Abstract
Objective
To analyze and summarize the clinical features, diagnosis, and treatment of children with Henoch-Schönlein purpura (HSP) complicated by overt gastrointestinal bleeding (GI bleeding) for achieving early identification, prevention, and treatment in terms of severe GI bleeding.
Methods
A retrospective analysis was conducted on children with HSP complicated by overt GI bleeding who were admitted to the Department of Traditional Chinese Medicine of Beijing Children’s Hospital from January 2017 to December 2019. According to the severity of GI bleeding, the patients were divided into mild bleeding group (61 cases) and moderate and severe bleeding group (38 cases). Inflammatory parameters, coagulation function, GI ultrasound findings, and clinical features were compared. Logistic regression analysis was used to determine the related variables affecting the severity of GI bleeding, and the ROC curve was used to determine the variable test efficacy.
Results
Onset in summer, wide distribution of skin rash with facial involvement, the elevation of D-dimer and high neutrophil-to-lymphocyte ratio (NLR) had significant effects on the severity of GI bleeding. ROC curve analysis showed that the optimal cut-off points of NLR and D-dimer for predicting severe GI bleeding in children with HSP were 10.56 and 0.89 mg/L, respectively.
Conclusion
Facial rash may be a warning sign of GI bleeding. Enhanced monitoring of NLR and D-dimer is helpful for early recognition of GI bleeding as well as assessment of severity.
Key Points • HSP associated with acute gastrointestinal bleeding is not uncommon and has a high incidence in summer; early recognition of severe bleeding is very necessary. • Wide distribution of skin rash with facial involvement is an independent risk factor for GI bleeding. • The optimal cut-off points of NLR and D-dimer for predicting severe GI bleeding in children with HSP were 10.56 and 0.89 mg/L, respectively. • Gastrointestinal ultrasound can identify swelling of the intestinal wall and is helpful for the diagnosis of GI HSP. |
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References
Trapani S, Micheli A, Grisolia F et al (2005) Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 35(3):143–153. https://doi.org/10.1016/j.semarthrit.2005.08.007
Mills JA, Michel BA, Bloch DA et al (1990) The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum 33(8):1114–1121. https://doi.org/10.1002/art.1780330809
Saulsbury FT (2001) Henoch-Schönlein purpura. Curr Opin Rheumatol 13(1):35–40. https://doi.org/10.1097/00002281-200101000-00006
Yamazaki T, Akimoto T, Iwazu Y et al (2015) Henoch-Schönlein purpura complicated with severe gastrointestinal bleeding. CEN case reports 4(1):106–111. https://doi.org/10.1007/s13730-014-0148-8
Ozen S, Pistorio A, Iusan SM et al (2010) EULAR/PRINTO/PRES criteria for Henoch Schönlein purpura, childhood polyarthritis nodes, childhood Wegener granulomatosis and childhood Takamasa arteritis: Ankara 2008. Part II: final classification criteria. Annals of the rheumatic diseases 69(5):798–806. https://doi.org/10.1136/ard.2009.116657
Immunology group, scientific branch, Chinese Medical Association, editorial board of Chinese Journal of Pediatrics, Evidence-based recommendations for the diagnosis and management in the children with Henoch-Schönlein purpura Chin J Pediatr, 2013,51(7): 502–507. https://doi.org/10.3760/cma.j.issn.0578-1310.2013.07.006
Karunakaravel Karuppasamy, Baljendra S Kapoor, Nicholas Fidelman, et al. ACR Appropriateness Criteria® Radiologic management of lower gastrointestinal tract bleeding: 2021 update. Journal of the American College of Radiology: JACR 2021 May;18(5S):S139-S152. https://doi.org/10.1016/j.jacr.2021.02.018
Nimarta Singh-Bhinder, David H Kim, Brian P Holly, et al. ACR Appropriateness Criteria® Nonvariceal upper gastrointestinal bleeding. Journal of the American College of Radiology: JACR 2017 May;14(5S): S177-S188. https://doi.org/10.1016/j.jacr.2017.02.038
Chinese Journal of Internal Medicine; National Medical Journal of China; Chinese Journal of Digestion et al. Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding (2018, Hangzhou).. Chin J Intern Med, 2019, 58(3): 173–180. https://doi.org/10.3760/cma.j.issn.0578-1426.2019.03.005
Section C (2020) Chinese Society of Digestive Endoscopology, Colorectal Section Digestive Physicians Branch, Chinese Medical Doctor Association, National Clinical Research Center for Digestive Diseases, Guideline for the diagnosis and treatment of lower gastrointestinal bleeding (2020). Chin J Dig Endosc 37(10):685–695. https://doi.org/10.3760/cma.j.cn321463-20200618-00544
Wan’er He, Tang Gong Si (2006) The diagnosis and therapy of gastrointestinal bleeding in children. Chin Pediatr Emerg Med 13(02):186–187. https://doi.org/10.3760/cma.j.issn.1673-4912.2006.02.045
Wang Lin, Wu Xiaoyan, Peng Hua, et al. a retrospective analysis of the risk factors of Henoch-Schonlein purpura with alimentary tract hemorrhage in children. Progress in Modern Biomedicine 2017,30:5870–5873 + 5882. https://doi.org/10.13241/j.cnki.pmb.2017.30.016
Hu Xu, Ling Lu, Hong W et al (2012) Clinical analysis of Henoch-Schonlein purpura with digestive tract hemorrhage in children. Anhui Medical Journal 33(06):664–665. https://doi.org/10.3969/j.issn.1000-0399.2012.06.006
Jing Liao, Jing Qing Wu, Yanmei, et al (2019) Serological risk factors for gastrointestinal bleeding in children with Henoch Schönlein purpura. Journal of Modern Clinical Medicine 45(01):44–46. https://doi.org/10.11851/j.issn.1673-1557.2019.01.015
Paul Brogan, Arvind Bagga, Leukocytoclastic vasculitis. In Ross E. Petty, Ronald M. Laser, Carol B., Lindsley, Lucy R. Wedderburn (2016) Textbook of Pediatric Rheumatology (7th ed) 452–460
Peter Trnka; Henoch-Schönlein purpura in children (2013 Dec) J Paediatr Child Health 49(12):995–1003. https://doi.org/10.1111/jpc.12403
Yang Y-H, Hung C-F, Hsu C-R et al (2005) A nationwide survey on epidemiological characteristics of childhood Henoch-Schönlein purpura in Taiwan. Rheumatology (Oxford) 44(5):618–622. https://doi.org/10.1093/rheumatology/keh544
Karadağ Şerife Gül, Tanatar Ayşe, Sönmez HafizeEmine et al (2019) The clinical spectrum of Henoch-Schönlein purpura in children: a single-center study. Clinical rheumatology 38(6):1707–1714. https://doi.org/10.1007/s10067-019-04460-1
Andreas Woerner, Christoph Rudin, Caterina Bonetto, et al. IgA vasculitis (Henoch-Schönlein): case definition and guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2017 03 13;35(11):1559–1566. https://doi.org/10.1016/j.vaccine.2016.09.024
Hyun Ho Hwang, In Seok Lim, Byung-Sun Choi, et al. Analysis of seasonal tendencies in pediatric Henoch-Schönlein purpura and comparison with outbreak of infectious diseases. Medicine 2018 Sep;97(36): e12217. https://doi.org/10.1097/MD.0000000000012217
Ellen C (2008) Ebert; Gastrointestinal manifestations of Henoch-Schonlein purpura. Dig Dis Sci 53(8):2011–2019. https://doi.org/10.1007/s10620-007-0147-0
Tsunehisa Nagamori, Hideharu Oka, Shin Koyano, et al. Construction of a scoring system for predicting the risk of severe gastrointestinal involvement in Henoch-Schönlein Purpura. SpringerPlus 2014; 3:171. https://doi.org/10.1186/2193-1801-3-171
Marieke H Heineke, Aranka V Ballering, Agnès Jamin, et al. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schönlein purpura). Autoimmunity reviews 2017 Dec;16(12):1246–1253 . https://doi.org/10.1016/j.autrev.2017.10.009
Hong J (2015) Hye Ran Yang; Laboratory markers indicating gastrointestinal involvement of Henoch-Schönlein purpura in children. Pediatric gastroenterology, hepatology & nutrition 18(1):39–47. https://doi.org/10.5223/pghn.2015.18.1.39
Balahan Makay, Özge Altuğ Gücenmez, Murat Duman, et al. The relationship of neutrophil-to-lymphocyte ratio with gastrointestinal bleeding in Henoch-Schonlein purpura. Rheumatology international 2014 Sep;34(9):1323–7. https://doi.org/10.1007/s00296-014-2986-2
Wu Yemei Xu, Mingguo (2020) Research progress of peripheral blood cell parameters in clinical prediction of Kawasaki disease. Chin J Appl Clin Pediatr 35(13):1027–1030. https://doi.org/10.3760/cma.j.cn101070-20190702-00591
Qian W, Yuping L, Ping S et al (2016) Relationship of gastrointestinal bleeding with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in adult patients with Henoch-Schönlein purpura. Chin J Dermatol 49(9):641–644. https://doi.org/10.3760/cma.j.issn.0412-4030.2016.09.008
Xiaoding Hu, Xuejuan C, Zhenfei Li et al (2020) Relationship between peripheral blood NLR, PLR, LMR and gastrointestinal involvement in children with Henoch-Schönlein purpura. Medical Innovation of China 17(36):10–14. https://doi.org/10.3969/j.issn.1672-0709.2020.01.014
Chan Hyuk Park, Dong Soo Han, Jae Yoon Jeong, et al. The optimal cut-off value of neutrophil-to-lymphocyte ratio for predicting prognosis in adult patients with Henoch-Schönlein purpura. PloS one 2016;11(4): e0153238. https://doi.org/10.1371/journal.pone.0153238
Tanoglu A (2014) Ergenekon Karagoz; Predictive role of neutrophil to lymphocyte ratio in Henoch-Schonlein purpura related gastrointestinal bleeding. Rheumatol Int 34(9):1331–1332. https://doi.org/10.1007/s00296-014-3028-9
Seung Hee Hong (2018) Chan Jong Kim, Eun Mi Yang; Neutrophil-to-lymphocyte ratio to predict gastrointestinal bleeding in Henoch: Schönlein purpura. Pediatrics international: official journal of the Japan Pediatric Society 60(9):791–795. https://doi.org/10.1111/ped.13652
Yueming Zhang, Lihong Xin, Zhen Wang, Wen Zhang, Dong Wang; D-dimer: the risk factor and predictive indicator of necrotizing pneumonia in children. Clinical laboratory 2021 Jul 01;67(7). https://doi.org/10.7754/Clin.Lab.2020.201109
Jie W, Dongmei F, Lisa H et al (2020) Value of monitoring the dynamic changes of d-dimer in predicting the curative effects and prognosis of patients with Henoch-Schönlein purpura. Chinese Journal of Dermatology and Venereology of integrated traditional Chinese and Western medicine 19(01):65–67. https://doi.org/10.3969/j.issn.1672-0709.2020.01.014
Kai C, Yuan Liping Hu, Bo, et al (2019) Clinical significance of serum gastrin, C-reactive protein and D-dimer in Henoch-Schönlein purpura children with abdominal symptoms. Chinese Journal of Applied Clinical Pediatrics 34(11):827–831. https://doi.org/10.3760/cma.j.issn.2095-428X.2019.11.007
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Yang, Y., Shu, J., Mu, J. et al. Clinical analysis of 99 children with Henoch-Schönlein purpura complicated with overt gastrointestinal bleeding. Clin Rheumatol 41, 3783–3790 (2022). https://doi.org/10.1007/s10067-022-06323-8
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DOI: https://doi.org/10.1007/s10067-022-06323-8