Clinical epidemiology, determinants, and outcomes of severe viral encephalitis in Chinese children: a multicenter retrospective cohort study

In China, there were few studies about the etiology, outcome and disease burden of severe viral encephalitis (VE) in recent years. The aims of this study were to characterize the etiology, prognosis and identify the factors predicting severe VE in Chinese children. A multicenter retrospective cohort study was conducted at six hospitals from 2015 to 2021 in China. The clinical and outcome data were collected during patients’ hospitalization. We analyzed the epidemiologic characteristics and disease burden of hospitalized children (≤ 14 years old) with VE in China. Univariate and multivariate logistic regression analyses were used to identify the factors predicting severe VE. In total, 801 episodes of VE were included. There were 272 females and 529 males among the included patients, with a mean age of 4.81 ± 3.46 years. There were 29 cases diagnosed severe VE, with an incidence of 3.6% (29/801). Among the severe cases, Enterovirus (EV) 55.2% (16/29) was the main pathogen. A total of 11 (1.4%) in-hospital deaths occurred, and 32 (4.0%) patients had the sequelae. The incidence of sequelae, the number of patients receiving treatment in the ICU, and the number of deceased patients were all higher in the severe VE group. After accounting for circularity between severity definition and predictors, significant factors for severe VE were abnormal brain imaging and EV infection. Coma was a defining criterion and not considered an independent predictor. This study will help understand the clinical epidemiology, prognosis and disease burden of hospitalized children with severe VE in China and offer useful information for identifying high-risk patients who are susceptible to poor prognosis.