Henoch-Schönlein purpura in Saudi Arabia: characteristics and rare vital organ involvement

Construction and internal validation of a predictive model for risk of gastrointestinal bleeding in children with abdominal Henoch-Schönlein purpura: A single-center retrospective case-control study

Early identification of gastrointestinal (GI) bleeding in children with abdominal Henoch-Schönlein purpura (HSP) is essential for their subsequent treatment, and a risk prediction model for GI bleeding in abdominal HSP was constructed in this study to assist physicians in their decision-making. In a single-center retrospective study, the children collected were divided into two parts, a training set and a validation set, according to the time of admission. In the training set, univariate analysis was performed to compare demographic data and laboratory tests between the two groups of children with GI and non-GI bleeding, and the independent risk factors were derived using binary logistic equations to develop a scoring model for predicting GI bleeding in children by odds ratio (OR) values and receiver operating characteristic curves. The scoring model was then internally validated in validation set. The results showed that there were 11 indicators were statistically different between the two groups in the training set, including white blood cells, neutrophil-to-lymphocyte ratio, platelets, eosinophils (EO), high sensitivity C-reactive protein (hsCRP), activated partial thromboplastin time (APTT), sodium, potassium (K), albumin (ALB), Total bilirubin, and Immunoglobulin E (IgE) in the univariate analysis. Among them, the independent risk factors for GI bleeding included the six indicators of EO ≤ 0.045×10^9/L, hsCRP ≥ 14.5 mg/L, APTT ≤ 28.1 s, K ≥ 4.18 mmol/L, ALB ≤ 40.6 g/L, and IgE ≥ 136 ng/mL. According to the OR values, where EO ≤ 0.045 ×10^9/L, hsCRP ≥ 14.5 mg/L, APTT ≤ 28.1 s, ALB ≤ 40.6 g/L each scored 3 points, K ≥ 4.18 mmol/L, IgE ≥ 136 ng/mL each scored 2 points, and the total score was 0-16 points. The sensitivity and specificity of predicting GI bleeding were 88.7% and 64.2%, respectively, when the child scored ≥ 7 points. In the validation set, the sensitivity, specificity and accuracy of the model in predicting GI bleeding were 77.4%, 74.5% and 75.2%, respectively. In conclusion, the construction of a scoring model to predict the risk of GI bleeding from abdominal HSP would greatly assist pediatricians in predicting and identifying children at high risk for GI bleeding at an early stage.

Meta-analysis of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in Henoch-Schonlein purpura and its complications

OBJECTIVE

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with the severity of Henoch-Schonlein purpura (HSP). Therefore, we conducted a meta-analysis to evaluate the clinical significance of NLR and PLR in HSP and its complications.

METHODS

A comprehensive literature search was conducted by searching the PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP, and SinoMed databases from their inception to September 31, 2020. We used the standard mean difference (SMD) with a 95% confidence interval (CI) to estimate the pooled effect and used subgroup analysis to investigate heterogeneity.

RESULTS

A total of 1,691 HSP patients and 563 healthy controls (HCs) from 15 studies were included in the analysis. The NLR value was significantly higher in 431 HSP patients with gastrointestinal complications (HSP-GCs) than that in 833 HSP patients without GCs (SMD = 1.09, 95% CI: 0.62-1.57, P < 0.001); in 83 HSP adult patients with renal involvement (HSP-RI) than that in 131 adult HSP patients without RI (SMD = 0.33, 95% CI: 0.05-0.60, P = 0.021); and in 831 HSP patients than that in 563 HCs (SMD = 0.70, 95% CI: 0.51-0.89, P < 0.001). The PLR was significantly higher in 417 HSP patients than that in 264 HCs (SMD = 0.39, 95% CI: 0.06-0.71, P = 0.02).

CONCLUSIONS

NLR could serve as a useful biomarker to predict GCs and RI in patients with HSP. However, further well-designed and large cohort studies are warranted to confirm these findings.