Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Data Collection and Statistical Analysis
2.3. Treatment
2.4. Statstical Analysis
3. Results
Neurological Outcomes in Patients with and without Brainstem Involvement
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Demographics | All | Survivors | Non-Survivors | p Value |
---|---|---|---|---|
Number of patients | 26 | 15 | 11 | |
Gender, male, n (%) | 14 (53.8) | 10 (66.7) | 4 (36.3) | 0.362 |
Age, years, median (IQR) | 4.0 (2.3–8.4) | 4.0 (2.5–11.3) | 3.4 (2.3–7.4) | 0.256 |
Inotropic agents used, n, (%) | 14 (53.8) | 4 (26.7) | 10 (90.9) | 0.001 * |
Brainstem involvement, n, (%) | 18 (69.2) | 7 (46.7) | 11 (100) | 0.001 * |
Kidney or heart impairment, n, (%) | 12 (46.1) | 3 (20) | 9 (75) | 0.002 * |
Post–pulse therapy infection, n, (%) | 4 (15.3) | 3 (20) | 1 (9) | 0.316 |
Onset, days, median (IQR) | 2.0 (1.0–3.0) | 2.0 (1.0–3.0) | 2.0 (1.0–3.0) | 0.399 |
GCS, median (IQR) | 8 (3–10) | 9 (3–10.5) | 5 (3–10) | 0.221 |
Laboratory examination, median (IQR) | ||||
WBC, µ/L | 8900 (6150–13,900) | 8400 (6300–11,100) | 11700 (6300–11,100) | 0.471 |
PLT,(x104/ µL) | 19.3 (15.85–28.9) | 21.2 (16–29) | 18.6 (9.8–23.7) | 0.049 * |
ALT, U/L | 113 (29–407) | 55 (16–410) | 135 (66.8–941) | 0.159 |
AST, U/L | 111 (31–490) | 58 (30–350) | 111 (50–1274) | 0.162 |
Lactate, mg/dl | 27.3 (13.0–50.5) | 14.9 (9.3–30.9) | 30.75 (13.3–65.8) | 0.038 * |
CRP, mg/dl | 16.3 (6.1–42.7) | 9.1 (4.9–19.8) | 19.4 (13.7–50.4) | 0.198 |
Procalcitonin, ng/mL | 10.5 (2.8–61.2) | 7.6 (2.1–47.6) | 10.4 (5.3–69.7) | 0.441 |
Ferritin, ng/ml | 2726 (511.4–15,411) | 816.4 (356.9–2973.5) | 9169 (1379–24,288) | 0.022 * |
CK(U/L) | 233.5 (158.5–289) | 226(118–433) | 405(162–1153) | 0.454 |
CSF lactate, mg/dl | 21.2 (18.3–37.6) | 20.0 (17.5–22.1) | 37.6 (18.9–118.6) | 0.201 |
CSF leukocyte, µ/L | 3.5 (1.0–15.5) | 1 (0–7) | 6 (3–310) | 0.062 |
CSF protein, mg/dl | 66.3 (38.3–460.1) | 64.9 (30.7–111.1) | 460.1 (32.6–937.5) | 0.086 |
Pathogen, n (%) | ||||
Influenza A | 10 (38.4) | 5 (33.3) | 5 (45.4) | 0.885 |
Influenza B | 3 (11.5) | 3 (20) | 0 | 0.088 |
Mycoplasma | 5 (19.2) | 2 (13.3) | 3 (27.2) | 0.564 |
Unknown | 11 (42.3) | 5 (33.3) | 6 (54.5) | |
ANE-SS risk, n (%) | 26 | 15 | 11 | <0.001 * |
ANE-SS (0–1) low risk, n (%) | 3 (11.5) | 3 (20) | 0 | |
ANE-SS(2–4) medium risk, n (%) | 7 (26.9) | 7 (46.7) | 0 | |
ANE-SS(5–9) high risk, n (%) | 16 (61.5) | 5 (33.3) | 11 (100) | |
Treatment, n (%) | ||||
Pulse steroid therapy | 21 (80.7) | 12 (80) | 9 (81.8) | 0.344 |
Pulse steroid + IVIG | 15 (57.6) | 8 (53.3) | 7 (63.6) | 0.858 |
Early pulse steroid therapy | 15 (57.6) | 8 (53.3) | 7(63.6) | 0.039 * |
All | Low Risk (ANE-SS 0–1) | Medium Risk (ANE-SS 2–4) | High Risk (ANE-SS 5–6) | p Value | Good (PCPS 1–3) | Poor (PCPS 4–6) | p Value | |
---|---|---|---|---|---|---|---|---|
All patients, n (%) | 18 | 0 | 3 | 15 | 3 | 15 | ||
Pulse steroid therapy, n (%) | 13 | 0 | 1 (33.3) | 12 (80) | 0.546 | 1 (33.3) | 12 (80) | 0.271 |
IVIG alone used, n (%) | 3 | 0 | 2 (66.7) | 1 (6.6) | 0.019 | 2 (66.7) | 1 (6.6) | 0.06 |
Pulse steroid + IVIG, n (%) | 10 | 0 | 1 (33.3) | 9 (60) | 0.865 | 1 (33.3) | 9 (60) | 0.593 |
Early pulse steroid therapy, n (%) | 7 | 0 | 1 (33.3) | 6 (40) | 1 | 1 (33.3) | 6 (40) | 0.726 |
No IVIG or pulse steroid therapy, n (%) | 3 | 0 | 0 | 3 (20) | 0.748 | 0 | 3 (20) | 0.445 |
All | Low Risk (ANE-SS 0–1) | Medium Risk (ANE-SS 2–4) | High Risk (ANE-SS 5–6) | p Value | Good (PCPS 1–3) | Poor (PCPS 4–6) | p Value | |
---|---|---|---|---|---|---|---|---|
All patients, n (%) | 8 | 3 | 4 | 1 | 7 | 1 | ||
Pulse steroid alone therapy , n (%) | 3 | 1 (33.3) | 1 (25) | 1 (100) | 0.375 | 2 (28.5) | 1 (100) | 0.77 |
Pulse steroid + IVIG, n (%) | 5 | 2 (66.7) | 3 (75) | 0 | 0.375 | 5 (71.4) | 0 | 0.77 |
Early steroid therapy, n (%) | 8 | 3 (100) | 4 (100) | 1 (100) | 1 | 7 (100) | 1 (100) | <0.001 |
Outcome | Our Study | Mizuguchi’s Study [7] | ||||
---|---|---|---|---|---|---|
ANE without brainstem involvement | Early pulse steroid | Non-early pulse steroid | p value | Early steroid | Non-early steroid | p value |
(n = 8) | (n = 0) | (n = 12) | (n = 5) | |||
Good, n (%) | 7 (87.5) | 0 | <0.01 | 7 (58.3) | 0 | 0.044 |
Poor, n (%) | 1 (12.5) | 0 | 5 (41.7) | 5 (100) | ||
ANE with brainstem involvement | (n = 7) | (n = 14) | (n = 9) | (n = 8) | ||
Good, n (%) | 1 (14.2) | 2 (14.2) | 0.51 | 0 | 2 (25) | 0.39 |
Poor, n (%) | 6 (85.8) | 12 (85.8) | 9 (100) | 6 (75) |
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Chang, H.-P.; Hsia, S.-H.; Lin, J.-J.; Chan, O.-W.; Chiu, C.-C.; Lee, E.-P. Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy. Children 2022, 9, 136. https://doi.org/10.3390/children9020136
Chang H-P, Hsia S-H, Lin J-J, Chan O-W, Chiu C-C, Lee E-P. Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy. Children. 2022; 9(2):136. https://doi.org/10.3390/children9020136
Chicago/Turabian StyleChang, Han-Pi, Shao-Hsuan Hsia, Jainn-Jim Lin, Oi-Wa Chan, Chun-Che Chiu, and En-Pei Lee. 2022. "Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy" Children 9, no. 2: 136. https://doi.org/10.3390/children9020136