Analysis of Risk Factors Associated With Poor Outcome in Posterior Reversible Encephalopathy Syndrome After Treatment in Children: Systematic Review and Meta-Analysis

Abstract

Objective: Chemotherapy and hematopoietic stem cell transplantation (HSCT) play important roles in clinical etiology, symptoms, signs, imaging findings, and biochemical parameters for inducing posterior reversible encephalopathy syndrome (PRES) in pediatric oncologic diseases. We aimed to evaluate various risk factors of pediatric oncologic diseases after conducting chemotherapy and HSCT to induce PRES for predicting the clinical prognosis frequency. Methods: The literature was performed on PubMed, Web of Science, and Embase databases to recognize the qualified studies. The odds ratios (ORs) of related risk factors and their corresponding 95% confidence intervals (CIs) were used to compute the pooled assessments of the outcomes. Results: Six studies were included in the meta-analysis, involving 828 records. The risk of female children has a significantly higher incidence than male children in oncologic age groups of PRES. Children over the age of 10 years old in oncologic age groups develop a significantly increased risk of PRES. Acute graft-versus-host disease (GVHD) has a significant promotion effect on the occurrence of PRES. Hypertension can promote the occurrence of PRES in children. The risk of PRES in immunodeficient children increases significantly. Children with sickle cell disease (SCD) have a significantly increased risk of PRES. The risk of PRES in children with T-cell leukemia rises considerably. The central nervous system (CNS) leukemia/involvement has a significant role in promoting the occurrence of PRES in children. The pooled OR for the factors male, ≥10 years old of age, acute GVHD, hypertension, immunodeficiency, SCD, T-cell leukemia, CNS leukemia/involvement was 0.66 (95% CI: 0.58, 0.76; P

Management and Clinical Outcome of Posterior Reversible Encephalopathy Syndrome in Pediatric Oncologic/Hematologic Diseases: A PRES Subgroup Analysis With a Large Sample Size

“…(4) Some of the included case series had insufficient patient information, corresponding to a low level of evidence. (5) In our previous study, we identified several factors associated with a poor outcome for PRES in pediatric oncologic/hematologic diseases ( 10 ); however, the random-effects model in the present study identified only 2 of these factors (hypertension and blood transfusion) as being significantly associated with PRES, indicating low concordance between the findings of the 2 studies.…”

“…Although the exact cause of PRES is not known, it is thought to be related to the production of toxins induced by HSCT and chemotherapy that target capillary endothelial cells, leading to the failure of cerebral blood pressure autoregulation, endothelial dysfunction, and vasogenic edema ( 52 , 97 ). PRES is usually observed in the context of acute hypertension (sometimes treatment-induced) ( 10 – 12 , 15 , 17 – 19 , 22 – 28 , 32 , 33 , 44 , 46 , 47 , 57 , 65 , 98 – 105 ), and may be overlooked in patients with near-normal blood pressure at symptom onset ( 98 – 100 ). Hypertension is more common in children than in adults with PRES ( 106 ).…”

“…Hypertension is more common in children than in adults with PRES ( 106 ). Between 67 and 100% of patients with PRES have hypertension after undergoing HSCT or receiving chemotherapy in pediatric oncologic/hematological diseases ( 10 – 13 , 15 , 24 – 28 , 36 , 40 , 46 , 56 , 57 , 105 , 107 , 108 ). In our systematic review, the rate of hypertension was higher after HSCT than after chemotherapy (75.0 vs. 51.0%) in pediatric patients with oncologic/hematologic diseases and PRES; we previously showed that hypertension leads to a poor outcome in this group ( 10 ) ( Figure 4 ).…”

“…A previous retrospective study found that mechanical ventilation was required in 71% of adult patients with severe PRES; the mortality rate attributed to PRES was 5.7%, with toxicity (44%) and hypertensive encephalopathy (41%) being the main causes of death ( 47 ). In pediatric patients with oncologic/hematologic diseases, early diagnosis of PRES is critical for avoiding neurologic sequelae and death ( 10 – 12 , 15 , 17 , 19 , 24 , 32 , 105 , 111 ). PRES in children is more common in hematologic diseases compared to other malignancies and is associated with hypertension, infection, and steroid use; seizures are the most common acute manifestation.…”

“…This is mainly due to the reduction of risk and adverse reactions associated with cytotoxic therapies including hematopoietic stem cell transplantation (HSCT) and chemotherapy. Posterior reversible encephalopathy syndrome (PRES), a severe neurologic complication and adverse reaction in pediatric oncologic/hematologic patients following chemotherapy and HSCT treatment (10)(11)(12)(13)(14)(15)(16), is a clinical syndrome characterized by headache, seizures, mental and visual impairment, and vomiting accompanied by reversible vasogenic edema observed by magnetic resonance imaging (MRI) that impacts the subcortical white matter of supratentorial lobes, especially in the parieto-occipital lobes (17)(18)(19).…”