Predictors of unfavorable outcomes in enterovirus 71-related cardiopulmonary failure in children.
BACKGROUND
Enterovirus 71 (EV71) can sometimes cause fatal or disabling diseases in children; therefore EV71-infected children with cardiopulmonary failure were investigated at Chang Gung Children's Hospital to discover the prognostic predictors.


METHODS
We investigated 27 EV71-infected children with cardiopulmonary failure from May 2000 to September 2001 and analyzed their clinical data to find predictors associated with unfavorable outcomes of deaths or ventilator dependence.


RESULTS
Of the 27 patients, 8 (30%) died and 10 (37%) were ventilator-dependent. Troponin I levels correlated most strongly with fatality, with 5 of the 6 children with troponin I levels >40 ng/ml dying (P = 0.001). Other factors correlated with fatality were cerebrospinal fluid white blood cell count > or =100/microL (P = 0.002) and initial systolic pressure < or =100 mm Hg (P = 0.05). Of the 19 survivors, 10 (53%) were left with central hypoventilation, dysphagia and/or limb weakness plus atrophy. The factors associated with ventilator dependence included higher inotrope equivalent (P < 0.001), duration of hypotension > or =40 hours, initial blood systolic pressure < or =100 mm Hg, positive EV71 isolation and age > or =12 months.


CONCLUSIONS
Poor prognostic factors were related to cardiovascular and neurologic damage; therefore physicians may consider advanced cardiovascular support for EV71-infected children with cardiopulmonary failure.
Hsia
Shao-Hsuan
SH
Divisions of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Wu
Chang-Teng
CT
Chang
Jia-Jen
JJ
Lin
Tzou-Yien
TY
Chung
Hung-Tao
HT
Lin
Kuang-Lin
KL
Hwang
Mao-Sheng
MS
Chou
Min-Liang
ML
Chang
Luan-Yin
LY
D002648:Child; D004770:Enterovirus / Q000145:classification / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index; D012122:Ventilators, Mechanical