Characteristics and Outcomes of Critically Ill Pediatric Patients with Posterior Reversible Encephalopathy Syndrome.
Adolescent
Anemia
/ epidemiology
Anticonvulsants
/ therapeutic use
Atypical Hemolytic Uremic Syndrome
/ complications
Autoimmune Diseases
/ epidemiology
Bone Marrow Transplantation
Calcium
/ blood
Case-Control Studies
Child
Child, Preschool
Creatinine
/ blood
Critical Illness
Dermatomyositis
/ complications
Disease Progression
Epilepsy
/ epidemiology
Female
Glomerulonephritis
/ complications
Headache
/ physiopathology
Hospital Mortality
Humans
Hypertension
/ epidemiology
Immunocompromised Host
Immunosuppressive Agents
/ therapeutic use
Intensive Care Units, Pediatric
Length of Stay
/ statistics & numerical data
Lupus Erythematosus, Systemic
/ complications
Male
Medulloblastoma
/ complications
Microscopic Polyangiitis
/ complications
Osteosarcoma
/ complications
Peritonitis
/ complications
Posterior Leukoencephalopathy Syndrome
/ blood
Retrospective Studies
Seizures
/ drug therapy
Sepsis
/ epidemiology
Vision Disorders
/ physiopathology
Hypertension
Immunosuppression
PRES
Posterior reversible encephalopathy syndrome
Seizures
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
pubmed:
10
5
2019
medline:
9
2
2021
entrez:
10
5
2019
Statut:
ppublish
Résumé
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity, typically manifesting as reversible neurological symptoms and signs of white matter edema on magnetic resonance imaging. PRES has been widely described in adults. Studies of PRES in children are mostly limited to case series and case controls. Retrospective chart review of patients under 21 years with PRES admitted at a tertiary children's hospital from 2011 to 2016. They were compared to controls matched for age and mortality risk using the Pediatric Index of Mortality-2 score.
RESULTS: Sixteen cases of PRES were identified in 13 patients (ages 5-17 years, 46% male). PRES presented with altered mental status (75%), seizures (77%), headache (31%), and vision changes (23%). In patients who recovered (n = 11), median days to symptom resolution was three (range 1-8). PRES patients had a higher mortality rate (15% vs. 5%, p < 0.05) and higher mean length of stay (13.1 vs. 4.6 days) and were more likely to have autoimmune disease (p < 0.05), immunosuppression (p < 0.05), and anemia (p < 0.05). No PRES patients were diagnosed with epilepsy by last known follow-up, and all of whom had been started on an antiepileptic drug were discontinued within 13 months. Sepsis was suspected in 53% of PRES patients and 59% of controls (p = 1.00). All PRES patients had stage II hypertension, versus 41% of controls (p < 0.05). Average creatinine in PRES was 2.35 mg/dL compared to 0.90 mg/dL in controls (p < 0.05). PRES patients had lower serum calcium (p < 0.05). After correcting for albumin, no association between PRES and hypocalcemia remained. PRES patients had a higher length of stay (13.1 vs. 4.6 days, p < 0.05) and mortality rate (15% vs. 3%, p < 0.05). Immunosuppression, autoimmune disease, renal insufficiency, anemia, and hypertension are associated with PRES after controlling for mortality risk in critically ill children. There was no association between corrected serum calcium and sepsis with PRES.
Sections du résumé
BACKGROUND/OBJECTIVE
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity, typically manifesting as reversible neurological symptoms and signs of white matter edema on magnetic resonance imaging. PRES has been widely described in adults. Studies of PRES in children are mostly limited to case series and case controls.
METHODS
Retrospective chart review of patients under 21 years with PRES admitted at a tertiary children's hospital from 2011 to 2016. They were compared to controls matched for age and mortality risk using the Pediatric Index of Mortality-2 score.
RESULTS: Sixteen cases of PRES were identified in 13 patients (ages 5-17 years, 46% male). PRES presented with altered mental status (75%), seizures (77%), headache (31%), and vision changes (23%). In patients who recovered (n = 11), median days to symptom resolution was three (range 1-8). PRES patients had a higher mortality rate (15% vs. 5%, p < 0.05) and higher mean length of stay (13.1 vs. 4.6 days) and were more likely to have autoimmune disease (p < 0.05), immunosuppression (p < 0.05), and anemia (p < 0.05). No PRES patients were diagnosed with epilepsy by last known follow-up, and all of whom had been started on an antiepileptic drug were discontinued within 13 months. Sepsis was suspected in 53% of PRES patients and 59% of controls (p = 1.00). All PRES patients had stage II hypertension, versus 41% of controls (p < 0.05). Average creatinine in PRES was 2.35 mg/dL compared to 0.90 mg/dL in controls (p < 0.05). PRES patients had lower serum calcium (p < 0.05). After correcting for albumin, no association between PRES and hypocalcemia remained. PRES patients had a higher length of stay (13.1 vs. 4.6 days, p < 0.05) and mortality rate (15% vs. 3%, p < 0.05).
CONCLUSIONS
Immunosuppression, autoimmune disease, renal insufficiency, anemia, and hypertension are associated with PRES after controlling for mortality risk in critically ill children. There was no association between corrected serum calcium and sepsis with PRES.
Identifiants
pubmed: 31069660
doi: 10.1007/s12028-019-00720-9
pii: 10.1007/s12028-019-00720-9
doi:
Substances chimiques
Anticonvulsants
0
Immunosuppressive Agents
0
Creatinine
AYI8EX34EU
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
145-151Références
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