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Open Access Research

Construction of a scoring system for predicting the risk of severe gastrointestinal involvement in Henoch-Schönlein Purpura

Tsunehisa Nagamori1*, Hideharu Oka2, Shin Koyano1, Hironori Takahashi1, Junichi Oki2, Yuko Sato3, Koichi Murono3, Kenichi Iseki4, Ryou Takeguchi5, Takahiro Takeda5, Masayuki Sato6, Rika Sugai6, Hiroyuki Kitamura7, Hiroki Kajino7, Yurika Miura8, Toru Ishioka8 and Hiroshi Azuma1

Author Affiliations

1 Department of Pediatrics, Asahikawa Medical University, Asahikawa, Hokkaido, Japan

2 Department of Pediatrics, Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan

3 Department of Pediatrics, Nayoro City Hospital, Nayoro, Hokkaido, Japan

4 Department of Pediatrics, Fukagawa City Hospital, Fukagawa, Hokkaido, Japan

5 Department of Pediatrics, Wakkanai City Hospital, Wakkanai, Hokkaidō, Japan

6 Department of Pediatrics, Extended Mombetsu City Hospital, Mombetsu, Hokkaido, Japan

7 Department of Pediatrics, Abashiri Kosei Hospital, Abashiri, Hokkaido, Japan

8 Department of Pediatrics, Engaru Kosei Hospital, Hokkaido, Japan

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SpringerPlus 2014, 3:171  doi:10.1186/2193-1801-3-171

Published: 2 April 2014

Abstract

Objective

To evaluate the parameters associated with significant gastrointestinal (GI) involvement in Henoch-Schönlein Purpura (HSP), and construct a scoring system for the identification of patients at high risk of gross blood in stools.

Study design

Data for HSP patients hospitalized at each of seven institutes were retrospectively analyzed. Patients were divided into four groups according to the consequent severity of GI involvement. Identification of laboratory parameters at the time of admission were then used to differentiate the groups, and a scoring system to predict gross intestinal bleeding was constructed. Prognostic efficiency, correlation with the subsequent duration of abdominal pain, and association with manifestations excluding abdominal pain were also analyzed.

Results

An analysis of variance (ANOVA) test showed significant intergroup differences in white blood cell (WBC) count, neutrophil count, serum albumin, potassium, plasma D-dimer and coagulation factor XIII activity. A scoring system consisting of these parameters showed a good prognostic value for gross intestinal bleeding in a receiver operating characteristic (ROC) analysis, and a cut-off value of 4 points showed a sensitivity of 90.0% and specificity of 80.6%. The score was also correlated with the duration of abdominal pain after admission. A significantly higher score (s) was observed in patients presenting with nephritis, although the predictive value was poor.

Conclusion

A scoring system consisting of generally available parameters was of use in predicting severe GI involvement in HSP patients. Although further study is needed, initial therapy in accordance with disease activity may be taken into consideration using this scoring system.