Ferritin as an Effective Predictor of Neurological Outcomes in Children With Acute Necrotizing Encephalopathy

Background Acute necrotizing encephalopathy (ANE) is a fulminant disease with poor prognosis. Cytokine storm is the important phenomenon of ANE that affected the brain and multiple organs. The study aimed to identify whether hyperferritinemia was associated with poor prognosis in patients with ANE. Methods All patients with ANE had multiple symmetrical lesions located in the bilateral thalami and other regions such as brainstem tegmentum, cerebral white matter and cerebellum. Neurologic outcome at discharge was evaluated by pediatric neurologists using the system of Pediatric Cerebral Performance Category (PCPC) Scale. All risk factors associated with poor prognosis were further analyzed using receiver operating characteristic curve analysis. Results 29 patients with ANE were enrolled in the current study. 9 (31%) patients achieved a favorable neurologic outcome and 20 (69%) patients had poor neurologic outcomes. The group of poor neurologic outcome had significantly higher proportion of shock on admission and brainstem involvement. Based on multivariate logistic regression analysis, ferritin, AST, and ANE-severity score (ANE-SS) were the predictors associated with outcomes. The appropriate cutoff value for predicting neurologic outcomes in patients with ANE was 1823 ng/mL in ferritin, 78 U/L in AST and 4.5 in ANE-SS. Besides, comparison analyses showed that higher level of ferritin and ANE-SS were significantly correlated with brainstem involvement (p<0.05). Conclusions Ferritin may potentially be a prognostic factor in patients with ANE. Hyperferritinemia is associated with poor neurologic outcomes in patients with ANE and the ferritin levels more than 1823 ng/ml having about 8-fold increasing risk of poor neurologic outcome.