title: Predictors of unfavorable outcomes in enterovirus 71-related cardiopulmonary failure in children.
abstract: 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.
authors.affiliation: Divisions of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan.
authors.forename: Shao-Hsuan
authors.initials: SH
authors.lastname: Hsia
authors.forename: Chang-Teng
authors.initials: CT
authors.lastname: Wu
authors.forename: Jia-Jen
authors.initials: JJ
authors.lastname: Chang
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
authors.forename: Hung-Tao
authors.initials: HT
authors.lastname: Chung
authors.forename: Kuang-Lin
authors.initials: KL
authors.lastname: Lin
authors.forename: Mao-Sheng
authors.initials: MS
authors.lastname: Hwang
authors.forename: Min-Liang
authors.initials: ML
authors.lastname: Chou
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
mesh_terms: 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