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

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。

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.