• DOI:10.1186/s13054-021-03603-8
• Corpus ID: 235234752

Factors associated with death in children with purpura fulminans: a French national prospective cohort study

@article{Madhi2021FactorsAW,
  title={Factors associated with death in children with purpura fulminans: a French national prospective cohort study},
  author={Fouad Madhi and Naim Ouldali and Corinne Levy and Muhamed-Kheir Taha and Robert Cohen and Abi Abou Al Al Bongo Chalvon Colin Dit Dolfi Duval El Abdelhadi Aberrane Warde Tara Abrudan Adam Adamon and Abdelhadi and Aberrane and Abi Warde and A Tara and Abrudan and Adam and Adamon and Akitani and Alba-Sauviat and Aldair J. Chaar and Albertini and Aljazayri and Aljumaidi and Allali and Allia and Al Mazini and Amama and Amara and Amira and Amirault and Andriantahina and Ansoborlo and Arlet and Armengaud and Armouche and Arnault and Asensio and Aubert and Auburtin and Audry and Aujard and Autret and Azemar and Bachelier and Badran and Bajolle and Baleine and Bandin and Banegas and Banerjee and Banige and Barbier and Bardou and Baret and Barnaud and Baron-Joly and Barrans and Barraud and Barr{\'e} and Barrey and Barsotti and Barthez and Bartizel and Baruteau and Basmaci and Bassil and Battaglini and Bayle and Bednarek and Belgaid and Belivier and Bellulo and Benabdelmalek and Benchekroun and B{\'e}n{\'e}zech and Bengrina and Benmahammed and Benmoulai and Benoist and Benoit and Bensaid and Benseddik and Benzaim and Berche and Berrahma and Beretta-Salaun and Bergounioux and Berterottiere and Berthier and Bertrou and Besson-Leaud and Biendo and Biessy and Billaud and Billion and Bina and Bineau and Biran and Bitar-Obeid and Blanc and Blasquez and Blondel and Blondin and Boileau and Boivin and Boize and Bolot and Bonacorsi and Boniface and Bongo Boina and Bonnin and Boquet and Bordes and Born and Bosdure and Bosi and Bost-Bru and Bouainane and Bouderlique and Boukezia and Boulard and Bour and Bourennane and Bourgeois-Nicolaos and Boussadia and Boussicault and Boutros and Boutte and Bouvet and Bouziges and Bovero and Boyer and Branca and Branger and Bresson and Breton and Breuil and Briand and Brieu and Brizard and Brocard and Brouard and Bruna and Brunel and Bruno and Bruyas and Bucher and Bucur and Buisson-Touati and Bulteau-Cowan and Cabaret and Cadot and Caillon and Callamand and Calvez and Cambonie and Campet and Canis and Canzi and Capdeville and Carbajal and Carbonnelle and Carr{\'e} and Carre-Cavellier and Carrer and Carri{\`e}re and Carroger and Cartier and Cartier-Riviere and Cascarigny and Castell{\'a} and Castelnau and Cathenoz and Cattoen and Cattoir and Cau and Cavalier and 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Sartre and Saumureau and Saunier and Savoy and Scanvic and Scat and Schaefer and Schneider and Seaume and Sebag and Secher and See and Sevin and Sfez and Simonin and Siouala and Sirot and Sivadon-Tardy and Smati and Smets and Sommabere and Soto and Soustelle and Spicq and Stefaniuk and St{\'e}phan and Sweertvaegher and Tahiri and Tarral and Tchanga and Terki and Texier and Therond and Th{\'e}venot and Thibault and Thiriez and Thore and Thouvenin and Tiry and Tixier and Tommasi and Toubiana and Touroult-Jupin and Tourrand and Tran and Trioche and Troller and Tronc and Trouilloud and Tuypens and Tytgat and Ursulescu and Uzan and Vachee and Vaillant and Valade and Valayer and Valensi and Vallee and Vallet and Vandenesch and Van de Perre and Vanel Contamin and Varengue and Vasselon-Raina and Vaucel. and Venot and Verdan and Verdet and Vergerond and Vergnaud and Vergne and Vernet-Garnier and Vervel and Viala and Vialette and Vic and Vignaud and Vigneron and Villeneuve and Violette and Vittecoq and Vodoff and Vogt and Vorlet and Vray and Vrillon and Vu Thien and Warin and Wasels and Weber and Weisse and W{\'e}meau and Worcel and Yang Ting and Ygout and Youssef and Ythier and Zaoui and Zarzour and Zehani and Zelinsky-Gurung and Zenkhri and Zimmermann and Zitvogel and Zumbo},
  journal={Critical Care},
  year={2021},
  volume={25}
}

• F. Madhi, N. Ouldali, +917 authors Zumbo
• Published 28 May 2021
• Medicine
• Critical Care

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. To the editor, As there is a high mortality rate and major risk of sequelae of purpura fulminans (PF), early identification of patients at highest risk of poor outcome is crucial to optimize the initial management. To date, only a few studies have suggested clinical or biological factors associated with an unfavorable evolution because of the rarity of PF in children. These studies were most often monocentric and retrospective [1, 2] or did not specifically study PF in children [3]. We analyzed the clinical and biological factors available at initial presentation associated with death in children with PF. We conducted a national population-based prospective French cohort of pediatric PF over 15 years. From 2003 to 2017, we included all children < 15 years with PF with or without meningitis in one of the 227 participating centres. The methodology of this surveillance system was previously published [4]. The diagnosis of PF followed published recommendations [5] and remained unchanged over the study period. The main outcome was the case fatality rate before hospital discharge. We assessed demographic, clinical and biological factors, along with initial treatments used associated with death. For biological factors, we considered explorations performed at admission. We included 1042 cases of PF: N. meningitidis was the most frequent bacterium isolated (910, 86.5%), including 581 with serogroup B (64.5%), 218 serogroup C (24.2%). Table 1 shows the demographic and clinical characteristics at admission and outcomes. Among 1042 patients with PF, 166 (16.1%; 95% CI [13.9; 18.5]) died during hospitalization. For the 876 survivors, 143 (16.3%; 95% CI [13.9; 18.9]) had acute complications or sequelae, including extensive skin necrosis (n = 56), neurological complications (n = 32), and limb amputation (n = 20). Table 2 summarizes the risk factors for death in children with PF. On multivariate analysis, death was significantly associated with age < 1 year and leucopenia < 5000/mm3; while leukocytosis > 10,000/mm3 was protective. Initial appropriate antibiotic treatment was not associated with death. Furthermore, death was faster with than without leucopenia (mean time to death 1.9 vs. 4.9 days, p = 0.013). Our multivariable model estimated that the probability of death could range from 3% for children without risk factors to 36% for children < 1 year old and with leucopenia < 5000/mm3. Open Access