Blood purification on severe enterovirus 71-associated hand,foot and mouth disease in children / 中国小儿急救医学

ABSTRACT

Objective To assess the clinical benefits of continuous blood purification(CBP) in severe enterovirus 71(EV71)-associated hand,foot and mouth disease (HFMD) in children.Methods We retro-spectively analyzed the medical records of pediatric patients with EV71-associated HFMD admitted to PICU in Shanghai Children's Hospital from January 2012 to December 2016.Severity of EV71-associated HFMD was graded in the accordance with the expert consensus on severe EV71-infected HFMD.According to the severity,the patients with stage 2 HFMD were treated with standard management,and the patients with stage 3-4 HFMD were treated with continuous veno-venous hemodiafiltration(CVVHDF) as an adjuvant therapy. Patient demographics,clinical characteristics,cardiovascular function indexes,outcome and complications of CVVHDF were collected and analyzed.Results A total of 76 patients with severe EV71-associated HFMD were enrolled in this study.Among them,there were 21 patients with stage 3-4 HFMD,and 17 cases were treated with CVVHDF as an adjuvant therapy with a survival rate of 82.4 %(14/17).The median time of CVVHDF treatment was 48(36,64)h.The plasma levels of angiotensin Ⅱ[185.9(125.2,800.0) ng/L vs. 106.0(90.8,232.5) ng/L],aldosterone[165.7(94.0,353.3) ng/L vs. 103.3(84.3,144.3)ng/L],rennin [1.12(0.74,3.45) μg/(L·h) vs. 0.79(0.52,1.25) μg/(L·h) ],adrenaline[169.8(145.5,244.6) ng/L vs. 148.0(109.0,208.1) ng/L],dopamine[152.7(97.0,191.1) ng/L vs. 96.0(68.0,160.9) ng/L], and lactate[3.50(2.75,3.90) mmol/L vs. 1.30(0.95,1.90) mmol/L] were significantly decreased after CVVHDF treatment(all P<0.05,respectively).The fever,heart rate,systolic blood pressure,left ventricular ejection fraction and cardiac index of the patients were significantly improved after treatment(all P<0.05, respectively).Conclusion CBP is an important rescue therapy for patients with severe EV71-infected HFMD, which results in rapidly improving fever,cardiovascular function and stabling the levels of vasoactive mediators.