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Pan M, Li M, Li N, Mao J. Predicting renal damage in children with IgA vasculitis by machine learning. Pediatr Nephrol 2024:10.1007/s00467-024-06432-3. [PMID: 38916780 DOI: 10.1007/s00467-024-06432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/25/2024] [Accepted: 06/07/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Children with IgA Vasculitis (IgAV) may develop renal complications, which can impact their long-term prognosis. This study aimed to build a machine learning model to predict renal damage in children with IgAV and analyze risk factors for IgA Vasculitis with Nephritis (IgAVN). METHODS 50 clinical indicators were collected from 217 inpatients at our hospital. Six machine learning algorithms-Logistic Regression, Linear Discriminant Analysis, K-Nearest Neighbor, Support Vector Machine, Decision Trees, and Random Forest-were utilized to select the model with the highest predictive performance. A simplified model was developed through feature importance ranking and validated by an additional cohort with 46 patients. RESULTS The random forest model had the highest accuracy, precision, recall, F1 score, and area under the curve, with values of 0.91, 0.98, 0.70, 0.79 and 0.94, respectively. The top 11 features according to the importance ranking were anti-streptolysin O, corticosteroids therapy, antihistamine therapy, absolute eosinophil count, immunoglobulin E, anticoagulant therapy, C-reactive protein, prothrombin time, age at onset, D-dimer, recurrence of rash ≥ 3 times. A simplified model using these features demonstrated optimal performance with an accuracy of 84.2%, a sensitivity of 89.4%, and a specificity of 82.5% in external validation. Finally, we provided a web tool based on the simplified model, whose code was published on https://github.com/mulanruo/IgAVN_Prediction . CONCLUSION The model based on the random forest algorithm demonstrates good performance in predicting renal damage in children with IgAV, providing a basis for early clinical diagnosis and decision-making.
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Affiliation(s)
- Mengen Pan
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ming Li
- College of Computer Science and Technology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Na Li
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianhua Mao
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China.
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Cao Y, Chen X, Peng Q, Huang TT, Fan XC. Clinical characteristics and risk factors of cardiac involvement in pediatric immunoglobulin A vasculitis: A 7-year retrospective study from a single tertiary medical center. Eur J Pediatr 2024; 183:1871-1880. [PMID: 38300364 DOI: 10.1007/s00431-024-05438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/30/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
Immunoglobulin A vasculitis(IgAV) is the most common form of systemic vasculitis affecting children. To date, cardiac involvement in pediatric IgAV has not been fully investigated and its prevalence may be underestimated. This study aims to reveal the clinical and laboratory characteristics of cardiac involvement in pediatric IgAV and further determine its risk factors. A total of 1451 children with IgAV were recruited between January 2016 and December 2022. According to the severity of cardiac involvement, the patients were divided into the myocarditis/suspected myocarditis group, cardiac abnormalities group, and non-cardiac involvement group. Demographic, clinical, and laboratory characteristics were retrospectively extracted from the individual data collected in the medical records. Among the 1451 pediatric IgAV patients, 179 (12.3%) were identified with cardiac involvement, including 154 (10.6%) with cardiac abnormalities and 25 (1.7%) with myocarditis/suspected myocarditis. Cardiac involvement in pediatric IgAV mainly manifested as elevated cardiac biomarker levels (n = 162), electrocardiogram abnormalities (n = 46), and echocardiogram/chest X-ray abnormalities (n = 15); however, cardiac-related symptoms were only observed in 15.1% of patients with cardiac involvement. Multivariate analysis demonstrated that interval from disease onset to diagnosis > 7 days (OR, 2.157; 95% CI, 1.523-3.057; p < 0.001), IgAV with multi-organ involvement (OR, 1.806; 95% CI, 1.242-2.627; p = 0.002), and elevated D-dimer levels (OR, 1.939; 95% CI, 1.259-2.985; p < 0.001) were independent risk factors for cardiac involvement in pediatric IgAV. The length of hospital stay was significantly longer in the myocarditis/suspected myocarditis group compared with the other two groups (p < 0.05). Conclusion: This study suggests that cardiac involvements in pediatric IgAV is non-negligible, and cardiac involvement is associated with interval from disease onset to diagnosis > 7 days, IgAV with multi-organ involvement, and elevated D-dimer levels. Severe cardiac involvement may affect the prognosis of pediatric IgAV. What is Known: • Immunoglobulin A vasculitis (IgAV) is the most common form of systemic vasculitis affecting children and adolescents, which exhibits diverse clinical manifestations. Cases of severe IgAV complicated by cardiac involvement have been anecdotally reported. What is New: • The present study suggests that cardiac involvements in pediatric IgAV is non-negligible, and cardiac involvement is associated with interval from disease onset to diagnosis > 7 days, IgAV with multi-organ involvement, and elevated D-dimer levels. Severe cardiac involvement may affect the prognosis of pediatric IgAV.
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Affiliation(s)
- Yue Cao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Xin Chen
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Qi Peng
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Tian Tuo Huang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Xiao Chen Fan
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China.
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Mu J. Clinical characteristics and risk factors of IgA vasculitis with intussusception and intestinal perforation. J Paediatr Child Health 2024; 60:5-11. [PMID: 37942803 DOI: 10.1111/jpc.16516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
AIM Intussusception is the most common surgical complication of IgA vasculitis (IgAV), and intestinal perforation is usually associated with intussusception. If they are not recognised and treated in a timely manner, serious consequences may occur. The objective is to summarise the clinical features of IgAV complicated by intussusception and intestinal perforation and explore its risk factors. METHODS The clinical data of 32 patients with IgAV complicated by surgical complications (25 cases of intussusception and 7 cases of intestinal perforation) were retrospectively analysed. A total of 160 IgAV children with gastrointestinal (GI) involvement but without surgical complications were randomly selected as a control group. Binary logistic regression analysis was performed to explore the risk factors for IgAV with intussusception and intestinal perforation. RESULTS Compared with the intussusception group, the intestinal perforation group had a significantly higher number of patients with GI symptoms prior to skin purpura and GI bleeding, a significantly higher number of days of abdominal pain, a significantly higher Wong-Baker score, and a significantly higher white blood cell count. Multivariate logistic regression analysis indicated that age ≤7 years, GI symptoms prior to skin purpura, abdominal pain intensity (Wong-Baker scale) and timing of glucocorticoid treatment were independent risk factors of IgAV with intussusception and intestinal perforation. CONCLUSION Age less than 7 years, severe abdominal pain, and GI symptoms prior to skin purpura were risk factors for IgAV with intussusception and intestinal perforation. Early use of glucocorticoids may prevent intussusception and intestinal perforation.
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Affiliation(s)
- Jing Mu
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Bi Y, Quan W, Hao W, Sun R, Li L, Jiang C, Tian L, Liu L, Liu J, Li X, Li T. A simple nomogram for assessing the risk of IgA vasculitis nephritis in IgA vasculitis Asian pediatric patients. Sci Rep 2022; 12:16809. [PMID: 36207379 PMCID: PMC9547060 DOI: 10.1038/s41598-022-20369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
A nomogram for assessing the risk of IgA vasculitis nephritis (originally termed Henoch–Schönlein purpura nephritis, HSPN) in IgA vasculitis (originally termed Henoch–Schönlein purpura, HSP) pediatric patients can effectively improve early diagnosis and prognosis of IgA vasculitis nephritis. However, currently, no nomogram is available. 246 IgA vasculitis and 142 IgA vasculitis nephritis Asian pediatric patients confirmed by renal biopsy were enrolled. Univariate and multivariate logistic regressions were performed to identify the independent risk factors and construct a series of predictive models. The receiver operating characteristic curve, calibration plot, decision curve analysis, net reclassification index and integrated discrimination index were used to screen the best model. Stratification analysis was applied to optimize model’s clinical utility. An external validation set was introduced to verify the predictive efficiency. The final predictive model was converted to nomogram for visual use. We identified age, duration of rash (Dor), D-dimer and IgG as independent risk factors and constructed four models as follows: AIDD (Age + IgG + Dor + D-dimer), AIDi (Age + IgG + D-dimer), AIDo (Age + IgG + Dor) and ADD (Age + Dor + D-dimer), which achieved the receiver operator characteristic curve (AUROC) of 0.931, 0.920, 0.856 and 0.907, respectively. Finally, AIDi model with an AUROC of 0.956 and 0.897 in internal and external validating sets was proposed as a novel predictive model. In stratification analysis by gender and histological grade, the AUROC of AIDi was 0.949 in female, 0.926 in male, 0.933 in mild histological grades and 0.939 in severe histological grades, respectively. AIDi nomogram is an effective and visual tool for assessing the risk of nephritis in IgA vasculitis Asian pediatric patients, regardless of IgA vasculitis nephritis histological grades and gender.
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Affiliation(s)
- Yuna Bi
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, 215003, Jiangsu, China.,Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Wei Quan
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, 215003, Jiangsu, China
| | - Wei Hao
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Rui Sun
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liwen Li
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Chunping Jiang
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Lingling Tian
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Lin Liu
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Jie Liu
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, 303 Jingde Road, Suzhou, 215003, Jiangsu, China.
| | - Tao Li
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324#, Jing 5 Road, Jinan, 250021, China.
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Xi L, Xu S, Jiang Y, Su H, Sun Y, Wen Y, Wu J, Ren X. Predictive Value of Laboratory Indexes on Renal Involvement in Children with Henoch-Schönlein Purpura. Int J Gen Med 2021; 14:7951-7959. [PMID: 34795511 PMCID: PMC8594786 DOI: 10.2147/ijgm.s337437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Henoch-Schönlein purpura (HSP) is the most common vasculitis in children. Renal involvement is the main long-term complication of HSP, and presently there is no way to predict which children may have irreversible renal damage from the outset. This study aimed to explore the prediction value of laboratory indexes on renal involvement in children with HSP, which could help the early identification and intervention. Methods Children with HSP hospitalized at the First Affiliated Hospital of Henan University of Chinese Medicine from June 2019 to December 2020 were included. The demographic findings, clinical features, laboratory findings including blood routine examination, serum immunoglobulin, complement, T cell subsets levels, liver and kidney function, coagulation function were recorded. Laboratory indexes were analyzed, logistic regression analysis was performed to identify the independent predictors in HSP patients with renal involvement, and receiver operating characteristic (ROC) curves were further used to assess the value of prediction indexes, as well as the efficacy of combined diagnosis. Results The study included 146 HSP patients, among them, 50 patients (34.2%) had renal involvement. Age, platelet distribution width (PDW), CD3+ and fibrinogen (FIB) were positively correlated with renal involvement, while the levels of Immunoglobulin G (IgG), C-reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) were negatively correlated with renal involvement. The area under the ROC Curve (AUC) of these biomarkers ranged from 0.6284 to 0.7009, and among the combinations, a combination of NLR, CRP, CD3+, FIB, PDW, IgG and age had the best AUC value (0.9774). Conclusion Age, PDW, CD3+, FIB, CRP, NLR and IgG were prediction indexes for renal involvement in HSP patients, and these indexes can be combined appropriately to improve the diagnostic efficacy.
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Affiliation(s)
- Leying Xi
- Department of Pediatrics, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Shuang Xu
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yingying Jiang
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Hang Su
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yuying Sun
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Yingying Wen
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Jingjing Wu
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
| | - Xianqing Ren
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People's Republic of China
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Zhao Q, Yang Y, He SW, Wang XT, Liu C. Risk factors for intussusception in children with Henoch-Schönlein purpura: A case-control study. World J Clin Cases 2021; 9:6244-6253. [PMID: 34434991 PMCID: PMC8362585 DOI: 10.12998/wjcc.v9.i22.6244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The etiology of Henoch-Schönlein purpura (HSP) with intussusception remains undefined.
AIM To investigate the risk factors for intussusception in children with HSP and gastrointestinal (GI) involvement.
METHODS Sixty children with HSP and concomitant intussusception admitted to the Beijing Children’s Hospital of Capital Medical University between January 2006 and December 2018 were enrolled in this study. One hundred pediatric patients with HSP and GI involvement but without intussusception, admitted to the same hospital during the same period, were randomly selected as a control group. The baseline clinical characteristics of all patients, including sex, age of onset, duration of disease, clinical manifestations, laboratory test results, and treatments provided, were assessed. Univariate and multiple logistic regression analyses were performed to identify possible risk factors.
RESULTS The 60 children in the intussusception group comprised 27 girls (45%) and 33 boys (55%) and the 100 children in the non-intussusception group comprised 62 girls (62%) and 38 boys (38%). The median age of all patients were 6 years and 5 mo. Univariate and multiple regression analyses revealed age at onset, not receiving glucocorticoid therapy within 72 h of emergence of GI symptoms, hematochezia, and D-dimer levels as independent risk factors for intussusception in children with HSP (P < 0.05).
CONCLUSION The four independent risk factors for intussusception in pediatric HSP with GI involvement would be a reference for early prevention and treatment of this potentially fatal disease.
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Affiliation(s)
- Qian Zhao
- Traditional Chinese Medicine Department, National Children's Medical Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Yan Yang
- Traditional Chinese Medicine Department, National Children's Medical Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Song-Wei He
- Traditional Chinese Medicine Department, National Children's Medical Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Xin-Tai Wang
- Traditional Chinese Medicine Department, National Children's Medical Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
| | - Chang Liu
- Traditional Chinese Medicine Department, National Children's Medical Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
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Sestan M, Kifer N, Frkovic M, Sapina M, Srsen S, Batnozic Varga M, Ovuka A, Held M, Gudelj Gracanin A, Kozmar A, Bulimbasic S, Coric M, Laskarin G, Gagro A, Jelusic M. Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211024828. [PMID: 34262620 PMCID: PMC8252396 DOI: 10.1177/1759720x211024828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/24/2021] [Indexed: 01/29/2023] Open
Abstract
Background: We analysed clinical and biochemical parameters in predicting severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) and the risk of developing renal complications. Methods: A national multicentric retrospective study included children with IgAV reviewed in five Croatian University Centres for paediatric rheumatology in the period 2009–2019. Results: Out of 611 children, 281 (45.99%) had at least one GI manifestation, while 42 of 281 (14.95%) had the most severe GI manifestations. Using logistic regression several clinical risk factors for the severe GI manifestations were identified: generalized rash [odds ratio (OR) 2.09 (95% confidence interval (CI) 1.09–4.01)], rash extended on upper extremities (OR 2.77 (95% CI 1.43–5.34)] or face [OR 3.69 (95% CI 1.42–9.43)] and nephritis (IgAVN) [OR 4.35 (95% CI 2.23–8.50)], as well as lower values of prothrombin time (OR 0.05 (95% CI 0.01–0.62)], fibrinogen [OR 0.45 (95% CI 0.29–0.70)] and IgM [OR 0.10 (95% I 0.03–0.35)]] among the laboratory parameters. Patients with severe GI involvement more frequently had relapse of the disease [OR 2.14 (CI 1.04–4.39)] and recurrent rash [OR 2.61 (CI 1.27–5.38)]. Multivariate logistic regression found that the combination of age, GI symptoms at the beginning of IgAV and severity of GI symptoms were statistically significant predictors of IgAVN. Patients in whom IgAV has started with GI symptoms [OR 6.60 (95% CI 1.67–26.06)], older children [OR 1.22 (95% CI 1.02–1.46)] with severe GI form of IgAV (OR 5.90 (95% CI 1.12–31.15)] were particularly high-risk for developing IgAVN. Conclusion: We detected a group of older children with the onset of GI symptoms before other IgAV symptoms and severe GI form of the IgAV, with significantly higher risk for acute and chronic complications of IgAV.
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Affiliation(s)
- Mario Sestan
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nastasia Kifer
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Frkovic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Matej Sapina
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty and Faculty of Dental Medicine and Health Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Sasa Srsen
- Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia
| | - Mateja Batnozic Varga
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Aleksandar Ovuka
- Department of Paediatrics, University of Rijeka, Faculty of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Martina Held
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Ana Kozmar
- Clinical Department of Laboratory Diagnostics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijana Coric
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Alenka Gagro
- Department of Paediatrics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Department of Paediatrics, University of Zagreb School of Medicine, Division of Clinical Immunology, Rheumatology and Allergology, Centre of Reference for Paediatric and Adolescent Rheumatology of Ministry of Health of the Republic Croatia, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10 000, Croatia
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Abstract
We describe the case of a child with progressive abdominal pain and rash admitted to a large tertiary children's hospital in the Chicago metropolitan area and subsequently found to have immunoglobulin A (IgA) vasculitis and coronavirus disease 2019 (COVID-19). This patient presented with abdominal pain, purpuric lesions, hematochezia, increasingly elevated D-dimer, and abnormal inflammatory markers on laboratory evaluation. To the best of our knowledge, this article describes the only reported pediatric case of COVID-19 associated with IgA vasculitis. [Pediatr Ann. 2021;50(1):e44-e48.].
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Paek EY, Yi DY, Kang B, Choe BH. Fecal calprotectin as a marker of gastrointestinal involvement in pediatric Henoch-Schönlein purpura patients: a retrospective analysis. BMC Pediatr 2020; 20:374. [PMID: 32770991 PMCID: PMC7414667 DOI: 10.1186/s12887-020-02263-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background Henoch–Schönlein purpura is a type of systemic vasculitis found in children. Its prognosis is usually good; however, recurrence is relatively common. If the intestines are affected, severe complications could arise. Here, we investigated the value of fecal calprotectin in the early screening of Henoch–Schönlein purpura and as a useful factor for predicting gastrointestinal manifestations. Methods We retrospectively reviewed the medical records of pediatric patients who were diagnosed with Henoch–Schönlein purpura and underwent fecal calprotectin testing during the acute phase. The patients were categorized into gastrointestinal involvement and non-gastrointestinal involvement groups based on their clinical symptoms. Moreover, gastrointestinal involvement was categorized as follows: upper gastrointestinal tract involvement (up to the duodenum) and lower gastrointestinal tract involvement (from the terminal ileum). Results A total of 69 patients were diagnosed with Henoch–Schönlein purpura and underwent fecal calprotectin testing. Among them, 40 patients (58.0%) showed signs of gastrointestinal involvement. The gastrointestinal involvement group had higher fecal calprotectin levels (379.9 ± 399.8 vs. 77.4 ± 97.6 mg/kg, P = 0.000). There were no significant differences in the recurrence of Henoch–Schönlein purpura symptoms or gastrointestinal symptoms. The cut-off value to identify gastrointestinal involvement was 69.10 mg/kg (P < 0.01). Patients with fecal calprotectin levels of > 50 mg/kg showed more frequent gastrointestinal involvement (77.8% vs. 20.8%, P = 0.000) and more severe gastrointestinal symptoms. Significant differences in abdominal pain duration, Henoch–Schönlein purpura clinical score, and abdominal pain severity were observed (P = 0.002, P = 0.000, and P = 0.000, respectively). Additionally, fecal calprotectin levels were significantly higher in patients with lower gastrointestinal tract involvement (214.67 ± 150.5 vs. 581.8 ± 510.1 mg/kg, P = 0.008), and the cut-off value was 277.5 mg/kg (P < 0.01). Conclusion Fecal calprotectin testing is useful for identifying gastrointestinal involvement in pediatric Henoch–Schönlein purpura patients.
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Affiliation(s)
- Eun Young Paek
- Department of Pediatrics, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea. .,College of Medicine, Chung-Ang University, Seoul, South Korea.
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, South Korea
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Shimoyama T, Matsuda N, Kurobe M, Hayakawa T, Nishioka M, Shimohira M, Takasawa K. Colonoscopic diagnosis and reduction of recurrent intussusception owing to Henoch-Schönlein purpura without purpura. Paediatr Int Child Health 2019; 39:219-223. [PMID: 29621936 DOI: 10.1080/20469047.2018.1457273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
About 50-75% of patients with Henoch-Schönlein purpura (HSP) develop gastro-intestinal symptoms with surgical complications such as intussusception occurring in 0.7-13.6%. In 10-40% of patients, however, gastro-intestinal manifestations may precede the onset of purpura. In patients with gastro-intestinal tract involvement without purpura, confirming the diagnosis of HSP and determining the appropriate treatment remains difficult. A seven-year-old boy presented with recurrent intussusception owing to HSP without purpura. It was confirmed pathologically and treated via colonoscopy. Early colonoscopic intervention can contribute to the early diagnosis of HSP and its subsequent management by avoiding unnecessary surgical invasion.
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Affiliation(s)
- Teruyoshi Shimoyama
- a Departments of Pediatrics , Kawaguchi Municipal Medical Center , Saitama , Japan
| | - Nozomi Matsuda
- a Departments of Pediatrics , Kawaguchi Municipal Medical Center , Saitama , Japan
| | - Masashi Kurobe
- a Departments of Pediatrics , Kawaguchi Municipal Medical Center , Saitama , Japan
| | - Takehiko Hayakawa
- b Departments of Gastroenterology , Kawaguchi Municipal Medical Center , Saitama , Japan
| | - Masato Nishioka
- a Departments of Pediatrics , Kawaguchi Municipal Medical Center , Saitama , Japan
| | - Masayuki Shimohira
- a Departments of Pediatrics , Kawaguchi Municipal Medical Center , Saitama , Japan
| | - Kei Takasawa
- a Departments of Pediatrics , Kawaguchi Municipal Medical Center , Saitama , Japan.,c Department of Pediatrics and Developmental Biology , Tokyo Medical and Dental University , Tokyo , Japan
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Shi X, Li WC, Mo LJ, Li XH, Luo YZ, Qin LQ, Yang Z, Mo WN. Altered mean platelet volume in children with Henoch-Schonlein purpura and its association with disease activity. Ann Clin Biochem 2017; 55:368-372. [PMID: 28774183 DOI: 10.1177/0004563217727015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Henoch-Schonlein purpura is a systemic small-vessel vasculitis that occurs mainly in children. A review of the literature has suggested a correlation between mean platelet volume and several inflammatory disorders. However, to the best of our knowledge, any potential correlation between mean platelet volume and Henoch-Schonlein purpura has not been reported in the literature. Therefore, our study aimed to evaluate the role of mean platelet volume concentrations in patients with Henoch-Schonlein purpura. Methods This study included 97 children with Henoch-Schonlein purpura and 120 healthy individuals as controls. Results Mean platelet volume concentrations were found to be significantly lower in Henoch-Schonlein purpura patients compared with healthy controls (8.1 ± 0.86 vs. 9.4 ± 0.81, P < 0.001). Similarly, significant negative correlations were observed between mean platelet volume and neutrophil count, platelet count and erythrocyte sedimentation rate in patients with Henoch-Schonlein purpura (r=−0.327, P = 0.001; r=−0.419, P < 0.001; r=−0.255, P = 0.012). Interestingly, mean platelet volume was significantly lower in the acute phase compared with the convalescent phase of Henoch-Schonlein purpura patients (7.8 ± 0.86 vs. 8.3 ± 0.77, P = 0.002). A cut-off value for mean platelet volume was 7.85 with area under the curve of 0.726 to identify acute phase vs. convalescent phase in patients with Henoch-Schonlein purpura. Mean platelet volume was independently associated with Henoch-Schonlein purpura in logistic regression analysis (odds ratio = 0.114, 95% confidence interval = 0.053–0.243, P < 0.001). Conclusions Our results suggest that mean platelet volume is inversely associated with disease in patients with Henoch-Schonlein purpura, and mean platelet volume may be a useful marker to identify active disease in Henoch-Schonlein purpura patients.
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Affiliation(s)
- Xiang Shi
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Wen-Chao Li
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Li-Jun Mo
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xiao-Hong Li
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yu-Zhen Luo
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Liu-Qun Qin
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zheng Yang
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Wu-Ning Mo
- Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Guangxi, China
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Wang X, Zhu Y, Gao L, Wei S, Zhen Y, Ma Q. Henoch-Schönlein purpura with joint involvement: Analysis of 71 cases. Pediatr Rheumatol Online J 2016; 14:20. [PMID: 27029321 PMCID: PMC4815193 DOI: 10.1186/s12969-016-0080-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although joint involvement is the second most common clinical manifestation after skin involvement in patients with Henoch-Schönlein purpura (HSP), it has not been well characterized. The aim of this study was to profile the clinical characteristics and identify the potential risk factors for kidney damage in HSP patients having joint involvement. METHODS We retrospectively reviewed 71 cases of HSP patients with joint involvement who attended our hospital between January 2010 and March 2012 and analyzed their epidemiological profile, clinical characteristics, follow-up findings (up to three years) and overall prognosis. Logistic regression analysis was performed to identify risk factors associated with renal symptoms in HSP patients with joint involvement. RESULTS Average age of patients was 8.55 ± 2.13 years with male to female ratio at 1.29:1. The peak age of disease onset was six to 11 years. The most common triggers included upper respiratory infection, vigorous physical activity, and autumn and winter seasons. Forty cases (56.35 %) had gastrointestinal involvement and 37 (52.11 %) had kidney damage; gastrointestinal system, scrotal involvement, and increased D-dimer levels were significantly associated with kidney injury (P < 0.05) by multivariate analysis. Glucocorticoid therapy was effective in alleviating symptoms. CONCLUSION Gastrointestinal symptoms, scrotal involvement, and increased D-dimer are the potential risk factors for kidney damage in HSP patients having joint involvement. Rational use of corticosteroids was probably responsible for the good clinical outcomes.
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Affiliation(s)
- Xuehong Wang
- Dongying Hospital of Shandong Provincial Hospital, Dongying, Shandong province 257091 China
| | - Yongmei Zhu
- Dongying Hospital of Shandong Provincial Hospital, Dongying, Shandong province 257091 China
| | - Laiqiang Gao
- Dongying Hospital of Shandong Provincial Hospital, Dongying, Shandong province 257091 China
| | - Shuyue Wei
- Dongying Hospital of Shandong Provincial Hospital, Dongying, Shandong province 257091 China
| | - Youyou Zhen
- Dongying Hospital of Shandong Provincial Hospital, Dongying, Shandong province 257091 China
| | - Qiang Ma
- Dongying Hospital of Shandong Provincial Hospital, Dongying, Shandong province, 257091, China.
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Tian M, Liu C. Heparin calcium treated Henoch–Schönlein purpura nephritis in children through inhibiting hyperfibrinolysis. Ren Fail 2015; 37:1100-4. [DOI: 10.3109/0886022x.2015.1061668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Cayci FS, Ekim M, Egin Y, Gökce H, Yalcinkaya F, Ozcakar B, Akar N. An analysis of the levels of the soluble form of the endothelial protein C receptor in children with Henoch-Schönlein Purpura. Pediatr Hematol Oncol 2015; 32:115-22. [PMID: 24308805 DOI: 10.3109/08880018.2013.860648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The pathogenesis of Henoch-Schönlein Purpura (HSP) has not been clearly defined. Inflammatory cytokines have been associated with HSP but there are only a few reports that have focused on coagulation. The endothelial protein C receptor (EPCR), which has anticoagulant and antiinflammatory activity, is the key component of the protein C pathway. Recent studies have implicated the soluble form of EPCR (sEPCR) in Wegener's granulomatosis, Behçet's disease, and systemic lupus erythematosus. The aim of this study was to evaluate the levels of sEPCR in HSP children. Twenty-two children with HSP and 17 healthy children were included. We found no significant differences (P > .05) between patient and control groups in the levels of von Willebrand factor and thrombomodulin. The median sEPCR values in the HSP group were lower than the control group (79 vs. 102 ng/mL, respectively) (P > .05). The mean sEPCR value in HSP patients with severe abdominal pain was lower than without (88.8 ± 54.9 vs. 108.2 ± 66.3 ng/mL, respectively) (P > .05). In addition, the mean IL-6 serum levels were significantly elevated in HSP patients during the acute stage of HSP (2.1 ± 1.7 vs. 1.5 ± 1.2 pg/mL, P = .038). We also observed a slight negative correlation between the levels of sEPCR and IL-6 (R = -.135, P > .05). To our knowledge, this was the first study to analyze sEPCR levels in HSP. Our results did not conclusively identify a direct role of sEPCR in HSP, but our findings warrant further investigations, especially in severe HSP cases characterized by gastrointestinal bleeding or renal involvement.
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Affiliation(s)
- Fatma Semsa Cayci
- Department of Pediatric Nephrology and Rheumatology, Ankara University School of Medicine , Ankara , Turkey
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Hong J, Yang HR. Laboratory markers indicating gastrointestinal involvement of henoch-schönlein purpura in children. Pediatr Gastroenterol Hepatol Nutr 2015; 18:39-47. [PMID: 25866732 PMCID: PMC4391999 DOI: 10.5223/pghn.2015.18.1.39] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine clinically useful biochemical markers reflecting disease activity and/or gastrointestinal (GI) tract involvement in Henoch-Schönlein purpura (HSP). METHODS A total of 185 children with HSP and 130 controls were included. Laboratory data indicating inflammation, standard coagulation, and activated coagulation were analyzed for the HSP patients, including measurements of the hemoglobin level, white blood cell (WBC) count, absolute neutrophil count (ANC), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, prothrombin time, activated partial thromboplastin time, and fibrinogen, D-dimer, and fibrin degradation product (FDP) levels. The clinical scores of the skin, joints, abdomen, and kidneys were assessed during the acute and convalescence phases of HSP. RESULTS The WBC count, ANC, ESR, and CRP, fibrinogen, D-dimer, and FDP levels were significantly higher in the acute phase compared with the convalescent phase of HSP (p<0.05). The total clinical scores were more strongly correlated with the D-dimer (r=0.371, p<0.001) and FDP (r=0.369, p<0.001) levels than with inflammatory markers, such as the WBC count (r=0.241, p=0.001), ANC (r=0.261, p<0.001), and CRP (r=0.260, p<0.001) levels. The patients with GI symptoms had significantly higher ANC (median [interquartile range], 7,138.0 [4,446.4-9,470.0] vs. 5,534.1 [3,263.0-8,153.5], p<0.05) and CRP (0.49 [0.15-1.38] vs. 0.23 [0.01-0.67], p<0.05), D-dimer (2.63 [1.20-4.09] vs. 1.75 [0.62-3.39]), and FDP (7.10 [0.01-13.65] vs. 0.10 [0.01-7.90], p<0.05) levels than those without GI symptoms. CONCLUSION D-dimer and FDPs are more strongly associated with disease activity and more consistently reflect GI involvement than inflammatory markers during the acute phase of HSP.
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Affiliation(s)
- Jeana Hong
- Department of Pediatrics, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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Park SJ, Suh JS, Lee JH, Lee JW, Kim SH, Han KH, Shin JI. Advances in our understanding of the pathogenesis of Henoch-Schönlein purpura and the implications for improving its diagnosis. Expert Rev Clin Immunol 2014; 9:1223-38. [PMID: 24215411 DOI: 10.1586/1744666x.2013.850028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis classically characterized by palpable purpura, arthritis, abdominal pain and renal disease. In this article, we summarize our current understanding of the pathogenesis of HSP and the implications for improving its diagnosis. Although the pathogenesis of HSP is not fully understood yet, exciting new information has emerged in recent years, leading to a better understanding of its pathogenesis. Here, we discuss genetic predisposition, immunoglobulins with a particular emphasis on IgA1, activated complements, cytokines and chemokines, abnormal coagulation and autoantibodies in the underlying pathogenic mechanisms. Finally, diagnostic criteria for HSP developed by institutions such as the American College of Rheumatology and the European League against Rheumatism/Paediatric Rheumatology European Society were proposed to improve early detection and diagnosis.
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Affiliation(s)
- Se Jin Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Nagamori T, Oka H, Koyano S, Takahashi H, Oki J, Sato Y, Murono K, Iseki K, Takeguchi R, Takeda T, Sato M, Sugai R, Kitamura H, Kajino H, Miura Y, Ishioka T, Azuma H. Construction of a scoring system for predicting the risk of severe gastrointestinal involvement in Henoch-Schönlein Purpura. SPRINGERPLUS 2014; 3:171. [PMID: 24808995 PMCID: PMC4006069 DOI: 10.1186/2193-1801-3-171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022]
Abstract
Objective To evaluate the parameters associated with significant gastrointestinal (GI) involvement in Henoch-Schönlein Purpura (HSP), and construct a scoring system for the identification of patients at high risk of gross blood in stools. Study design Data for HSP patients hospitalized at each of seven institutes were retrospectively analyzed. Patients were divided into four groups according to the consequent severity of GI involvement. Identification of laboratory parameters at the time of admission were then used to differentiate the groups, and a scoring system to predict gross intestinal bleeding was constructed. Prognostic efficiency, correlation with the subsequent duration of abdominal pain, and association with manifestations excluding abdominal pain were also analyzed. Results An analysis of variance (ANOVA) test showed significant intergroup differences in white blood cell (WBC) count, neutrophil count, serum albumin, potassium, plasma D-dimer and coagulation factor XIII activity. A scoring system consisting of these parameters showed a good prognostic value for gross intestinal bleeding in a receiver operating characteristic (ROC) analysis, and a cut-off value of 4 points showed a sensitivity of 90.0% and specificity of 80.6%. The score was also correlated with the duration of abdominal pain after admission. A significantly higher score (s) was observed in patients presenting with nephritis, although the predictive value was poor. Conclusion A scoring system consisting of generally available parameters was of use in predicting severe GI involvement in HSP patients. Although further study is needed, initial therapy in accordance with disease activity may be taken into consideration using this scoring system.
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Affiliation(s)
- Tsunehisa Nagamori
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Hideharu Oka
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Shin Koyano
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Hironori Takahashi
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Junichi Oki
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Yuko Sato
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Koichi Murono
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Kenichi Iseki
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Ryou Takeguchi
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Takahiro Takeda
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Masayuki Sato
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Rika Sugai
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Hiroyuki Kitamura
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Hiroki Kajino
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
| | - Yurika Miura
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Toru Ishioka
- Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan
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Harada T, Kaneko T, Ito S, Hataya H, Nariai A, Mori M, Yokota S. Superior mesenteric artery syndrome: risk factor for duodenal involvement in Henoch-Schönlein purpura. Pediatr Int 2011; 53:630-633. [PMID: 21129122 DOI: 10.1111/j.1442-200x.2010.03298.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The anatomical location of the third portion of the duodenum is between the superior mesenteric artery (SMA) and the abdominal aorta (AA). When the aorto-mesenteric angle (AMA) is small and the aorto-mesenteric distance (AMD) is short, the duodenum becomes tightly compressed between these two blood vessels. Severe compression can obstruct the duodenum, resulting in vomiting and abdominal pain. This clinical condition is termed superior mesenteric artery syndrome (SMA syndrome). The duodenum is frequently affected in Henoch-Schönlein purpura (HSP). The aim of the present study was to verify that duodenal anatomy mimicking SMA syndrome is a risk factor for duodenal involvement and abdominal pain in HSP. METHODS A prospective case-control study involving 12 HSP patients compared with 48 age- and sex-matched children (controls) was conducted. Bowel abnormalities were defined as thickened wall >3 mm and paralytic ileus detected on ultrasound. AMA, AMD and obesity index (OI) were compared between the two groups on Mann-Whitney testing. The correlation between duodenal bowel abnormalities and SMA syndrome was examined using Fisher's exact test. RESULTS AMA, AMD and OI were significantly smaller in the HSP patients (P < 0.001, 0.003 and 0.026, respectively). All HSP patients, but only 10 controls, met the ultrasound diagnostic criteria for SMA syndrome (100% vs 20.8%, P < 0.001). CONCLUSIONS Duodenal compression by SMA against the AA, which mimics SMA syndrome, may lead to duodenal bowel abnormalities with abdominal pain in thin children with HSP.
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Affiliation(s)
- Tomonori Harada
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuji Kaneko
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Hataya
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Akiyoshi Nariai
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaaki Mori
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Shumpei Yokota
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
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Shin J, Song K, Kim H, Cho N, Kim J, Kim H, Lee J. The gene expression profile of matrix metalloproteinases and their inhibitors in children with Henoch-Schönlein purpura. Br J Dermatol 2011; 164:1348-55. [DOI: 10.1111/j.1365-2133.2011.10295.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Biss TT, Brandão LR, Kahr WHA, Chan AKC, Williams S. Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism. J Thromb Haemost 2009; 7:1633-8. [PMID: 19682234 DOI: 10.1111/j.1538-7836.2009.03572.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Childhood pulmonary embolism (PE) causes significant mortality and evidence suggests that it is under-diagnosed. Clinical probability scores and D-dimer estimation to assess pre-test probability have not been studied in children with suspected PE. PATIENTS/METHODS This retrospective cohort study evaluated Wells simplified probability score for PE in 50 children with PE and 25 PE negative control patients, and D-dimer values in 27 PE positive and 12 PE negative children. RESULTS PE positive and PE negative groups had similar rates of risk factors for venous thromboembolism (VTE). Wells simplified probability score showed a small difference between PE positive and PE negative children (median score: PE positive, 4.5; PE negative, 4; P = 0.009), children with PE are more likely to obtain a 'PE likely' score (score > 4), P = 0.012. The difference was of slightly greater significance when the Wells score was adjusted to account for pediatric normal ranges for heart rate, P = 0.007, and signs/symptoms of upper limb DVT, P = 0.006. Children with PE were as likely as PE negative patients to have a D-dimer value within the normal range (PE positive, 15%; PE negative, 25%; P = 0.654). A combination of a 'PE unlikely' score and normal D-dimer value occurred in 1/12 (8%) of PE negative children. CONCLUSIONS The Wells clinical probability score and D-dimer estimation may lack utility in the determination of pre-test probability of PE in children. Validation of a pediatric clinical probability score, incorporating D-dimer estimation, by prospective study, would be difficult as a result of the rarity of childhood PE.
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Affiliation(s)
- T T Biss
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Shin JI, Lee JS. Comment on: Left hand compartment syndrome: a rare complication of Henoch-Schönlein purpura. J Paediatr Child Health 2009; 45:242. [PMID: 19493113 DOI: 10.1111/j.1440-1754.2009.01509.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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High factor VIII or homocysteine levels and thrombosis in Henoch-Schönlein purpura. Rheumatol Int 2008; 29:1251-2. [DOI: 10.1007/s00296-008-0812-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
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Topaloglu R, Bayrakci US, Cil B, Orhon D, Bakkaloglu A. Henoch–Schonlein purpura with high factor VIII levels and deep venous thrombosis: an association or coincidence? Rheumatol Int 2008; 28:935-7. [DOI: 10.1007/s00296-008-0542-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 02/04/2008] [Indexed: 11/29/2022]
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Ozsoylu S. Treatment of visceral leishmaniasis. Pediatr Hematol Oncol 2006; 23:449-51; author reply 455-7. [PMID: 16728366 DOI: 10.1080/08880010600642810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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