Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Pediatric, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
PLoS One. 2021 Feb 4;16(2):e0246301. doi: 10.1371/journal.pone.0246301. eCollection 2021.
In 2017, a diphtheria outbreak occurred in several provinces in Indonesia. The aim of this study was to identify predictors of mortality outcome of pediatric patients with clinical diphtheria.
A retrospective cohort study was conducted using patient medical records at five referral hospitals in the Province of Jakarta and one in Tangerang District, Banten Province during January 2017 to 31 August 2018. All children in the age group of 1-18 years old discharged with diagnosis of clinical diphtheria formed the study group. All anonymized patient data were evaluated for demographic issues, clinical features, immunization status, complication, laboratory profiles and outcome.
A total of 283 patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. All mortal patients had the complication of myocarditis. Regression analyses revealed factors for predicting mortality. Incomplete primary diphtheria toxoid immunization, stridor, bull neck, leukocytosis ≥15 x109 cells/L and thrombocytopenia ≤150 x109 cells/L in each combination for 2 predictors modeling were correlated with death.
We report key predictors of mortality in pediatric patients with clinical diphtheria. The presence of these features when admitted to the hospital must be taken into account, because they can lead to fatal outcome.
2017 年，印度尼西亚多个省份发生白喉疫情。本研究旨在确定儿科临床白喉患者死亡结局的预测因素。
这是一项回顾性队列研究，使用了 2017 年 1 月至 2018 年 8 月期间雅加达省的五家转诊医院和万丹省的丹格朗区的患者病历资料。所有年龄在 1-18 岁之间，出院诊断为临床白喉的儿童均为研究组。对所有匿名患者数据进行评估，以了解人口统计学问题、临床特征、免疫状况、并发症、实验室特征和结局。
共有 283 名患有临床白喉的患者被纳入研究组，病死率为 3.5%。所有死亡患者均有心肌炎并发症。回归分析显示了预测死亡的因素。不完全的白喉类毒素基础免疫、喘鸣、牛颈、白细胞计数≥15×109 个细胞/L 和血小板计数≤150×109 个细胞/L 这两个预测因子的每个组合都与死亡相关。
我们报告了儿科临床白喉患者死亡的关键预测因素。入院时存在这些特征时，必须加以考虑，因为它们可能导致致命结局。
