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<0.001), coma (p<0.05), ecchymotic or necrotic purpura (p<0.01), temperature <36°C (p<0.05), no clinical meningism (p<0.001), white cell count <10,000/mm³ (p<0.05), thrombocytopenia <100,000 (p<0.01), fibrinogen <1.5 g/l (p<0.001), kalemia >5 mEq/l (p<0.01), spinal fluid cell count <20/mm³ (p<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%.