Corticosteroids may improve clinical outcomes during hospitalization for Henoch-Schönlein purpura.
OBJECTIVE
To characterize the effect of corticosteroid exposure on clinical outcomes in children hospitalized with new-onset Henoch-Schönlein purpura (HSP).


METHODS
We conducted a retrospective cohort study of children discharged with an International Classification of Diseases, Clinical Modification code of HSP between 2000 and 2007 by using inpatient administrative data from 36 tertiary care children's hospitals. We used stratified Cox proportional hazards regression models to estimate the relative effect of time-varying corticosteroid exposure on the risks of clinical outcomes that occur during hospitalization for acute HSP.


RESULTS
During the 8-year study period, there were 1895 hospitalizations for new-onset HSP. After multivariable regression modeling adjustment, early corticosteroid exposure significantly reduced the hazard ratios for abdominal surgery (0.39 [95% confidence interval (CI): 0.17-0.91]), endoscopy (0.27 [95% CI: 0.13-0.55]), and abdominal imaging (0.50 [95% CI: 0.29-0.88]) during hospitalization.


CONCLUSIONS
In the hospital setting, early corticosteroid exposure was associated with benefits for several clinically relevant HSP outcomes, specifically those related to the gastrointestinal manifestations of the disease.
Weiss
Pamela F
PF
Division of Rheumatology, Children's Hospital of Philadelphia, and Department of Pediatrics, Center for Clinical Epidemiology and Biostatistics, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Room 1539, North Campus, 3535 Market St, Philadelphia, PA 19104, USA. weisspa@email.chop.edu
Klink
Andrew J
AJ
Localio
Russell
R
Hall
Matt
M
Hexem
Kari
K
Burnham
Jon M
JM
Keren
Ron
R
Feudtner
Chris
C
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000188:drug therapy*; D007422:Intestines / Q000601:surgery; D008297:Male; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids