Construction of a scoring system for predicting the risk of severe gastrointestinal involvement in Henoch-Schönlein Purpura

Abstract

ObjectiveTo evaluate the parameters associated with significant gastrointestinal (GI) involvement in Henoch-Schönlein Purpura (HSP), and construct a scoring system for the identification of patients at high risk of gross blood in stools.Study designData for HSP patients hospitalized at each of seven institutes were retrospectively analyzed. Patients were divided into four groups according to the consequent severity of GI involvement. Identification of laboratory parameters at the time of admission were then used to differentiate the groups, and a scoring system to predict gross intestinal bleeding was constructed. Prognostic efficiency, correlation with the subsequent duration of abdominal pain, and association with manifestations excluding abdominal pain were also analyzed.ResultsAn analysis of variance (ANOVA) test showed significant intergroup differences in white blood cell (WBC) count, neutrophil count, serum albumin, potassium, plasma D-dimer and coagulation factor XIII activity. A scoring system consisting of these parameters showed a good prognostic value for gross intestinal bleeding in a receiver operating characteristic (ROC) analysis, and a cut-off value of 4 points showed a sensitivity of 90.0% and specificity of 80.6%. The score was also correlated with the duration of abdominal pain after admission. A significantly higher score (s) was observed in patients presenting with nephritis, although the predictive value was poor.ConclusionA scoring system consisting of generally available parameters was of use in predicting severe GI involvement in HSP patients. Although further study is needed, initial therapy in accordance with disease activity may be taken into consideration using this scoring system.

Neutrophil‐to‐lymphocyte ratio: a biomarker for predicting systemic involvement in adult IgA vasculitis patients

“…This highlights the importance and the need of prognostic markers that can help identify IgAV patients who are at risk of developing unfavourable extracutaneous manifestations. While predictive factors have been extensively studied in children, there are limited data on adults …”

“…While predictive factors have been extensively studied in children, there are limited data on adults. [5][6][7] Blood neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and easily obtainable laboratory marker for quantifying systemic inflammation, which has been used to predict clinical outcomes in patients with various internal malignancies, cardiovascular disease and liver cirrhosis. [8][9][10][11][12] As this ratio integrates information on two immune pathways, it may provide a predictive ability that outweighs other inflammatory parameters.…”

Risk factors of long hospital stay for immunoglobulin A vasculitis: Single‐center study

“…The length of hospitalization was calculated as the actual period of time from admission to discharge. Based on previous studies of the potential risk factors related to prolonged hospitalization, we collected the following information from the patients’ medical records: age, gender, previous episodes, abdominal pain, GI bleeding, GI symptoms other than abdominal pain, fever, use of glucocorticoid before or on admission day, laboratory and urinalysis data, ultrasound findings, and the length of hospital stay …”

“…Based on previous studies of the potential risk factors related to prolonged hospitalization, we collected the following information from the patients' medical records: age, gender, previous episodes, abdominal pain, GI bleeding, GI symptoms other than abdominal pain, fever, use of glucocorticoid before or on admission day, laboratory and urinalysis data, ultrasound findings, and the length of hospital stay. 4,6,7,[10][11][12][13] Gastrointestinal bleeding was defined as hematemesis, melena, hematochezia, or positive stool guaiac test. Stool guaiac test was conducted on a case-by-case basis.…”

Serum neopterin and ischemia modified albumin levels are associated with the disease activity of adult immunoglobulin A vasculitis (Henoch‐Schönlein purpura)

“…This brings attention to the need for the discovery of new prognostic markers that can help to identify IgAV patients who are at risk of developing damage. Although there are several studies investigating predictive factors of the disease in childhood, studies carried out with adults are limited . Neopterin is a component of the cellular immune system which is secreted by macrophages, monocytes and dendritic cells.…”