In children with seizures and/or impaired consciousness accompanied by fever without known etiology (SICF), an increase in the aspartate aminotransferase (AST) level to ≥73 IU/L within 12 hours of seizure onset may be predictive of poor outcomes following the initiation of targeted temperature management (TTM) within 24 hours, according to study findings published in Brain & Development.

Researchers retrospectively reviewed medical records of children admitted to a children’s hospital in Japan with SICF between 2002 and 2016 (n=73; mean age, 24.2 months [range, 2.9 to 174.9 months]). The treatment regimen used TTM in all patients, and researchers categorized the patients into 2 groups: satisfactory outcomes andpoor outcomes.

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During TTM, body temperature was reduced to 36.0±0.5℃ ≥48 hours with a cooling blanket. Acetaminophen was used after TTM to maintain skin temperature <38.5℃.

Neurologic outcome was measured 1 month following onset of SICF. Clinical characteristics and laboratory findings were compared in both groups in univariate and multivariate logistic regression analyses.

A total of 10 children in the final cohort were categorized into the poor outcomes group and 63 patients exhibited satisfactory outcomes. In the univariate analysis, factors associated with poor outcomes included treatment with ≥4 types of anticonvulsants, use of methylprednisolone pulse therapy, and an AST level ≥73 IU/L.

The multivariate analysis, however, demonstrated that an elevated AST level was the only independent predictor of poor outcome in these patients (odds ratio, 26.50; 95% CI, 4.75-148.00; P <.001). Of the 10 patients who had a poor outcome, 8 were subsequently diagnosed with acute encephalopathy with biphasic seizures and late reduced diffusion.

Study limitations include its retrospective nature, the small sample size, and the lack of a comparator control group.

The investigators concluded that “future large-scale studies are required to confirm whether high AST levels are an independent predictor of a poor outcome in children with SICF treated using TTM.”

Reference

Tanaka T, Nagase H, Yamaguchi H, et al. Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology [published online March 28, 2019]. Brain Dev. doi:10.1016/j.braindev.2019.03.007