Abdominal pain in pediatric immunoglobulin A vasculitis: Risk factors and severity predictors in a multicenter cohort
Francisco Hugo Rodrigues Gomes, Natalia Maronese, Leticia Lizardo Magalhaes, Davi Casale Aragon, Gleice Clemente, Maria Teresa Terreri, Claudio Arnaldo Len, Rozana Gasparello de Almeida, Marta Cristine Felix Rodrigues, Flavio Sztajnbok, Lia Vineyard Steuer, Matheus Santos França, Clovis Artur Almeida da Silva, Virginia Paes Leme Ferriani, Luciana Martins de CarvalhoAbstract
Objectives
To identify risk factors for abdominal pain and predictors of complicated abdominal pain in pediatric immunoglobulin A vasculitis (IgAV).
Methods
Retrospective multicenter study including children and adolescents (≤18 years) fulfilling the European League Against Rheumatism/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society (EULAR/PRINTO/PRES) criteria for IgAV and followed at four tertiary centers in Brazil. Factors associated with abdominal pain in the overall cohort and with complicated abdominal pain (defined as abdominal pain associated with intussusception, intestinal bleeding, or acute abdomen) were evaluated during the first 3 months of the disease and at the end of follow‐up. Univariate analyses, a pre‐specified multivariable log‐binomial regression model, and receiver operating characteristic (ROC) curve analysis were performed.
Results
Among the 687 pediatric patients with IgAV, 420 (61.1%) developed abdominal pain within the first 3 months and 428 (62.3%) by the end of follow‐up (median follow‐up of 54.1 months [interquartile range 50.7–59.3]). Among patients with abdominal pain, 22.2% developed complications. Prolonged purpuric/petechial rash (>29 days; RRadj 1.78, 95% confidence interval [CI] 1.09–2.91) and leukocytosis (>13,500/mm 3 ; RRadj 2.30, 95% CI 1.41–3.73) were independently associated with complications. Leukocytosis showed good discriminatory performance for predicting acute abdomen (area under the curve 0.813, 95% CI 0.704–0.923).
Conclusion
Prolonged purpuric/petechial rash and leukocytosis were independently associated with complicated abdominal pain. Leukocytosis may help identify children at higher risk of acute abdomen.