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2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection

BACKGROUND: Disseminated neonatal herpes simplex virus (dHSV) infection is associated with substantial morbidity and an estimated case fatality rate of ~25% despite antiviral therapy. Contemporary data on predictors of mortality among infants with dHSV infection are limited. METHODS: From January 20...

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Autores principales: Ouellette, Christopher, Mejias, Asuncion, Shimamura, Masako, Marzec, Laura, Salamon, Doug, Leber, Amy, Sanchez, Pablo J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809495/
http://dx.doi.org/10.1093/ofid/ofz360.2016
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author Ouellette, Christopher
Mejias, Asuncion
Shimamura, Masako
Marzec, Laura
Salamon, Doug
Leber, Amy
Sanchez, Pablo J
author_facet Ouellette, Christopher
Mejias, Asuncion
Shimamura, Masako
Marzec, Laura
Salamon, Doug
Leber, Amy
Sanchez, Pablo J
author_sort Ouellette, Christopher
collection PubMed
description BACKGROUND: Disseminated neonatal herpes simplex virus (dHSV) infection is associated with substantial morbidity and an estimated case fatality rate of ~25% despite antiviral therapy. Contemporary data on predictors of mortality among infants with dHSV infection are limited. METHODS: From January 2012 to December 2018, neonates with HSV infection were identified by the Virology database at Nationwide Children’s Hospital. Demographic, clinical, laboratory, and radiographic data were obtained from the infants’ electronic healthcare records to identify cases of dHSV infection and to determine possible predictor(s) of mortality. dHSV was defined as detection of HSV DNA by polymerase chain reaction (PCR) in blood, cerebrospinal fluid, or skin/eye/mouth, and evidence of hepatitis, pneumonitis, sepsis, or coagulopathy, with or without central nervous system involvement. RESULTS: Of 43 neonates with HSV infection, 12 (28%) infants (median [IQR] age: 8.5 [7–11] days) had dHSV and 6 (50%) died. Clinical and laboratory findings of neonates who survived vs. those who died are presented in Table 1. The median duration of symptoms at presentation was 1.5 [1–2] days. Among infants who died, the median duration of hospitalization to time of death was 1.5 days (range, 0 to 4 days). Clinical signs at presentation and blood semiquantiative viral loads (cycle threshold, Ct) were not different between infants who survived (Ct 18.0 [15.4–23.3]) and those who died (16.6 [13.4–23.3]; P > 0.05). Initial serum alanine aminotransferase (ALT), INR or lactate were not different between the two groups. However, initial serum median albumin concentration was lower among those who died vs. survivors (1.8 g/dL vs. 2.7 g/dL, P = 0.004). To assess the sensitivity and specificity of potential laboratory predictors of mortality, serum laboratory values were evaluated as follows (sensitivity, specificity): ALT > 800 (67%, 80%), INR > 2.7 (67%, 80%), serum lactate > 3 mmol/L (80%, 100%), and initial serum albumin < 2 g/dL (100%, 100%). CONCLUSION: Albumin concentrations < 2 g/dL at presentation correlated highly with mortality in neonatal dHSV infection, suggesting that hypoalbuminemia may reflect components of both viral sepsis and poor synthetic liver function. Larger cohorts of neonates with dHSV infection are needed to confirm this result. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68094952019-10-28 2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection Ouellette, Christopher Mejias, Asuncion Shimamura, Masako Marzec, Laura Salamon, Doug Leber, Amy Sanchez, Pablo J Open Forum Infect Dis Abstracts BACKGROUND: Disseminated neonatal herpes simplex virus (dHSV) infection is associated with substantial morbidity and an estimated case fatality rate of ~25% despite antiviral therapy. Contemporary data on predictors of mortality among infants with dHSV infection are limited. METHODS: From January 2012 to December 2018, neonates with HSV infection were identified by the Virology database at Nationwide Children’s Hospital. Demographic, clinical, laboratory, and radiographic data were obtained from the infants’ electronic healthcare records to identify cases of dHSV infection and to determine possible predictor(s) of mortality. dHSV was defined as detection of HSV DNA by polymerase chain reaction (PCR) in blood, cerebrospinal fluid, or skin/eye/mouth, and evidence of hepatitis, pneumonitis, sepsis, or coagulopathy, with or without central nervous system involvement. RESULTS: Of 43 neonates with HSV infection, 12 (28%) infants (median [IQR] age: 8.5 [7–11] days) had dHSV and 6 (50%) died. Clinical and laboratory findings of neonates who survived vs. those who died are presented in Table 1. The median duration of symptoms at presentation was 1.5 [1–2] days. Among infants who died, the median duration of hospitalization to time of death was 1.5 days (range, 0 to 4 days). Clinical signs at presentation and blood semiquantiative viral loads (cycle threshold, Ct) were not different between infants who survived (Ct 18.0 [15.4–23.3]) and those who died (16.6 [13.4–23.3]; P > 0.05). Initial serum alanine aminotransferase (ALT), INR or lactate were not different between the two groups. However, initial serum median albumin concentration was lower among those who died vs. survivors (1.8 g/dL vs. 2.7 g/dL, P = 0.004). To assess the sensitivity and specificity of potential laboratory predictors of mortality, serum laboratory values were evaluated as follows (sensitivity, specificity): ALT > 800 (67%, 80%), INR > 2.7 (67%, 80%), serum lactate > 3 mmol/L (80%, 100%), and initial serum albumin < 2 g/dL (100%, 100%). CONCLUSION: Albumin concentrations < 2 g/dL at presentation correlated highly with mortality in neonatal dHSV infection, suggesting that hypoalbuminemia may reflect components of both viral sepsis and poor synthetic liver function. Larger cohorts of neonates with dHSV infection are needed to confirm this result. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809495/ http://dx.doi.org/10.1093/ofid/ofz360.2016 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Ouellette, Christopher
Mejias, Asuncion
Shimamura, Masako
Marzec, Laura
Salamon, Doug
Leber, Amy
Sanchez, Pablo J
2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection
title 2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection
title_full 2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection
title_fullStr 2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection
title_full_unstemmed 2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection
title_short 2338. Early Predictors of Mortality in Neonatal Disseminated Herpes Simplex Virus Infection
title_sort 2338. early predictors of mortality in neonatal disseminated herpes simplex virus infection
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809495/
http://dx.doi.org/10.1093/ofid/ofz360.2016
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