The Influencing Factors Of Early Prognosis In Adult With Viral Encephalitis(Viral Meningitis)

Background:Viral encephalitis (VE)/viral meningitis (VM) is a common disease of infections of central nervous system. The clinical manifestations of VE (VM) are lack of specificity. The treatment is not high sensitivity. The mortality rate and disability rate are increasing year by year. It brings a heavy economic burden to the family and society, and becomes one of the major diseases that seriously affect public health in the world. It is very important for physician to identify and monitor the risk factors at early stages of the disease. At present, the researches on the early prognosis of patients with VE (VM) is mainly focused on children, few researches on adult. There are obviously differences in the brain development, the body resistance, nutritional status, pathogen infection, clinical characteristics between children and adults. It is necessary to study the clinical manifestations, laboratory tests, EEG and imaging findings of adult patients. Physician can monitor and intervene the risk factors in early stage to improve the level of clinical diagnosis and treatment.Objectives:To explore the influencing factors of early poor prognosis in adult patients with viral encephalitis (viral meningitis), and to provide physician with a theoretical basis for correct clinical treatment. Physician can identify and monitor the risk factors at early stages of the disease.Methods:Ninety cases of adults patients diagnosed as viral encephalitis (viral meningitis) who hospitalized in the Department of Neurology, Zhongda Hospital Southeast University between January 2013 and December 2015 were selected. According to Glasgow Outcome Scale (GOS), the patients who discharged were divided into good prognosis group (n=66) and poor prognosis group (n=24).30 factors from clinical manifestations, laboratory findings and physical examination outcomes were chosen, Univariate analysis and Binary logistic regression multivariate analysis were uesd, to investigate the influencing factors of early poor prognosis in subjects with viral encephalitis (viral meningitis).Results:The average age of 90 cases of patients diagnosed as viral infection of central nervous system was (41+16.11) years. The average course of disease before hospitalization was (5.43 ±4.88) days. 66 cases (73.33%) patients were assigned to the good prognosis group,24 cases (26.67%) patients were assigned to the poor prognosis group.22 (24.44%) cases were subjected with consciousness disorder at early stages of the disease,20 (22.22%) with seizures and with status epilepticus. In poor prognosis group,1 patient died,3 were with vegetative state,16 with seizures,2 with seizures and motor weakness,5 with cranial nerve palsy,2 with behavioral or emotional problems. Compared with the good prognosis group, peripheral blood white blood cell count, blood sugar concentrations, CSF white blood cell count, glocore in CSF, chlorine content in CSF showed to be significant different in patients with poor prognosis group using Univariate analysis of continuous data (P< 0.05). Univariate analysis of categorical data showed that conscious disturbance at the early stage, presence or absence of seizure, presence or absence positive sign (meningeal irritation sign and/or localizing signs), changes in EEG, abnormal neuroimaging findings (computed tomography [CT] or magnetic resonance imaging[MRI]) had significant differences between good and poor short-term outcome groups (P<0.05). In Binary logistic regression multivariate analysis, factors indicating a poor prognosis during the early stage were:(1) presence or absence of seizure (OR=96.000,95%CI 17.828～516.936, P=0.002), (2) presence or absence positive sign (meningeal irritation sign and/or localizing signs) (OR=8.726,95%CI 2.628～28.970, P=0.001), (3) abnormal neuroimaging findings (OR=3.055,95%CI 1.280～7.292, P=0.012).Conclusions:Presence or absence of seizure, presence or absence positive sign (meningeal irritation sign and/or localizing signs) and abnormal neuroimaging findings could be the risk factors of viral infection of central nervous system in adults. Physician can correctly evaluate the relevant clinical data of patients with confirmed diagnosis, actively intervene on modifiable risk factors and provide correct treatment.