Clinical profile and risk factors of mortality in acute febrile encephalopathy in children: an experience from tertiary care center of central India

Background: Acute febrile encephalopathy (AFE) is characterized by fever, altered mental state, and/or seizures due to infections agents, metabolites and toxins.
Objectives: To determine the clinical profile and risk factors of mortality in children with AFE.
Method: A two-year retrospective observational study was done on paediatric intensive care unit admitted children, aged 1 month to 12 years, with a history of recent onset fever and altered sensorium with or without seizures. Children with space occupying lesion, cerebrovascular accident, traumatic brain injury, and seizure disorder were excluded. Demographic, clinical and relevant laboratory data were extracted from medical records. Student’s t-test, Chi-square test and univariate / multi-variate regression model were used for statistical analysis.
Results: Males outnumbered females and 63.8% were less than 5 years old. Two-third were from lower-socio-economic class of rural residences. Almost two-third presented during winter and summer. All cases presented with fever and altered sensorium and 81.9% had seizures. Glasgow coma scale (GCS) score <8 was noted in 46.8% cases, with mean score 7.65±2.87. Signs included raised intracranial pressure (82.7%), meningeal irritation (59.6%), abnormal pupillary size (42.6%) and abnormal tone (87.2%). Pyogenic meningitis and viral encephalitis were the common causes. Mortality was 40.4%; 60.7% survivors had neurological sequelae. GCS score <8, hypotension, respiratory distress/cyanosis, need for mechanical ventilation, low serum albumin, low sugar and high protein in cerebrospinal fluid (CSF) were the risk factors for mortality.
Conclusions: Hypotension, respiratory distress, need for mechanical ventilation and presence of high protein in CSF were the independent predictors of mortality.