Risk Factors for Severe Gastrointestinal Involvement in Childhood HenochSchoenlein Purpura

Background: Henoch–Schonlein Purpura (HSP) is an IgAmediated vasculitis of children. It is often regarded as a benign disease. Nevertheless, some patients may manifest severe renal or gastrointestinal (GI) involvement. We sought to identify the risk factors for severe GI involvement in HSP. Methods and findings: We performed a retrospective study of all children who had Henoch-Sch？nlein purpura with gastrointestinal (GI) involvement admitted during a 10 years period to a single pediatric department. The GI involvement was categorized as severe in children who isease: intense abdominal pain with a score > 3 on a 0-10 self- report scale, or scopresented at least one of the following items on initial presentation and/or on the whole course of the dre <10 on the Amiel-Tison scale for children younger than 3 years, the need for enteral tube feeding or corticosteroid administration, upper or lower gastrointestinal bleeding, intussusception or parietal hematoma on abdominal ultrasound data and if a surgical intervention was needed (group A). The group B included all children diagnosed with HSP without GI involvement or presented with mild abdominal pain (group B). We compared the two groups, using initially Chi square (χ2) and student “t” tests, and thereafter, we employed logistic stepwise regression analysis. Conclusion: Independent risk factors for severe digestive involvement were hyperleukocytosis (p=0.004; Adj OR: 4.5 [1.6–13]), neutrophilia (p<10-3; Adj OR: 8.7 [3.5-26.2]) and renal involvement. The risk factors for severe gastrointestinal involvement in SHP are close to those of severe renal impairment. The identification of these risk factors could guide the indication of hospitalization and the therapeutic modalities.