Observation of the clinical characteristics of chronic diarrhea in children and evaluation of the prognostic value of nutritional and immune indicators

  • JianYun Hao Children's Hospital of Capital Institute of Pediatrics
  • Xin Ma Children's Hospital of Capital Institute of Pediatrics
  • YouZhe Gong Children's Hospital of Capital Institute of Pediatrics
  • Dan Zhu Children's Hospital of Capital Institute of Pediatrics
  • HuiJuan Ning Children's Hospital of Capital Institute of Pediatrics
  • XueMei Zhong Children's Hospital of Capital Institute of Pediatrics
DOI: https://doi.org/10.5937/jomb0-48174
Keywords: Chronic diarrhea, Clinical features, Nutritional status, Immune indicators, Prognosis

Abstract


Objective: This research targeted to assess the clinical characteristics of chronic diarrhea in children, and explore the prognostic value of nutritional status and immune indicators.

Methods: A total of 190 patients with chronic diarrhea from January 2017 to June 2020 were enrolled to analyze their epidemiology. The patients were divided into a better prognosis group (cured, improved) and a poor prognosis group (uncured), followed by determining the diagnostic efficacy of nutritional status and immune indicators in the prognosis of children with chronic diarrhea.

Results: Most of the patients were 0-3 years old (74.2%), of which 54.3% were less than 1 year old, and the highest proportion (48.95%) had diarrhea with a course of 1 to 2 months. The levels of albumin, immunoglobulin G (IgG), IgA and IgM, as well as albumin, globulin and the ratio of albumin to globulin in the better prognosis group were higher than those in the poor prognosis group. The AUC (area under the curve) of the combined detection in evaluating the prognosis of children with chronic diarrhea was greater than that of the albumin and globulin alone (P < 0.05). IgG ≥ 10.05g/L and IgA ≥ 7.72g/L were protective factors affecting the prognosis of children with chronic diarrhea.

Conclusion: Children with chronic diarrhea are mainly infants and young children with various clinical symptoms, and are prone to comorbidities such as malnutrition, anemia, hypoalbuminemia, and impaired immune function. The combined detection of nutritional status and immune indicators in children is of value in evaluating the prognosis of children.

References

[1]Cornejo-Tapia A, Orellana-Peralta F, Weilg P, et al. Etiology, epidemiology and clinical characteristics of acute diarrhea in hospitalized children in rural Peru[J]. J Infect Dev Ctries, 2017, 11(11):826-832.
[2]Wang C, Zhou X, Zhu M, et al. The application research of xTAG GPP multiplex PCR in the diagnosis of persistent and chronic diarrhea in children[J]. BMC Pediatr, 2020, 20(1):309-312.
[3]Girish Kumar CP, Giri S, Chawla-Sarkar M, et al. Epidemiology of rotavirus diarrhea among children less than 5years hospitalized with acute gastroenteritis prior to rotavirus vaccine introduction in India[J]. Vaccine, 2020, 38( 51):8154-8160.
[4]Sanz-Paris A, Martinez-Trufero J, Lambea-Sorrosal J, et al. Clinical and Nutritional Effectiveness of a Nutritional Protocol with Oligomeric Enteral Nutrition in Patients with Oncology Treatment-Related Diarrhea[J]. Nutrients, 2020, 12(5):1534-1539.
[5]Karabulut S, Dogan I, Usul Afsar C, et al. Does nutritional status affect treatment tolerability, response and survival in metastatic gastric cancer patients? Results of prospective multicenter study[J]. J Oncol Pharm Pract, 2022, 28(1):127-134.
[6]Chai YN, Qin J, Li YL, et al. TMT proteomics analysis of intestinal tissue from patients of irritable bowel syndrome with diarrhea: Implications for multiple nutrient ingestion abnormality - ScienceDirect[J]. J Proteomics, 2021, 231(1):103995.
[7]Fan J, Li MJ, Wu Q, et al. Diagnosis and management of infectious diarrhea in children:2017 Infectious Diseases Society of America Clinical Practice Guidelines for Diagnosis and Management of Infectious Diarrhea [J]. Chinese Journal of Applied Clinical Pediatrics, 2019, 34(15):1121-1126. DOI:10.3760/cma.j.issn.2095-428X.2019.15.001.
[8]Lo Vecchio A, Conelli ML, Guarino A. Infections and Chronic Diarrhea in Children. Pediatr Infect Dis J. 2021;40(7):e255-e258. doi:10.1097/INF.0000000000003182
[9]World Health Organization. WHO child growth standards:length/height-for-age,weight-for-age,weight-for-length,weight-for-height and body mass index-for-age:method and development[EB/OL].(2006)[2020-09-20].https://apps.who.int/iris/handle/10665/43413.
[10]World th-reference-data-for-5to19-years/indicators/bmi-for-age.
[11]Shen XM, Wang WP. Pediatrics [M].7th Edition. Beijing: People's Medical Publishing House, 2008:253-255.
[12]Xin Z, Pestana L, Kane SV. Current Utilization and Diagnostic Yield of Random Colonic Biopsies in Evaluation of Chronic Diarrhea[J]. Gastroenterology, 2017, 152(5):S225.
[13]Zhou YL, Wu L, Yin Q, et al. Infections of Clostridium difficile, Blastocystis hominis and Cryptosporidium spp.in patients with chronic diarrhea [J]. Chinese Journal of Parasitology and Parasitic Diseases, 2019, 37(6):723-726.
[14]Gao L, Zhang YJ, Liu XM, et al. Changes in serum inflammatory factors and immunoglobulins and their correlation with changes in intestinal flora in patients with ulcerative colitis with different disease states [J]. Guangdong Medical Journal, 2021, 42(11):1342-1346.
[15]Zeng Y, Li T, Zhao B, et al. Molecular epidemiology of group A rotavirus in outpatient diarrhea infants and children in Chongqing, China, 2011-2015[J]. J Med Virol, 2019, 91(10):1788-1796.
[16]Yuan L, Lum G, Zhao J, et al. Epidemiology of Acute Rotavirus Diarrhea Among Hospitalized Children Under Five Years of Age in Hefei, China, During 2015 - 2018[J]. Jundishapur J Microbiol, 2020, 13(7):6-9.
[17]Schmidt SB, Boltzmann M, Krauss JK, et al. Standardized nutritional supply versus individual nutritional assessment: Impact on weight changes, complications and functional outcome from neurological early rehabilitation[J]. Clin Nutr, 2020, 39( 4):1225-1233.
[18]Savaş Şen Z, Taşar MA, Demirel Kaya F, et al. A Rare Complication of Acute Diarrhae Caused by Cryptosporidium: Possible Hepatobiliary System Involvement in a Child without Immunodeficiency[J]. Mikrobiyol Bul, 2019, 53(4):464-471.
[19]Oktaria V, Lee KJ, Bines JE, et al. Nutritional status, exclusive breastfeeding and management of acute respiratory illness and diarrhea in the first 6months of life in infants from two regions of Indonesia[J]. Bmc Pediatr, 2017, 17(1):211-215.
[20]Kikuchi T, Endoh T, K Takadate, et al. Association between nutritional status and the risk for poor prognosis of clostridium difficile-associated diarrhea[J]. Clin Nutr, 2018, 37(1):S190-S191.
[21]Ma W, Abu-Sbeih H, Y Peng, et al. Outcome of immune checkpoint inhibitor (ICI) related diarrhea/colitis (IMDC) in cancer patients with superimposed GI infections[J]. J Clin Oncol, 2020, 38(15):e15166-e15166.
[22]Wang HF, Li WG, Sun J, et al. Clinical and pathological features of common variable immunodeficiency characterized by chronic diarrhea [J]. Journal of Internal Medicine Concepts & Practice, 2020, 15(3):167-173.
[23]Yang YJ and Liang ZH. A case report of common variant immunodeficiency disease characterized by chronic diarrhea [J]. Chongqing Medicine, 2017, 46(10):149-150.
[24]Kirles B, Parul T, Samuel BB, et al. 453 - The Risk of Diarrhea and Colitis in Patients with Lung Cancer Undergoing Immune-Checkpoint Inhibitor Therapy[J]. Gastroenterology, 2018, 154(6):S104-S105.
[25]Chen Y and Bai HT. A case report of a child with malnutrition-refeeding syndrome mainly manifested by chronic diarrhea and hypophosphatemia [J]. Chinese Journal of Practical Pediatrics, 2021, 36(1):75-76,80.
[26]Zheng Q, Wang J, Zheng H, et al. What Types of Patients with Chronic Diarrhea Benefit More from Acupuncture Treatment? A Secondary Analysis of a Randomized Controlled Trial[J]. Eur J Integr Med, 2020, 35(2):101098.
[27]Tandon P, Bourassa-Blanchette S, Bishay K, et al. The Risk of Diarrhea and Colitis in Patients With Advanced Melanoma Undergoing Immune Checkpoint Inhibitor Therapy: A Systematic Review and Meta-Analysis[J]. J Immunother, 2018, 41(3):101-108.
Published
2024/06/16
Issue
Ahead of print
Section
Original paper

Copyright (c) 2024 JianYun Hao, Xin Ma, YouZhe Gong, Dan Zhu, HuiJuan Ning, XueMei Zhong

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