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Severe gastrointestinal involvement in pediatric IgA vasculitis: a retrospective single-center cohort study in China
Yifan Li1, Xiaomei Zhang1, Haimei Liu1
1Department of Rheumatology, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
Insights
Severe gastrointestinal (GI) involvement in IgA vasculitis (IgAV) is common in Chinese children. Factors like young age, vomiting, and specific lab results predict severe GI issues, requiring intensive treatment.
Area of Science:
- Pediatrics
- Gastroenterology
- Rheumatology
Background:
- IgA vasculitis (IgAV) is the most common childhood vasculitis.
- Gastrointestinal (GI) manifestations are frequent in IgAV, ranging from mild symptoms to severe complications.
- Understanding risk factors for severe GI involvement is crucial for timely intervention.
Purpose of the Study:
- To describe the characteristics of GI involvement in hospitalized children with IgAV in China.
- To identify clinical and laboratory factors associated with severe GI involvement in pediatric IgAV patients.
Main Methods:
- Retrospective review of 1,179 hospitalized IgAV patients (January 2014-December 2020).
- Patients categorized into severe and non-severe GI groups based on bleeding and complications.
- Analysis of clinical features, laboratory data, and treatment strategies.
Main Results:
- GI involvement occurred in 50% of patients; 48.9% of these had severe GI involvement.
- Risk factors for severe GI involvement included rare onset age (<3 or 13-17 years), purpura above the waist, vomiting, high neutrophil-to-lymphocyte ratio, and low serum albumin.
- Severe GI group showed higher rates of renal involvement and nephritis, requiring higher corticosteroid doses and more second-line therapies.
Conclusions:
- Severe GI involvement is a significant concern in pediatric IgAV.
- Early identification of risk factors can guide management.
- Patients with severe GI manifestations necessitate aggressive treatment, including higher corticosteroid doses and potentially second-line agents.
Objectives:
The study aimed to describe the characteristics of gastrointestinal (GI) involvement in a cohort of hospitalized children with IgA vasculitis (IgAV) in China.
Method:
We reviewed the records of hospitalized IgAV patients from January 2014 to December 2020 at one tertiary medical center. The patients were divided into the severe GI group and the non-severe GI group according to the presence of massive GI bleeding and complications. The clinical manifestations, laboratory factors, and treatment were analyzed between the two groups.
Results:
A total of 1,179 patients were hospitalized due to IgAV. GI involvement was noted in 50% (589) of the patients, of whom 288 (48.9%) had severe GI involvement. GI complications were observed in 34 patients with IgAV with GI involvement. Rare onset age (<3 years or within 13-17 years), purpura above the waist, vomiting, high neutrophil-to-lymphocyte ratio, and decreased serum albumin were factors associated with severe GI involvement. Frequencies of renal involvement and biopsy-proven nephritis were higher in the severe GI group. The most commonly used medications were corticosteroids (100.0%) in the severe GI group. The maximum corticosteroid dose was higher (2.9 vs. 2.0 mg/kg), and more second-line therapies were needed (30.9% vs. 16.94%) in the severe GI group.
Conclusions:
Severe GI involvement in children is common in our center. Rare onset age, purpura above the waist, vomiting, high neutrophil-to-lymphocyte ratio, and decreased serum albumin are associated with severe GI involvement. Patients with severe GI involvement need higher doses of corticosteroids and second-line therapy.
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