USING CHARACTERISTIC CHANGES IN LABORATORY VALUES TO ASSIST IN THE DIAGNOSIS OF HEMORRHAGIC-SHOCK AND ENCEPHALOPATHY SYNDROME

Objectives. (1) To determine whether the laboratory abnormalities in h emorrhagic shock encephalopathy syndrome (HSES) follow a characteristi c pattern of evolution; and (2) to describe the clinical characteristi cs and outcome of this group of children. Design. Retrospective review of hospital records. Setting. Pediatric intensive care unit in an aca demic children's hospital. Patients. Seventeen children who received t he diagnosis of HSES. Measurements. (1) To support the diagnosis of HS ES, the following laboratory tests were obtained: creatine phosphokina se, alanine aminotransferase, aspartate aminotransferase, blood urea n itrogen, creatinine, anemia, thrombocytopenia, coagulation abnormaliti es, and a metabolic acidosis; and (2) patient characteristics at the t ime of admission and during the illness and patient outcome were recor ded. Results. The median time for laboratory abnormalities in HSES to reach the most aberrant levels was 1.2 to 1.4 days. After reaching max imal deviation, the laboratory values gradually returned to normal. Th e severity of laboratory abnormalities was not predictive of mortality . All patients were comatose, had seizures, and required fluid resusci tation. Respiratory failure occurred in 12 (71%) of 17 patients. Vasop ressor infusions were used for 8 (47%). Viral cultures were performed in 15 patients and were positive in 8 (53%). Eleven (64%) patients sur vived. Conclusions. The laboratory abnormalities that are characterist ic of HSES follow a distinctive pattern of evolution during the course of the illness. Although the sensitivity, specificity, and predictive value of this pattern of laboratory abnormalities are not known, it m ight provide a useful tool in diagnosing HSES and excluding other illn esses. Viral illness is common in HSES. The severity of illness and mo rtality in this group of patients is similar to other descriptions of HSES.