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.
- severe outcome
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Contributors Conceptualisation: ALV, AGu. Project administration: ALV, LG. Database creation and curation: ALV, MDC. Formal analysis: ALV, LG, CM. Methodology: ALV, LG. Data collection: AK, PV, NR, SG, IR, MDG, EM, GZ, MRG, MS, MLM, BV, SC, SE, ML, MV, SB, MDC, CM, DS, CDC, AGr, DP. Laboratory genotype analysis: FM. Writing original draft: AVL, LG, CM. Writing, review and editing: AGu, LG, CM, EB, AVL.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study was conducted according to the principles of the Declaration of Helsinki and approved by the Paediatric Ethics Committee of the Tuscany region.
Provenance and peer review Not commissioned; externally peer reviewed.
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