Risk factors for recurrence of co-infections in children with primary nephrotic syndrome
OBJECTIVE To retrospectively analyze the risk factors for recurrence of co-infections in children with primary nephrotic syndrome(PNS).METHODS Totally 153 children with PNS complicated with infections admit-ted to Guiyang Matemity and Child Care Hospital from Feb.2018 to Feb.2023 were retrospectively selected as the study subjects,all of whom were treated with standard hormone therapy and anti-infection therapy.After the complete disappearance of infection symptoms,the children were followed up for 6 months,and were divided into a recurrent group(82 cases)and a non-recurrent group(71 cases)according to the recurrence of infection.The clinical characteristics,the pathogenic bacteria and drug resistance,the non-bacterial pathogen detection results,and immune function indicators at admission were compared between two groups.RESULTS The serum albumin(ALB)level at admission in the recurrent group was(17.52±5.31)g/L,lower than that in the non-recurrent group(P＜0.05),and the 24-hour urine protein quantification and the proportion of immunosuppressive agents application were(148.64±69.63)mg and 42.68％(35/82)respectively,higher than those in the non-recurrent group(P＜0.05).There was no statistically significant difference in the proportion of pathogenic bacteria detected in the infection samples between the patients in the two groups.The detection rates of extended-spectrum β-lacta-mases(ESBLs)producing strains,the multidrug-resistant organisms(MDROs)strains in the recurrent group were 47.22％(17/36)and 33.33％(12/36)respectively,higher than those of the non-recurrent group(P＜0.05),and the positive rate of serum mycoplasma antibody detection was 39.02％(32/82),higher than that in the non-recurrent group(P＜0.05).The application of immunosuppressants(OR=2.968,95％CI:1.876-4.060,P＜0.001)was the risk factor of the recurrence of PNS complicated with infections in children,while the serum ALB level(OR=0.642,95％CI:0.434-0.850,P＜0.001),the serum IgG level(OR=0.573,95％CI:0.385-0.761,P＜0.001),the peripheral blood CD4+/CD8+T lymphocyte ratio(OR=0.415,95％CI:0.290-0.540,P＜0.001)and NK(CD16+56+)cell percentage(OR=0.672,95％CI:0.452-0.892,P＜0.001)were the protective factors.CONCLUSIONS Children with PNS complicated with infections who received hormone therapy had a higher risk of short-term infection recurrence.The pathogens and drug resistance of chil-dren with recurrence had certain characteristics,and their baseline immune function indicators correlated with the risk of recurrence.Clinical practice should strengthen the evaluation and improvement of immune function in chil-dren.
ChildrenPrimary nephrotic syndromeInfectionRecurrenceRisk factorImmune function
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