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Grade I Reye's Syndrome — Outcome and Predictors of Progression to Deeper Coma Grades

1984; Massachusetts Medical Society; Volume: 311; Issue: 24 Linguagem: Inglês

10.1056/nejm198412133112404

1533-4406

James E. Heubi, Cynthia C. Daugherty, Jacqueline S. Partin, John C. Partin, William K. Schubert,

Neuroscience of respiration and sleep

We studied 83 biopsy-proved cases of Grade I Reye's syndrome to determine the outcome, possible clinical or laboratory predictors of progression to deeper coma grades, and hepatic ultrastructural findings. Seventy-eight patients had no change in coma grade during hospitalization, whereas five (6 per cent) had progression to deeper coma grades. All the patients survived without sequelae except one who sustained severe brain damage. The mean (±S.E.) level of serum ammonia on admission was significantly higher (P = 0.005) in patients whose disease progressed to deeper neurologic grades (291±42 μg per deciliter) than in those whose disease did not so progress (53±5 μg per deciliter), and the corrected prothrombin time was significantly more prolonged (P = 0.005) in patients with progressing coma (3.9±0.5 seconds) than in those whose coma grade did not change (1.6±0.2 seconds). The combination of a prothrombin time 3 seconds or longer than that of the control and a serum level of ammonia on admission of 100 μg per deciliter or more correctly predicted progression in 71.5 per cent of the cases (sensitivity, 100 per cent; specificity, 97.6 per cent). Our findings suggest that the prognosis is excellent for survival without sequelae in Grade I Reye's syndrome (98.8 per cent) when management includes hospital surveillance and intravenous glucose and electrolyte infusion. (N Engl J Med 1984; 311:1539–42.)