Complications and risk factors for severe outcome in children with measles

Andrea Lo Vecchio, Andrzej Krzysztofiak, Carlotta Montagnani, Piero Valentini, Nadia Rossi, Silvia Garazzino, Irene Raffaldi, Maria Di Gangi, Susanna Esposito, Barbara Vecchi, Maria Luisa Melzi, Marcello Lanari, Giorgio Zavarise, Samantha Bosis, Mariella Valenzise, Salvatore Cazzato, Michele Sacco, Maria Rita Govoni, Elena Mozzo, Maria Donata CambrigliaEugenia Bruzzese, Chiara Di Camillo, Davide Pata, Alessandro Graziosi, Debora Sala, Fabio Magurano, Alberto Villani, Alfredo Guarino, Luisa Galli

Research output: Contribution to journalArticle

Abstract

Objective and design: Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death. Results: Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01). Conclusion: The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.

Original languageEnglish
JournalArchives of Disease in Childhood
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Measles
C-Reactive Protein
Genotype
Hospitalized Child
Encephalitis
Critical Care
ROC Curve
Pancreatitis
Communicable Diseases
Retrospective Studies
Pediatrics

Keywords

  • children
  • complication
  • genotype
  • measles
  • severe outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Complications and risk factors for severe outcome in children with measles. / Lo Vecchio, Andrea; Krzysztofiak, Andrzej; Montagnani, Carlotta; Valentini, Piero; Rossi, Nadia; Garazzino, Silvia; Raffaldi, Irene; Di Gangi, Maria; Esposito, Susanna; Vecchi, Barbara; Melzi, Maria Luisa; Lanari, Marcello; Zavarise, Giorgio; Bosis, Samantha; Valenzise, Mariella; Cazzato, Salvatore; Sacco, Michele; Govoni, Maria Rita; Mozzo, Elena; Cambriglia, Maria Donata; Bruzzese, Eugenia; Di Camillo, Chiara; Pata, Davide; Graziosi, Alessandro; Sala, Debora; Magurano, Fabio; Villani, Alberto; Guarino, Alfredo; Galli, Luisa.

In: Archives of Disease in Childhood, 01.01.2018.

Research output: Contribution to journalArticle

Lo Vecchio, A, Krzysztofiak, A, Montagnani, C, Valentini, P, Rossi, N, Garazzino, S, Raffaldi, I, Di Gangi, M, Esposito, S, Vecchi, B, Melzi, ML, Lanari, M, Zavarise, G, Bosis, S, Valenzise, M, Cazzato, S, Sacco, M, Govoni, MR, Mozzo, E, Cambriglia, MD, Bruzzese, E, Di Camillo, C, Pata, D, Graziosi, A, Sala, D, Magurano, F, Villani, A, Guarino, A & Galli, L 2018, 'Complications and risk factors for severe outcome in children with measles', Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2018-315290
Lo Vecchio, Andrea ; Krzysztofiak, Andrzej ; Montagnani, Carlotta ; Valentini, Piero ; Rossi, Nadia ; Garazzino, Silvia ; Raffaldi, Irene ; Di Gangi, Maria ; Esposito, Susanna ; Vecchi, Barbara ; Melzi, Maria Luisa ; Lanari, Marcello ; Zavarise, Giorgio ; Bosis, Samantha ; Valenzise, Mariella ; Cazzato, Salvatore ; Sacco, Michele ; Govoni, Maria Rita ; Mozzo, Elena ; Cambriglia, Maria Donata ; Bruzzese, Eugenia ; Di Camillo, Chiara ; Pata, Davide ; Graziosi, Alessandro ; Sala, Debora ; Magurano, Fabio ; Villani, Alberto ; Guarino, Alfredo ; Galli, Luisa. / Complications and risk factors for severe outcome in children with measles. In: Archives of Disease in Childhood. 2018.
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AU - Lo Vecchio, Andrea

AU - Krzysztofiak, Andrzej

AU - Montagnani, Carlotta

AU - Valentini, Piero

AU - Rossi, Nadia

AU - Garazzino, Silvia

AU - Raffaldi, Irene

AU - Di Gangi, Maria

AU - Esposito, Susanna

AU - Vecchi, Barbara

AU - Melzi, Maria Luisa

AU - Lanari, Marcello

AU - Zavarise, Giorgio

AU - Bosis, Samantha

AU - Valenzise, Mariella

AU - Cazzato, Salvatore

AU - Sacco, Michele

AU - Govoni, Maria Rita

AU - Mozzo, Elena

AU - Cambriglia, Maria Donata

AU - Bruzzese, Eugenia

AU - Di Camillo, Chiara

AU - Pata, Davide

AU - Graziosi, Alessandro

AU - Sala, Debora

AU - Magurano, Fabio

AU - Villani, Alberto

AU - Guarino, Alfredo

AU - Galli, Luisa

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N2 - Objective and design: Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death. Results: Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01). Conclusion: The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.

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