AB1009 CLINICAL FEATURES PREDICTIVE OF RENAL AND GASTROINTESTINAL INVOLVEMENT IN PATIENTS WITH HENOCH-SCHöNLEIN PURPURA
Authors: Chun-Hua Liao, LI-Chieh Wang, Bor-Luen Chiang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Henoch-Schönlein purpura (HSP), the most common form of vasculitis in children, predominantly involves the small vessels of the skin, the gastrointestinal (GI) tract, joints, and kidneys. GI involvement is the most severe short-term complication, in contrast, renal disease is the most troublesome long-term complication. Meanwhile, although the disease course of HSP is usually benign in children, recurrence still occurs in a subset of patients. Studies documenting the incidence and predictive factors of recurrent HSP, and biomarkers of the various manifestations of HSP are limited. <h3>Objectives</h3> We aimed to delineate characteristics and biomarkers of HSP patients with GI or renal involvement, and hoped to clarify the incidence and predictive markers of recurrent HSP <h3>Methods</h3> We retrospectively reviewed the medical records of 40 patients admitted in one tertiary medical center in Taipei, Taiwan over a 5-year period with a diagnosis of Henoch-Schönlein purpura. Incidence and risk factors for GI involvement, renal involvement, and recurrent HSP were analyzed. The Mann-Whitney U test and Fisher exact test were utilized for statistical assessment. <h3>Results</h3> From January 1, 2005 to December 31, 2010, 40 HSP patients aged &lt; 18 years were identified. The mean onset age was 8.35±3.3 years. Among them, 45%(18/40) of the patients were male. Ten patients had more than 2 HSP episodes (recurrence rate 25%). Renal involvement was noted in 17.5% (7/40) of the patients, and it was found to occur more frequently in children with later onset age (with renal involvement: 11.43±4.33 years; without renal involvement: 7.73±2.72 years; p=0.03). Recurrent HSP was found to occur more frequently in patients with renal involvement, though without statistical significance (odds ratio: 6; 95% confidence interval; 1.05-34.14; p=0.051). Renal involvement was not associated with GI involvement (p=0.69). GI involvement was noted in 47.5% (19/40) of the patients, and it was found to occur more frequently in patients with higher segmented neutrophil percentage as assessed by complete blood count (with GI involvement: 74.16±13.31%; without GI involvement: 63.14±11.11%; p=0.0056). GI involvement was not associated with relapse of HSP. Fourteen patiens(35%) had arthritis or arthralgia, and it was found to occur more frequently in children with earlier onset age (with arthralgia/arthritis: 7.26±2.55 years; without arthralgia/arthritis: 10.39±3.63 years; p=0.01). <h3>Conclusion</h3> HSP patients with GI involvement had higher segmented neutrophil percentage, consistent with previous studies proposing neutrophil-lymphocyte ratio as a biomarker for GI involvement. Patients with renal involvement had a later age of onset, and the relapse rate was higher in this subpopulation but not statistically significant. <h3>References</h3> [1] Hong, S. H., C. J. Kim and E. M. Yang (2018). "Neutrophil-to-lymphocyte ratio to predict gastrointestinal bleeding in Henoch: Schonlein purpura." Pediatr Int 60(9): 791-795. [2] Lei, W. T., P. L. Tsai, S. H. Chu, Y. H. Kao, C. Y. Lin, L. C. Fang, S. D. Shyur, Y. W. Lin and S. I. Wu (2018). "Incidence and risk factors for recurrent Henoch-Schonlein purpura in children from a 16-year nationwide database." Pediatr Rheumatol Online J 16(1): 25. <h3>Disclosure of Interests</h3> None declared