Key result
Lethargy, pneumonoedema, seizures, dyspnoea, and coma were significantly associated with death from hand-foot-mouth disease, with lethargy increasing the odds of death by over 6-fold (OR 6.62).
Why the study?
Outbreaks of hand-foot-mouth disease involving millions of children have become a major public health threat, prompting this study to quantitatively assess qualified studies and identify risk factors for HFMD death.
What are the clinical risk factors associated with death in patients with hand-foot-mouth disease?
Meta-Analysis (n=1,641)
What are the clinical risk factors associated with death in patients with hand-foot-mouth disease?
Odds Ratio: 6.62 (95% CI 3.61–12.14)
p-value: p=<0.0001
Neurological and respiratory manifestations such as lethargy, seizures, coma, dyspnea, and pulmonary edema/hemorrhage are significant risk factors for death in children with hand-foot-mouth disease.
May aid early risk stratification for intensive care in pediatric HFMD; supports pooled evidence from case-control studies but requires prospective validation.
In recent years, outbreaks of hand-foot-mouth disease (HFMD) in China, Singapore and other Western Pacific Region, involving millions of children, have become a big threat to public health. This study aimed to quantitatively assess all qualified studies and identify the risk factors for HFMD death. A systematic search of the databases PubMed, Medline, Embase and the Cochrane Library was performed. Study heterogeneity and publication bias were estimated. Seven case-control studies involving 1641 participants (634 died and 1007 survived) were included in the meta-analysis. Human enterovirus 71 infection, male, age ⩽3 years, vomiting, cyanosis, convulsion, duration of fever ⩾3 days, atypical rashes and abdominal distention were not significantly related to HFMD death (P ⩽ 0.05). Lethargy (odds ratio (OR) = 6.62; 95% CI 3.61-12.14; I2 = 0%; P < 0.0001), pneumonoedema/pneumorrhagia (OR = 4.09; 95% CI 2.44-6.87; I2 = 0%; P < 0.0001), seizures (OR = 6.85; 95% CI 2.37-19.74; I2 = 0%; P = 0.0004), dyspnoea (OR = 8.24; 95% CI 2.05-33.19; I2 = 83%; P = 0.003) and coma (OR = 3.76; 95% CI 1.85-7.67; I2 = 0%; P = 0.0003) were significantly associated with HFMD death, which were risk factors for HFMD death.
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Ni et al. (2020) conducted a meta-analysis in Hand-foot-mouth disease (n=1,641). Lethargy vs. Absence of lethargy was evaluated on Death from hand-foot-mouth disease (OR 6.62, 95% CI 3.61-12.14, p=<0.0001). Lethargy, pneumonoedema, seizures, dyspnoea, and coma were significantly associated with death from hand-foot-mouth disease, with lethargy increasing the odds of death by over 6-fold (OR 6.62).
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