Matched Case-control Study About Prognosis Factors Of Severe Hand, Foot And Mouth Disease (HFMD) Complicated By Neurogenic Pulmonary Edema

Objectives: In order to lower the fatality rate of HFMD, it is veryimportant to research the severe complication of HFMD, that is the relevantcharacters of neurogenic pulmonary edema in the early stage of SevereHFMD, and to put forward the risk factors that Severe HFMD developing toneurogenic pulmonary edema, also to provide evidence for early diagnosisand intervention of neurogenic pulmonary edema.Methods: It will choose the Severe HFMD patients in Shijiazhuang No.5Hospital from Apr.1,2010to Oct.30,2010, divided them to several groupsaccording to whether developing to neurogenic pulmonary edema, and start todo1to3matched cases-control study by choosing sex and age as matchedfactor. It will use unified questionnaires to gather patients' epidemiologic data,nosetiology data, symptom and physical sign by trained investigators, as wellas to examine the laboratory, build database, use t-test and χ2-test ofstatistical interpretation and grouping sample to do harmonious test on the twogroup of samples, and use single-factor and multi-factor logistic regressionanalysis the risk factors that Severe HFMD developing to neurogenicpulmonary edema.Results:1, There were20patients complicated by neurogenic pulmonaryedema, all were Severe HFMD children under3years old, and7patients weredead, the fatality rate is35%. There were16boys and4girls, sex ratio was4to1, and the average age was1.4±0.44. Among60control groups of patients,male was48, female was12, and the average age was1.2±0.47. Throughharmonious test, there was no statistic difference (χ2=0, P＞0.05) between twosex groups, also no statistic difference (t=1.521, P＞0.05) in age. Sex and age of the two groups of patients were harmoniously comparable, and can beregarded as matched evidence.2, The two groups of patients all showed significance(P<0.05)infactors of disease-diagnosis time, disease-severe time, the first diagnosis atvillage-level medical institutions and confirmed HFMD, the highesttemperature≥39℃, long-term high fever (temperature≥38.5℃and lasting for≥3days), weakness of limbs, tachypnea or arrhythmias, lungs souffle,blood pressure≥130mmHg, heart rate≥150time/min, oxygen saturationof blood≤91%, number of peripheral white blood cells＞12×109/L, bloodsugar＞8.3mmol/L, the rise of creatine kinase and the incidence rate of Creactive protein test positive. But there was no significant differences(P>0.05)in aspects of First symptoms, type of tetter, convulsion, vomitingand liver dysfunction. Single-factor logistic analysis found the risk factors thatSevere HFMD developing to neurogenic pulmonary edema were the firstdiagnosis at village-level medical institutions (OR=3.923, OR95%CI=1.263～12.189), the highest temperature≥39℃(OR=4.125, OR95%CI=1.426～11.929), long-term high fever (OR=3.667, OR95%CI=1.181～11.382),weakness of limbs (OR=15.615,95%CI=2.903～84.006), tachypnea orarrhythmias (OR=14.75, OR95%CI=1.539～141.333), lungs soufflé(OR=9.667, OR95%CI=1.705～54.817), blood pressure≥130mmHg(OR=19.667, OR95%CI=2.135～181.182), heart rate≥150time/min(OR=3.645,OR95%CI=1.217～10.918), oxygen saturation of blood≤91%(OR=10.412, OR95%CI=1.016～106.647), number of peripheralwhite blood cells＞12×109/L(OR=3.207,OR95%CI=1.034～9.944), bloodsugar＞8.3mmol/L(OR=5.107,OR95%CI=1.73～15.076), the rise ofcreatine kinase(OR=6.195,OR95%CI=1.9～20.202), C reactive protein testpositive(OR=2.958,OR95%CI=1.011～8.658), but confirmed HFMD at thefirst diagnosis is a protective factor(OR=0.216,OR95%CI=0.057～0.814).3, Putting significant items showed by single-factor analysis resultinto multi-factor logistic regression analysis, it is found that long-term highfever, weakness of limbs, heart rate≥150time/min and blood sugar＞ 8.3mmol/L constitute the high risk factors of Severe HFMD developing toneurogenic pulmonary edema, and confirmed HFMD at the first diagnosis is aprotective factor.Conclusions: There are differences in the thermal spike, respiratory andcirculatory system between patients complicated by neurogenic pulmonaryedema and control groups. Long-term high fever, weakness of limbs,heart rate≥150time/min and blood sugar＞8.3mmol/L constitute the riskfactors of Severe HFMD developing to neurogenic pulmonary edema, bloodsugar＞8.3mmol/L has the greatest dange(rOR=57.773,OR95%CI=6.128～544.626), and confirmed HFMD at the first diagnosis is a protective factor.