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Prognostic factors of severe infectious purpura in children
Insights
Identifying infectious purpura prognostic factors is crucial for pediatric intensive care. Key indicators of higher mortality include shock, coma, and specific lab values, enabling better patient management.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Hematology
Background:
- Infectious purpura poses a significant risk in pediatric patients.
- Prognostic factors for infectious purpura require further elucidation to improve outcomes.
Purpose of the Study:
- To prospectively identify prognostic factors for infectious purpura in hospitalized children.
- To develop a prognostic index for shocked patients with infectious purpura.
Main Methods:
- Prospective study of 90 pediatric infectious purpura cases.
- Statistical analysis (X2 test) to identify significant prognostic factors.
- Benzecri method applied to develop a prognostic index for shock patients.
Main Results:
- Significant mortality predictors include shock, coma, ecchymotic/necrotic purpura, hypothermia, absence of meningism, low white cell count, thrombocytopenia, low fibrinogen, high kalemia, and low spinal fluid cell count.
- Shock was a primary factor, with 23 deaths in 55 shocked patients versus 2 in 35 non-shocked.
- A prognostic index using age, kalemia, white cell count, meningism, and platelet count showed 91% predictive value for survival and 87% for death in the initial cohort.
Conclusions:
- Several clinical and laboratory parameters significantly correlate with mortality in pediatric infectious purpura.
- A validated prognostic index can aid in risk stratification and management of shock in infectious purpura.
Abstract:
The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p less than 0.001), coma (p less than 0.05), ecchymotic or necrotic purpura (p less than 0.01), temperature less than 36 degrees C (p less than 0.05), no clinical meningism (p less than 0.001), white cell count less than 10,000/mm3 (p less than 0.05), thrombocytopenia less than 100,000 (p less than 0.01), fibrinogen less than 1.5 g/l (p less than 0.001), kalemia greater than 5 mEq/l (p less than 0.01), spinal fluid cell count less than 20/mm3 (p less than 0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.