Risk Factors for Poor Prognosis of Severe Infection in Children With Idiopathic Nephrotic Syndrome: A Double-Center, Retrospective Study

Abstract

Background: Infection is the most common complication of Idiopathic Nephrotic Syndrome (INS) and the main cause of INS recurrence, severe infection and even leading to mortality. The purpose of this study was to investigate the risk factors of severe infection in INS children and the clinical parameters influencing prognosis.Methods: Totally 147 children with INS and concomitant infections were enrolled and classified into the severe infection group (SIG) and Non-severe infection group (Non-SIG). The clinical characteristics and auxiliary examination results were compared between the two groups, and the early-warning parameters for severe infection and risk factors for poor prognosis were evaluated.Results: There were 49 patients in the SIG, 98 patients in the Non-SIG. In the SIG, the most common severe infections disease included severe pneumonia (63.6%), severe sepsis (30.6%), septic shock (4.1%). In SIG, Gram-positive bacteria (GPB) were more common, as was respiratory syncytial virus (RSV), and the three most common strains were Pseudomonas aeruginosa, Staphylococcus aureus (SA) and Staphylococcus epidermidis. There were more steroid-resistant nephrotic syndrome and combination of steroids and immunosuppressants in SIG, compared with the Non-SIG (P = 0.000). Patients in the SIG has lower complement 3 (C3, ≤ 0.55 g/L,) and absolute lymphocyte count (ALC, ≤ 1.5 × 109/L) (P = 0.004). Logistic regression analysis revealed that the independent risk factors for severe infections were the combined use of immunosuppressants [95% confidence interval (CI):1.569–463.541, P = 0.023], steroid resistance (95% CI: 4.845–2,071.880, P = 0.003), C-reactive protein (CRP) ≥8 mg/L (95% CI: 43.581–959, 935.668, P = 0.001), and infections caused by GPB (95% CI: 27.126–2,118, 452.938, P = 0.002), influenza (95% CI: 2.494–1, 932.221, P = 0.012) and RSV (95% CI: 5.011–24 963.819, P = 0.007). The patients in the SIG were classified into the survival group (N = 39) and the mortality group (N = 5). Logistic regression analysis showed that white blood cell count (WBC) >15 × 109/L (95% CI: 1.046–2.844, P = 0.033) was an independent risk factor of poor prognosis for these patients.Conclusions: Resistance to steroids, combined with steroids and IS agents, and GPB infections (especially SA) are high-risk factors for severe infection in children with INS. We should monitor CRP ≥ 8 mg/L, C3 ≤ 0.55 g/L and ALC ≤ 1.5 × 109/L to avoid developing severe infection. Accompanied by an increase in ANC, WBC significantly increased, suggesting a fatal infection.

Complications Related to Childhood Idiopathic Nephrotic Syndrome, Its Treatment and the Associated Risks in Patients

“…In the present study the most common complication observed during follow-up was URTIs (37%). Similarly, other studies report that acute respiratory tract infection is the most common infection [8]. In terms of the frequency of complications in the present study URTIs were followed by pneumonia, chickenpox, peritonitis, gastroenteritis, UTI, cellulitis, bacteremia, and hepatitis B infection.…”

Immunosuppression Exposure and Risk of Infection-Related Acute Care Events in Patients With Glomerular Disease: An Observational Cohort Study

“…Results from the present study are generally consistent with the existing literature describing the epidemiology of infections among patients with nephrotic syndrome, most notably, that steroids confer an increased risk of severe infection in adults and children with nephrotic syndrome when used alone or in combination with other immunosuppressive medications. 32 , 33 , 34 An analysis of steroid-associated side effects identified in electronic medical records from 884 adults and children with primary proteinuric kidney disease found a 2-fold increased risk of infection in those treated with corticosteroids. 35 The rate of severe infections in this cohort was 4.61 infections per 100 person-years, a finding similar to the rate in our study (6.1 infections/100 person-years).…”

Tỷ Lệ Biến Chứng Nhiễm Khuẩn Trên Bệnh Nhân Hội Chứng Thận Hư Nguyên Phát Tại Bệnh Viện Nhi Đồng 2 Từ Tháng 01/2021 Đến Tháng 08/2022

“…Bệnh nhi với sang thương tối thiểu đáp ứng rất tốt với corticoidvốn là phương thức điều trị chính của HCTH, nhưng 75% trường hợp sẽ tái phát sau đó và 50% số ca bệnh sẽ diễn tiến đến tình trạng tái phát thường xuyên và lệ thuộc corticoid. Chính điều này sẽ dẫn đến việc sử dụng corticoid lâu dài, thậm chí cần phải kết hợp thêm những nhóm thuốc ức chế miễn dịch khác [3][4][5] .…”