Stosunek bilirubiny całkowitej do albuminy oraz wskaźnik systemowego zapalenia immunologicznego jako predyktory przebiegu padaczki związanej z gorączką w dzieciach
Total bilirubin-to-albumin ratio and systemic immune inflammation index as prognostic indicators in children with febrile infection-related epilepsy syndrome
W skrócie
Badanie dotyczy padaczki wywoływanej przez infekcję z gorączką u dzieci, choroby, która jest niebezpieczna i trudna do leczenia. Naukowcy zbadali dwa proste wskaźniki wykrywalne w krwi pacjentów - stosunek bilirubiny do albuminy i wskaźnik zapalenia - które mogą przewidzieć, jak poważna będzie choroba i jak dziecko się wyzdrowieć. Okazało się, że te wskaźniki mogą pomóc lekarzom szybciej rozpoznać ciężkie przypadki i zdecydować, czy jak najszybciej zastosować specjalną ketogenną dietę terapeutyczną, która znacznie poprawia szanse na przeżycie i zdrowienie dzieci.
Oryginalny abstract (angielski)
OBJECTIVE: Febrile infection-related epilepsy syndrome (FIRES) is associated with high mortality and poor neurological outcomes, yet reliable prognostic indicators are lacking. This study aimed to evaluate the prognostic value of inflammatory indexes in FIRES and to explore their potential role in guiding clinical management. METHODS: Children with FIRES hospitalized at the Children's Hospital affiliated to Chongqing Medical University between November 2015 and April 2024 and followed for more than 6 months were retrospectively included. Inflammatory indexes were analyzed at admission and after immunotherapy. Patients were categorized into death, KD, and non-KD survival groups according to clinical course and treatment pathway. Multivariate logistic and sequential logistic regression analyses were performed to identify prognostic factors. Receiver operating characteristic (ROC) curves and Gordon's coefficient were used to determine cut-off values. Sankey diagrams and nomograms were applied to validate prognostic stratification. RESULTS: Thirty-six children with FIRES were included (22 males; mean age 6.67 ± 3 years). Nine patients died, none of whom received KD. The KD group had significantly higher 6-month Glasgow Outcome Scale (GOS) scores than the non-KD survival and death groups (4 ± 1 vs. 3 ± 1 vs. 1 ± 0, p < 0.001). Multivariate analyses showed that total bilirubin-to-albumin ratio (TAR) at admission (18.48, 95% CI 6.86∼30.09, p = 0.002) and systemic immune inflammation index (SII) after immunotherapy (-0.001, 95% CI -0.001-0, p = 0.003) were independently associated with prognosis. Cut-off values of 0.145 and 0.195 for TAR and 1292 and 1892 for SII stratified patients into distinct severity groups. Higher TAR values and lower SII values were associated with milder disease and better outcomes. Sankey diagrams and nomograms further illustrated the prognostic stratification based on TAR and SII. CONCLUSION: TAR at admission and SII after immunotherapy are practical inflammatory indexes associated with disease severity and prognosis in FIRES. These findings support further investigation of early KD initiation, particularly in patients with low TAR at admission or persistently elevated SII after immunotherapy.