Clinical Value of PEWS Combined with Serum Neuron-Specific Enolase in the Assessment of Severity and Prognosis of Children with Viral Encephalitis

Abstract

Background: Viral encephalitis (VE) is an infectious disease of the nervous system caused by infection with the herpes simplex virus and other neurotropic viruses. The disease leads to disorders of consciousness and signs of meningeal irritation, and it has a high mortality rate if untreated. Even survivors often suffer from severe neurological complications. Objectives: The aim of this study was to investigate the assessment of serum neuron-specific enolase (NSE) on the severity of VE in children and to evaluate the potential benefits of integrating the pediatric early warning score (PEWS) with serum NSE. Methods: A total of 117 children diagnosed with VE were prospectively included. The children were classified into mild-moderate (n = 62) and severe (n = 55) groups. The prognosis of children at discharge was assessed using the Glasgow Outcome Scale (GOS). Serum NSE levels were determined using an enzyme-linked immunoassay. The PEWS test was administered to the children upon admission. Serum NSE cut-off values were calculated using receiver operating characteristic (ROC) analysis. The PEWS and serum NSE were compared between children in the good prognosis (n = 85) and poor prognosis (n = 32) groups. A clinical model for predicting poor prognosis in children with VE was constructed using multifactorial logistic regression analysis. Results: Serum NSE levels were significantly higher in the Severe group than in the mild-moderate group. Serum NSE levels greater than 80.4 ng/mL effectively distinguished children with severe VE. The PEWS was significantly lower, while serum NSE levels were higher in the poor prognosis group compared to the good prognosis group. The combination of PEWS and serum NSE provided predictive insights into poor outcomes for children with VE. Conclusions: Increased serum NSE levels are associated with the clinical severity of VE in patients. The PEWS and NSE level assessments can predict the prognosis of VE patients, especially in severe cases.