Márton Koch1, Éva Pozsgai2,3, Viktor Soós1, Anna Nagy4, János Girán5, Norbert Nyisztor6, Tibor Martyin6, Zsófia Müller7, Melánia Fehér7, Edit Hajdú8, Csaba Varga1,9. 1. Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400, Hungary. 2. Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624, Hungary. pozsgay83@gmail.com. 3. Institute of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, Pécs, 7623, Hungary. pozsgay83@gmail.com. 4. National Reference Laboratory for Viral Zoonoses; National Public Health Center, 1097 Albert Flórián Road 2-6, Budapest, Hungary. 5. Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624, Hungary. 6. Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700, Hungary. 7. Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000, Hungary. 8. Department of Infectology, University of Szeged, Albert Szent-Györgyi Health Center, Kálvária Avenue 57, Szeged, 6725, Hungary. 9. Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Mihály Street 4, Pécs, 7621, Hungary.
Abstract
BACKGROUND: West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most human infections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV -infected patients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. METHODS: We conducted a retrospective chart review of 66 WNV-infected patients from four Hungarian medical centers. Patients' neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60-90 days and 2nd follow-up, within 150-180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, "moderately severe" and "severe" based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. RESULTS: The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patients died. Each day's increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients' age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. CONCLUSIONS: Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infected patients.
BACKGROUND:West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most humaninfections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV -infectedpatients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. METHODS: We conducted a retrospective chart review of 66 WNV-infectedpatients from four Hungarian medical centers. Patients' neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60-90 days and 2nd follow-up, within 150-180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, "moderately severe" and "severe" based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. RESULTS: The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patientsdied. Each day's increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients' age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. CONCLUSIONS: Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infectedpatients.
Entities:
Keywords:
Emergency department; Modified Rankin scale; Neurological outcome; West Nile neuroinvasive disease; West Nile virus infection
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