Prognostic factors in the early phase of acute encephalopathy

Oba, Chizu; Kashiwagi, Masayuki; Tanabe, Takuya; Nomura, Shohei; Ogino, Mieko; Matsuda, Takuya; Murata, Shinichi; Nakamura, Michiko; Shirasu, Akihiko; Inoue, Kazuo; Okasora, Keisuke; Tamai, Hiroshi

doi:10.1111/ped.13492

Cited by 9 publications

(11 citation statements)

References 28 publications

(79 reference statements)

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“…When cytolysis occurs or the cell membrane is destroyed, LDH is released into the blood, resulting in an increase in serum LDH ( 4 ). LDH activity can be detected in malignant tumor tissues and leukemic cells ( 5 ), and serum LDH levels are correlated with the prognosis of adult T-cell leukemia-lymphoma ( 6 ), prostate cancer ( 7 ), acute myeloid leukemia ( 8 ), melanoma ( 9 ), neuroblastoma ( 10 ), glioblastoma multiforme ( 11 ), acute encephalopathy ( 12 ), and Mycoplasma pneumoniae pneumonia ( 13 ). Serum LDH levels reflect the degree of brain tissue injury, and Yu et al demonstrated that serum LDH activity is associated with middle cerebral artery occlusion in a dose-dependent manner ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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Introduction: We explored whether higher preoperative serum levels of lactate dehydrogenase (LDH) predicted outcome 3 months after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated using microsurgical clipping in our institution.Methods: Patients with aSAH treated at our institution between 2010 and 2018 were enrolled. The following parameters were recorded: age, sex, smoking and drinking history, medical history, Hunt–Hess and Fisher grades, aneurysm location, aneurysm size, surgical treatment, delayed cerebral ischemia (DCI), intracranial infection, hydrocephalus, pneumonia, and preoperative serum LDH levels within 24 h of aSAH. We investigated whether preoperative serum LDH levels were associated with Hunt–Hess grade, Fisher grade, and functional neurological outcome.Results: In total, 2,054 patients with aSAH were enrolled, 874 of whom were treated using microsurgical clipping. The average serum LDH level (U/L) was significantly lower in the good outcome group (180.096 ± 50.237) than in the poor outcome group (227.554 ± 83.002; p < 0.001). After propensity score matching, the average serum LDH level (U/L) was still lower in the good outcome group (205.356 ± 76.785) than in the poor outcome group (227.119 ± 86.469; p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.702 (95% confidence interval [CI]: 0.650–0.754; p < 0.001). Based on the ROC curve, the optimal cutoff value for serum LDH levels as a predictor of poor 3-month outcome (modified Rankin Scale score > 2) was 201.5 U/L. The results revealed that Hunt–Hess grade, Fisher grade, DCI, pneumonia, and serum LDH (>201.5 U/L) were significantly associated with poor outcome. After propensity score matching, serum LDH levels > 201.5 U/L were still considered an independent risk factor for poor outcome (odds ratio: 2.426, 95% CI = 1.378–4.271, p = 0.002). Serum LDH levels were associated with Hunt–Hess and Fisher grades and were correlated with functional neurological outcomes (p < 0.001).Conclusions: Our findings showed that higher preoperative serum levels of LDH correlated with Hunt–Hess grade, Fisher grade, and neurological functional outcome, and predicted the outcome of aSAH treated by microsurgical clipping at 3 months, which was involved in the related mechanisms of early brain injury and showed its potential clinical significance in patients with aSAH.

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Section: Introductionmentioning

confidence: 99%

Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

et al. 2021

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“…[ 19 ] However, a previous study reported that the platelet count in acute encephalopathy is higher in the poor prognosis group than in the good prognosis group (median 39.5 × 10 4 /μL vs. 25.1 × 10 4 /μL). [ 18 ] In this study, there was only 1 case with a platelet count of <10 × 10 4 /μL in the steroid pulse group, and none in the no steroid pulse group. Therefore, the relationship between a low platelet count and prognosis remains unknown.…”

Section: Discussionmentioning

confidence: 63%

Early steroid pulse therapy for children with suspected acute encephalopathy

et al. 2021

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Steroid pulse therapy is widely used to treat virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We sought to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels.We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature >38°C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at 6 hours from onset, and AST elevation >90 IU/L within 6 hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1-2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy.Fifteen patients with acute encephalopathy and 5 patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, P = .405). Even after excluding 2 patients with brainstem lesions, no significant correlation between PCPC and steroid pulse therapy timing (rs = 0.583, P = .060) was noted. However, the prognosis tended to be better in patients who received steroid pulse therapy earlier.Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with elevated AST. Still, even earlier administration of treatment could prevent the possible neurological sequelae of this condition.

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“…Regarding the differences in the platelet count, a previous study indicated that levels of < 10 × 10 4 /µL were a poor prognostic factor in in uenza encephalopathy [19]. However, a previous study reported that the platelet count in acute encephalopathy is higher in the poor prognosis group than in the good prognosis group (median 39.5 × 10 4 /µL vs. 25.1 × 10 4 /µL) [18]. In this study, there was only one case with a platelet count of < 10 × 10 4 /µL in the steroid pulse group, and none in the no steroid pulse group.…”

Section: Discussionmentioning

confidence: 95%

“…Other reports on the relationship between acute encephalopathy and AST elevation indicate that AST ≥ 46 IU/L on admission is an independent prognostic factor (odds ratio 18.5) for poor outcome in acute encephalopathy [18], while AST elevation on admission in in uenza encephalopathy is a predictor of mortality (odds ratio for AST < 100: 100-500: >500 = 1: 5.45: 17.38) [18,19]. We found that 60% of participants had severe sequelae, which is consistent with previous reports and indicates that AST elevation predicts poor prognosis early in the disease.…”

Section: Discussionmentioning

confidence: 95%

Early steroid pulse therapy for children with suspected acute encephalopathy: A historical cohort study

Ishida

Nishiyama

Yamaguchi

et al. 2020

Preprint

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Background Steroid pulse therapy is widely used for virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We aimed to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels. Methods We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature > 38˚C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at six hours from onset, and AST elevation > 90 IU/L within six hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1–2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy. Results Fifteen patients with acute encephalopathy and five patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, p = 0.405). Conclusions Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with AST elevation.

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Prognostic factors in the early phase of acute encephalopathy

Abstract: Age at onset, presence of BZD-resistant SE, and AST are associated with a poor prognosis in AE.

Cited by 9 publications

References 28 publications

Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

Early steroid pulse therapy for children with suspected acute encephalopathy

Early steroid pulse therapy for children with suspected acute encephalopathy: A historical cohort study

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