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Risk factors for death in children with critical and severe hand-foot-and-mouth disease in Chongqing, China: An observational study.

Abstract 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 (Pā€Š<ā€Š.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.
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Journal Title medicine
Publication Year Start




PMID- 29245260
OWN - NLM
STAT- MEDLINE
DCOM- 20171225
LR  - 20171225
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 49
DP  - 2017 Dec
TI  - Risk factors for death in children with critical and severe hand-foot-and-mouth
      disease in Chongqing, China: An observational study.
PG  - e8934
LID - 10.1097/MD.0000000000008934 [doi]
AB  - 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 &lt; .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.
FAU - Zheng, Gaihuan
AU  - Zheng G
AD  - 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.
FAU - Cao, Jiaoyang
AU  - Cao J
FAU - Yu, Jie
AU  - Yu J
FAU - Zhang, Zhenzhen
AU  - Zhang Z
FAU - Liu, Quanbo
AU  - Liu Q
FAU - Chen, Junhua
AU  - Chen J
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - China/epidemiology
MH  - Female
MH  - Hand, Foot and Mouth Disease/*mortality
MH  - Humans
MH  - Infant
MH  - Male
MH  - Risk Factors
MH  - Survival Rate
PMC - PMC5728875
EDAT- 2017/12/17 06:00
MHDA- 2017/12/26 06:00
CRDT- 2017/12/17 06:00
PHST- 2017/12/17 06:00 [entrez]
PHST- 2017/12/17 06:00 [pubmed]
PHST- 2017/12/26 06:00 [medline]
AID - 10.1097/MD.0000000000008934 [doi]
AID - 00005792-201712080-00049 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(49):e8934. doi: 10.1097/MD.0000000000008934.