Early risk factors for mortality in children with seizure and/or impaired consciousness accompanied by fever without known etiology

Publication date: Available online 19 March 2018
Source:Brain and Development
Author(s): Kazumi Tomioka, Hiroaki Nagase, Tsukasa Tanaka, Masahiro Nishiyama, Hiroshi Yamaguchi, Yusuke Ishida, Daisaku Toyoshima, Azusa Maruyama, Kyoko Fujita, Mariko Taniguchi-Ikeda, Kandai Nozu, Ichiro Morioka, Noriyuki Nishimura, Hiroshi Kurosawa, Yoshiyuki Uetani, Kazumoto Iijima
BackgroundChildren who present with seizure and/or impaired consciousness accompanied by fever without known etiology (SICF) may be diagnosed with either acute encephalopathy (AE) or febrile seizure (FS). Although approximately 5% of AE cases are fatal, it is difficult to identify fatal cases among children with SICF, which are often critical by the time of diagnosis. Thus, early prediction of outcomes for children with SICF, prior to diagnosis, may help to reduce mortality associated with AE. The aim of the present study was to identify clinical and laboratory risk factors for mortality acquired within 6 h of onset among children with SICF.MethodsWe retrospectively reviewed the medical records of children who had been admitted to Kobe Children's Hospital (Kobe, Japan) with SICF between October 2002 and September 2015. We compared clinical and laboratory characteristics acquired within 6 h of onset and outcomes between survivors and non-survivors using univariate and multivariate analyses.ResultsThe survivor and non-survivor groups included 659 and nine patients, respectively. All patients in the non-survivor group received a final diagnosis of AE. Univariate analysis revealed significant differences between the groups with regard to seizure duration and the following laboratory parameters: aspartate transaminase (AST), alanine aminotransferase, lactate dehydrogenase, sodium, and lactate. The multivariate analysis identified AST as a significant independent factor associated with mortality.ConclusionsElevation of AST within 6 h of onset is independently correlated with mortality in children with SICF. Our result may elucidate earlier intervention for patients with high risk of mortality.



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