The Clinical Characteristics And Severity Of Viral Encephalitis

Background:Viral encephalitis(VE)is an infectious disease of the central nervous system with an acute onset and poor prognosis,often with fever,seizures,headache and psychiatric behavioral abnormalities as the main symptoms.Epilepsy seizures are common as the first or accompanying symptom of VE.Most postencephalitic epilepsy(PE)is refractory epilepsy,which seriously affects the patient’s ability to perform daily living activities and return to society.Despite the rapid advances in the diagnosis and treatment of VE,the severity of viral encephalitis and epilepsy seizures could not be predicted in time.Early prediction and assessment of the severity of VE and whether it will be accompanied by seizures,and more accurate formulation of treatment plan can significantly improve the treatment effect,prognosis and reduce the burden on society.Objective:By comparing the clinical characteristics and ancillary examinations of patients with VE with or without epilepsy seizures,the influencing factors of severe VE were studied to explore whether there is a more accurate,simple and economic index to predict the severity of VE and whether it will be accompanied by seizures,and whether the novel inflammatory index NLR can be used to predict the severity of VE.Methods:1.A retrospective study was performed on 70 patients with VE was diagnosed in Huaihe Hospital of Henan University from January 2015 to September 2021,and this study was divided into non-epilepsy group and epilepsy group according to the presence or absence of epilepsy seizures.Sex,age,length of hospital stay,whether accompanied by fever,whether accompanied by prodromal infection,onset season and laboratory indicators(peripheral blood WBC,NLR,CSF pressure,CSF WBC,CSF protein,CSF chloride,CSF glucose),mRS score at discharge,the peak time of disease,EEG,Cranial MRI were recorded.Statistical analysis of the differences in the above factors between the two groups;2.70 patients with VE were divided into mild(mRS score ≤ 3 points)group and severe(mRS score > 3 points)group according to the mRS score at the peak of the disease.Sex,age,length of hospital stay,whether accompanied by fever,whether accompanied by prodromal infection,whether accompanied by disturbance of consciousness,whether accompanied by epilepsy seizures,onset season and laboratory indicators(peripheral blood WBC,NLR,CSF pressure,CSF WBC,CSF protein,CSF chloride,CSF glucose),mRS score at discharge,the peak time of disease,EEG,Cranial MRI were recorded.Statistical analysis of the differences in the above factors between the two groups,then the independent risk factors for the severity of VE were determined by multivariate Logistic regression analysis.Results:1.A total of 70 patients with VE were included,50 cases(71.4%)in the non-epilepsy group,including 31 males(62.0%)and 19 females(38.0%);20 patients(28.6%)in the epilepsy group,including13 males(65.0%)and 7 females(35.0%).Univariate analysis between the two groups showed that there were statistically significant differences in fever,NLR,Cranial MRI and EEG(P < 0.05).Sex,age,prodromal infection,length of hospital stay,onset season,the peak time of disease,mRS score at discharge,peripheral blood WBC,CSF pressure,CSF WBC,CSF protein,CSF chloride and CSF glucose had no statistical significance(P > 0.05).2.VE was classified according to the mRS score at the peak of the disease into a mild group(mRS score ≤ 3 points)in 42 cases,of which 23 males(54.8%)and 19 females(45.2%),and a severe group(mRS score > 3 points)in 28 cases,of which 21 males(75.0%)and 7 females(25.0%).Univariate analysis between the two groups showed that there were statistically significant differences in disturbance of consciousness,seizures,mRS score at discharge,NLR and EEG(P < 0.05).Sex,age,length of hospital stay,fever,prodromal infection,onset season,peak time of disease,peripheral blood WBC,CSF pressure,CSF WBC,CSF protein,CSF chloride,CSF glucose and Cranial MRI had no statistical significance(P > 0.05).Multivariate Logistic regression analysis showed that consciousness disorder and NLR were the independent risk factors for the severe VE.3.In this study,the receiver operating characteristic(ROC)curve of NLR for predicting the severity of disease was as follows: AUC=0.802(95% CI: 0.697-0.907),P = 0.000,best critical value is3.475,sensitivity was 82.1%,specificity was 71.4%.Conclusion:1.The epilepsy group has more likely to have fever,higher NLR,higher rates of abnormal Cranial MRI and EEG than the non-epilepsy group.2.The severe group has more consciousness disturbances,more seizures,higher NLR,and higher rates of abnormal EEG than the mild group.3.NLR and disturbance of consciousness are an independent risk factor for the severe VE and NLR has high predictive value for the severity of VE.