Zheng Gaihuan, Cao Jiaoyang, Yu Jie, Zhang Zhenzhen, Liu Quanbo, Chen Junhua
Infection Department of the Children's Hospital, The Pediatrics Institution of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, The Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.
Medicine (Baltimore). 2017 Dec;96(49):e8934. doi: 10.1097/MD.0000000000008934.
Hand-foot-and-mouth disease (HFMD) is a common childhood infection that may lead to serious complications and even death. Globally, epidemics of HFMD are increasing each year, especially in China. This study aimed to identify risk factors for death in children with critical and severe HFMD in Chongqing, China.We performed an observational study involving patients with critical and severe HFMD admitted to the Children's Hospital of Chongqing Medical University from January 2009 to December 2016. Overall, 179 patients aged 2 months to 16 years, were included; 127 died (non-survival group) and 52 survived (survival group); the case-fatality rate was 70.94%. Data comprising demographic characteristics, clinical symptoms and signs, and laboratory findings were collected. Non-conditional logistic regression analysis was performed to determine the risk factors for death.Univariate analysis showed that sex, coma, light-reflex insensitivity, pulmonary rales, pulmonary edema or hemorrhage, cold extremities, tachycardia, hypotension, white blood cell count, blood glucose concentration, serum lactate level, creatine kinase-MB isoenzyme level, and acidosis were associated with death (P < .05). Logistic regression analysis identified female sex (odds ratio [OR] 9.6, 95% confidence interval [CI] 3.0-30.2), light-reflex insensitivity (OR 4.4, 95% CI 1.4-13.1), tachycardia (OR 1.05, 95% CI 1.03-1.07), and higher serum lactate levels (OR 1.14, 95% CI 1.19-1.69) as independent risk factors; and longer onset-to-hospitalization time (OR 0.43, 95% CI 0.28-0.66) as an independent protective factor for death in children with critical and severe HFMD.Female sex, light-reflex insensitivity, tachycardia, and higher serum lactate level are potential independent risk factors; and longer onset-to-hospitalization time is possibly an independent protective factor for death in patients with critical and severe HFMD.
手足口病（HFMD）是一种常见的儿童感染性疾病，可能导致严重并发症甚至死亡。在全球范围内，手足口病的流行每年都在增加，尤其是在中国。本研究旨在确定中国重庆重症和危重症手足口病患儿的死亡危险因素。我们进行了一项观察性研究，纳入了2009年1月至2016年12月期间在重庆医科大学附属儿童医院住院的重症和危重症手足口病患者。总体而言，共纳入179例年龄在2个月至16岁之间的患者；其中127例死亡（非存活组），52例存活（存活组）；病死率为70.94%。收集了包括人口统计学特征、临床症状和体征以及实验室检查结果等数据。采用非条件logistic回归分析确定死亡危险因素。单因素分析显示，性别、昏迷、光反射迟钝、肺部啰音、肺水肿或出血、四肢冰凉、心动过速、低血压、白细胞计数、血糖浓度、血清乳酸水平、肌酸激酶-MB同工酶水平和酸中毒与死亡相关（P<0.05）。logistic回归分析确定女性（比值比[OR]9.6，95%置信区间[CI]3.0-30.2）、光反射迟钝（OR 4.4，95%CI 1.4-13.1）、心动过速（OR 1.05，95%CI 1.03-1.07）和较高的血清乳酸水平（OR 1.14，95%CI 1.19-1.69）为独立危险因素；而发病至住院时间较长（OR 0.43，95%CI 0.28-0.66）是重症和危重症手足口病患儿死亡的独立保护因素。女性、光反射迟钝、心动过速和较高的血清乳酸水平是潜在的独立危险因素；而发病至住院时间较长可能是重症和危重症手足口病患者死亡的独立保护因素。
