12例新型冠状病毒Omicron变异株感染相关急性坏死性脑病儿童的临床特点及预后分析

Clinical characteristics and prognosis in 12 children with SARS-CoV-2 Omicron variant infection-associated acute necrotizing encephalopathy

摘要:

目的 分析儿童新型冠状病毒Omicron变异株感染相关急性坏死性脑病的临床特点及预后。方法 回顾性分析2022年12月18—29日青岛大学附属妇女儿童医院PICU诊断为新型冠状病毒Omicron变异株感染相关急性坏死性脑病患儿12例的临床资料，根据结局分为死亡组（7例）和存活组（5例），比较两组临床表现、辅助检查结果等差异。结果 12例Omicron变异株感染相关急性坏死性脑病患儿的中位发病年龄为30个月，男女比例为1∶1，均有持续高热，中位最高体温为41℃，发热至出现惊厥或意识障碍中位时间为18 h。死亡组神经源性休克、凝血功能异常比例，以及乳酸、D-二聚体、白细胞介素-6、白细胞介素-8和白细胞介素-10水平均高于存活组（均P<0.05）。结论 儿童新型冠状病毒Omicron变异株感染相关急性坏死性脑病患儿多以持续高热起病，病情进展快，易于短时间内出现意识障碍、多器官功能障碍。患儿出现神经源性休克、凝血功能异常和细胞因子显著增高，提示死亡风险增高。

Abstract:

Objective To study the clinical characteristics and prognosis of SARS-CoV-2 Omicron variant infection-associated acute necrotizing encephalopathy (ANE) in children.Methods A retrospective analysis was conducted on the medical data of 12 children with SARS-CoV-2 Omicron variant infection-associated ANE who were admitted to the Pediatric Intensive Care Unit, Qingdao Women and Children′s Hospital from December 18 to 29, 2022. The children were divided into two groups based on outcomes: death group (7 cases) and survival group (5 cases). The clinical manifestations and auxiliary examination results were compared between the two groups.Results The median age of the 12 patients was 30 months, with a male-to-female ratio of 1:1. All patients presented with persistent high fever, with a median highest body temperature of 41℃. The median time from fever onset to seizure or consciousness disturbance was 18 hours. The death group had a higher proportion of neurogenic shock, coagulation dysfunction, as well as elevated lactate, D-dimer, interleukin-6, interleukin--8, and interleukin-10 levels compared to the survival group (P<0.05).Conclusions Children with SARS-CoV-2 Omicron variant infection-associated with ANE commonly present with persistent high fever, rapidly progressing disease, and have a high likelihood of developing consciousness disorders and multiorgan dysfunction within a short period. The occurrence of neurogenic shock, coagulation dysfunction, and significantly elevated cytokine levels suggests an increased risk of mortality.