Researchers of a recent multicenter study aimed to assess whether routine complete blood count (CBC) data collected during intensive care unit care can predict 12-month outcomes in cryptogenic febrile infection–related epilepsy syndrome (FIRES), a new-onset refractory status epilepticus subtype. Sixty-three patients (34 adults, 29 children) from 12 centers were followed and categorized as having unfavorable (Glasgow Outcome Score [GOS] 1–3) or favorable (GOS 4–5) outcomes. Demographic/clinical data and serial CBCs were grouped by treatment phase—pre/no immunotherapy, first-line immunotherapy, and second-line immunotherapy. Separate decision-tree models for adults and children were trained and validated with leave-one-patient-out testing.
Across 1,530 CBCs (997 adult; 533 pediatric), unfavorable outcomes occurred in 18 adults and 12 children; children more often received second-line immunotherapy. Adults with unfavorable outcomes showed higher neutrophil-to-lymphocyte (NLR) and monocyte-to-lymphocyte (MLR) ratios, while children with unfavorable outcomes had higher red-cell distribution width. NLR and MLR rose after immunotherapy initiation in both age groups. Although specific predictors varied by phase and cohort, leukocyte subtype proportions were consistently informative. Predictive accuracy was 87% in children (strongest in pre/first-line phases) and 83% in adults (strongest during/after second line), supporting standard CBCs as a rapid, accessible tool for early prognostication in cryptogenic FIRES—particularly in pediatric patients.
Reference: Guillemaud M, Hanin A, Riviello JJ, etal. Standard complete blood count to predict long-term outcomes in febrile infection-related epilepsy syndrome (FIRES): A multicenter study. Epilepsia. 2025. doi: 10.1111/epi.18605. Epub ahead of print.
Link: https://onlinelibrary.wiley.com/doi/10.1111/epi.18605?af=R
