Predictors In The Progression Of Severe Patients With Hand-Foot-Mouth Disease

Objective:By comparing the clinical features in severe,critically ill and death patients with hand-foot-mouth disease, find the predictors in the progression of severe and critically ill patients.Method:41 children with severe hand-foot-mouth disease admitted to Infectious Disease Hospital of Heze from March to May in 2009 and all the 44 death cases in Shandong province from March to August in 2009(including 7 deaths in Infectious Disease Hospital of Heze) were investigated in the research.All the 78 patients were divided into three groups:group A(severe cases, n=17); group B(critically ill cases, n=17);group C(death cases, n=44).The general features,clinical manifestation and laboratory findings were retrospectively reviewed. Multiple logistic regression analysis was used to examine the multivariate-adjusted odds ratio for risk factors that were significant in univariate analysis.Result:1. Most patients in all the three groups were 6 months to 2.5 years old. Mean age was 2.0±1.3y,1.5±0.6y,1.4±0.7y respectively. Patients aged 1.5～2 y in death group were significantly more than the other two groups. The ratio of male to female was respectively 1.43:1,1.43:1,3.4:l.There were no significant differences of sex ratio among three groups;2.1 Patients with persistent high fever (≥38.5℃and T≥3d) in death group were significantly more than the severe group; 2.2 Nervous system involvement such as vomiting, easily frightened or limb tremble,convulsions, showed no significant differences in three groups. However, the percentage of patients with drowsiness, stupor, coma, or positive meningeal irritation sign in critically ill group was significantly higher than the severe group;2.3Patients with tachypnea or moist rales in lung in critically ill and death group were significantly more than the severe group; Appearance of pink sputum in death group was significantly more likely than severe and the critically ill group.2.4 Patients in critically ill group with circulatory collapse(one of cold limbs, cyanosis, pale, increased capillary refill time(≥3s)), tachycardia(HR> 180 beats per minute), elevation of blood pressure(SBP≥130mmHg), difference between the anus and axillary temperature>1.6℃were significantly more than the severe group; Patients in death group with tachycardia(HR> 200 beats per minute)were significantly more than the critically ill group;3. Patients in critically ill and death group tended to higher total blood white cell counts(WBC> 15x 109/L),glucose level (BS> 7mmol/L),SO2< 91%and the possibility of changes on chest radiograph than severe group. In death group, patients with WBC> 17x 109/L,BS> 9mmol/L, SO2< 91% were significantly more than critically ill group. There were no significant differences of N%,CRP,CKMB among three groups.4.Multiple logistic regression analysis revealed that tachypnea and tachycardia(HR > 180 beats per minute)were major risk factors in progression of severe patients; and glucose level (BS> 7mmol/L) in the progression of critically ill patients to death.Conclusion:1.Factors including sex, vomiting, easily frightened, limb tremble, convulsions, N%,CRP,CKMB are proved no predictors in the progression of severe and critically ill patients.2.The predictors in the progression of severe patients with hand-foot-mouth disease are as follows:①drowsiness,stupor, coma, positive meningeal irritation sign;②tachypnea,moist rales;③tachycardia(HR> 180 beats per minute), elevation of blood pressure(SBP>130mmHg), difference between the anus and axillary temperature≥1.6℃,circulatory collapse(one of cold limbs, cyanosis, pale, increased capillary refill time(≥3s));④WBC>15×109/L,BS> 7mmol/L, S02< 91%,;⑥changes on chest radiograph. Major risk factors are tachypnea and tachycardia(HR> 180 beats per minute);3.The predictors in the progression of critically ill patients to death are as follows:①ages of 1.5～2 y;②pink sputum;③HR> 200 beats per minute;④WBC> 17x 109/L,BS> 9mmol/L,SO2< 91%.BS> 9mmol/L is the major risk factor.