroaki;Iijima, Kazumoto
背景资料：出现癫痫发作和/或意识障碍伴不明原因发热（SICF）的儿童可能被诊断为急性脑病（AE）或热性癫痫发作（FS）。尽管约5%的AE病例是致死性的，但难以在SICF儿童中确定致死性病例，这些病例在诊断时通常是关键的。因此，在诊断前早期预测SICF儿童的结局可能有助于降低与AE相关的死亡率。本研究的目的是确定临床和实验室的危险因素，获得6小时内发病的儿童SICF.Methods：我们回顾性分析了2002年10月和2015年9月之间的SICF. Methods已被收住到科比儿童医院（科比，日本）的儿童的医疗记录。我们比较了临床和实验室特征，在6小时内获得的发病和结果之间的幸存者和非幸存者使用单变量和多变量analysis.Results：幸存者和非幸存者组包括659和9例患者，分别。非存活组的所有患者均接受AE的最终诊断。单变量分析显示，两组在癫痫发作持续时间和以下实验室参数方面存在显著差异：天冬氨酸转氨酶（AST）、丙氨酸转氨酶、乳酸脱氢酶、钠和乳酸。多变量分析确定AST作为一个显着的独立因素与mortality.Conclusions：AST升高6小时内发病是独立相关的死亡率与儿童SICF。我们的研究结果可能阐明早期干预的高死亡风险的患者。(C)2018日本儿童神经病学学会Elsevier B. V.出版，保留所有权利。
Background: Children who present with seizure and/or impaired consciousness accompanied by fever without known etiology (SICF) may be diagnosed with either acute encephalopathy (AE) or febrile seizure (FS). Although approximately 5% of AE cases are fatal, it is difficult to identify fatal cases among children with SICF, which are often critical by the time of diagnosis. Thus, early prediction of outcomes for children with SICF, prior to diagnosis, may help to reduce mortality associated with AE. The aim of the present study was to identify clinical and laboratory risk factors for mortality acquired within 6 h of onset among children with SICF.Methods: We retrospectively reviewed the medical records of children who had been admitted to Kobe Children's Hospital (Kobe, Japan) with SICF between October 2002 and September 2015. We compared clinical and laboratory characteristics acquired within 6 h of onset and outcomes between survivors and non-survivors using univariate and multivariate analyses.Results: The survivor and non-survivor groups included 659 and nine patients, respectively. All patients in the non-survivor group received a final diagnosis of AE. Univariate analysis revealed significant differences between the groups with regard to seizure duration and the following laboratory parameters: aspartate transaminase (AST), alanine aminotransferase, lactate dehydrogenase, sodium, and lactate. The multivariate analysis identified AST as a significant independent factor associated with mortality.Conclusions: Elevation of AST within 6 h of onset is independently correlated with mortality in children with SICF. Our result may elucidate earlier intervention for patients with high risk of mortality. (C) 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.