Study on Acute Neurologic Manifestations and In-Hospital Mortality

Researchers have recently observed that there are differences in in-hospital mortality based on the type of acute neurologic manifestations (ANMs) with increased risk observed for patients with multiple acute neurologic manifestations.

The study is published in Pediatrics.

Acute severe neurologic involvement is the most threatening complication in children with hemolytic-uremic syndrome (HUS).

Hence, Clare C. Brown and colleagues from the Health Policy and Management Department, Fay W. Boozman College of Public Health conducted this study to describe the association between acute neurologic manifestations (ANMs) and in-hospital mortality among children with HUS.

Using the Pediatric Health Information System database, in this retrospective multicenter cohort study, the authors identified the first HUS-related inpatient visit among children ≤18 years (years 2004–2018). Frequency of selected ANMs and combinations of ANMs, as well as the rate of mortality, was calculated. Multivariate logistic regression was used to identify the association of ANMs and the risk of in-hospital mortality.

Results

• Among 3915 patients included in the analysis, an ANM was noted in 10.4% (n = 409) patients.
• Encephalopathy was the most common ANM (n = 245). Mortality was significantly higher among patients with an ANM compared with patients without an ANM (13.9% vs 1.8%; P < .001).
• Individuals with any ANM had increased odds of mortality (odds ratio [OR]: 2.25; 95% confidence interval [CI]: 1.29–3.93; P = .004), with greater risk (OR: 2.60; 95% CI: 1.34–5.06; P = .005) among patients with ≥2 manifestations.
• Brain hemorrhage (OR: 3.09; 95% CI: 1.40–6.82; P = .005), brain infarction (OR: 2.64; 95% CI: 1.10–6.34; P = .03), anoxic brain injury (OR: 3.92; 95% CI: 1.49–10.31; P = .006), and brain edema (OR: 4.81; 95% CI: 1.82–12.71; P = .002) were independently associated with mortality.

Therefore, it was concluded that "In this study, the largest systematic assessment of ANMs among children with HUS to date, we identify differences in in-hospital mortality based on the type of acute neurologic manifestations, with increased risk observed for patients with multiple ANMs."