Prognostic factors of severe infectious purpura in children

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%.

Definition of a new score for severity of generalizedNeisseria meningitidis infection

“…Higher mortality in the younger patients (see Table 2) was also expected [11]. The majority of patients with sepsis had sterile CSF cultures, but positive blood cultures for N. meningitidis [10]. The high proportion of patients with sepsis and the high mortality (4/17; 24%) is due to the fact that only severely ill patients needing intensive care units entered this study.…”

Interleukin 12 Levels During the Initial Phase of Septic Shock With Purpura in Children: Relation to Severity of Disease

“…2 WBC and CRP are negatively correlated with the fulminant evolution of meningococcal septic shock. 36,37 Low serum glucose levels are reported by some authors, 38 although this finding is not well understood. IL-12 p40 levels in our patients, correlated with all these parameters reflecting severity of the disease, except for serum lactate.…”

Meningococcal disease: A comparison of eight severity scores in 125 children

“…In contrast to the sepsis syndrome, meningococcal disease is a rapidly recognisable disease and therefore several simple scores have been developed which aim to predict outcome directly after admittance [10][11][12][13][14][15][16][17][18][19][20]. Unfortunately, most meningococcal disease scoring systems have been developed based on the analysis of small, and heterogenous, patient populations.…”