Predictive factors for hypertensive encephalopathy in hospitalized pediatric patients: a retrospective case-control study

Abstract

Background: Hypertensive emergency in children often exhibits neurological symptoms indicative of hypertensive encephalopathy (HE). The risk factors concerning HE development remain unclear, motivating the objective of this study to identify risk factors and formulate an equation for forecasting HE in hospitalized pediatric patients. Methods: This retrospective case-control study focused on pediatric patients aged 1–18 years diagnosed with hypertension from 2011 to 2021. Logistic regression analysis was utilized to identify variables associated with HE. A HE predictive equation was developed based on significant factors, with sensitivity, specificity, and predictive values assessed using receiver operating characteristics curves. Results: Three hundred thirty-two patients with mean age 9.3 years were recruited. 12.3% developed HE. Univariable analysis revealed risk factors for HE, including central nervous system symptoms, peak systolic and diastolic blood pressure z-score (Z-SBP and Z-DBP), corticosteroid and calcineurin inhibitor use, and leukemia/lymphoma. Logistic regression formed the equation predicting HE occurrence as follows: 2.162 (vomiting) + 2.921 (headache/dizziness) + 2.363 (leukemia/lymphoma) + 1.807 (corticosteroid) + 0.783 (peak Z-SBP). The equation demonstrated robust correlation with predicted probability of developing HE and had AUC of 0.95. A cutoff score of 4 showed high sensitivity (97.6%) and negative predictive value (99%), identifying 98% of HE cases. Conclusions: This study pinpointed key risk factors and introduced an accurate predictive equation, underscoring the significance of assessing multiple factors beyond blood pressure levels for HE prediction in hypertensive pediatric patients.