Analysis Of The Risk Factors Influencing The Short-term Poor Prognosis Of Acute Central Nervous System Viral Infection In Children

【Objective】To study risk factors of children with acute central nervous system viralinfection, so that pediatrician may identify children with poor prognosis at early stages of thedisease, and provide them with a theoretical basis for clinical treatment.【Methods】Retrospectively collected and analyzed the clinical data of a cohort of pediatricpatients of acute central nervous system viral infection who hospitalized at The FirstAffiliated Hospital of Fujian Medical University between January2010and June2013.According to Glasgow Outcome Scale (GOS) at discharge, children were divided into goodprognosis group and poor prognosis group. Clinical manifestations, laboratory findings, EEG,results of neuroimaging and outcomes were analyzed using Univariate analysis and Binarylogistic regression multivariate analysis, in order to investigate the risk factors for unfavorableoutcomes of childhood acute central nervous system viral infection diseases.【Results】310cases of children diagnosed as acute viral infection of central nervous system,5.16%(310/6005) of the total number of hospitalizations. Using of exclusion criteria,9patients were excluded, and at last301cases enrolled. According to our classification,278(92.36%) patients were assigned to the good prognosis group,23(7.64%) patients wereassigned to the poor prognosis group. Of these cases,7with seizures,2with seizures andmotor weakness,1with seizures and mental deterioration,4with motor weakness,1withspeech disorder,2with motor weakness and speech disorder,1with mental deterioration,1with cranial nerve palsy,1with behavioral or emotional problems and3patients died.Compared with the good prognosis group, longer duration before admission, longer time offever, lower CSF white blood cell count, a relatively lower calcium level were present morefrequently in children with poor prognosis group in the Univariate analysis of continuous data(P＜0.05), there were no significant differences between groups in age, WBC count,C-reactive protein, CSF protein levels, lactate levels, etc(P＞0.05). Univariate analysis ofcategorical data showed that conscious disturbance at the early stage, multiple seizures,convulsive status epilepticus, meningeal irritation sign, muscle weakness, severe changes inEEG, abnormal neuroimaging findings (computed tomography [CT] or magnetic resonanceimaging[MRI], or both) had significant differences between good and poor short-term outcome groups(P＜0.05), While there were no significant differences among groups in sex,residence, nutritional status, complications, etc(P＞0.05). In Binary logistic regressionmultivariate analysis, factors indicating a poor prognosis during the early stage were:(1)conscious disturbance at the early stage(OR=4.885,95%CI1.523～15.670, P=0.008),(2)multiple seizures(OR=6.352,95%CI1.905～21.178, P=0.003),(3)severe changes in EEG(OR=4.269,95%CI1.708～10.666, P=0.002),(4)abnormal neuroimaging findings(OR=9.740,95%CI2.360～40.192, P=0.002).【Conclusions】Conscious disturbance at the early stage, multiple seizures, severe changes inEEG and abnormal neuroimaging findings are risk factors of acute viral infection of centralnervous system in children. Identifying children with poor prognosis at early stages of thedisease, then enhancing communication with their families, and taking a more aggressiveintervention earlier, may improve the prognosis of children with a certain degree and reduceor avoid some disputes between doctors and patients.