Risk factors of severe hand, foot and mouth disease: a meta-analysis.
BACKGROUND
In recent years, outbreaks of hand, foot and mouth disease (HFMD) have increased, and more and more severe cases have appeared. We conducted a meta-analysis to generate large-scale evidence on the risk factors of severe HFMD.


METHODS
PubMed, Elsevier Science Direct, China National Knowledge Infrastructure (CNKI), and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 11.0.


RESULTS
We conducted a meta-analysis of 19 separate studies. Duration of fever ≥ 3 days (odds ratio (OR) 10.09, 95% confidence interval (CI) 6.22-16.35), body temperature ≥ 37.5°C (OR 4.91, 95% CI 1.26-19.18), lethargy (OR 7.75, 95% CI 3.78-15.89), hyperglycemia (OR 2.77, 95% CI 2.06-3.71), vomiting (OR 8.83, 95% CI 1.05-74.57), increased neutrophil count (weighted mean difference (WMD) 0.61, 95% CI 0.52-0.70), enterovirus 71 (EV71) infection (OR 5.13, 95% CI 3.11- 8.46), young age (WMD - 0.44, 95% CI - 0.69 to -0.19), and home care (OR 1.65, 95% CI 1.26-2.17) were significantly related to the risk of severe HFMD. We also found that a confirmed diagnosis at first visit to hospital significantly decreased the risk of severe HFMD (OR 0.30, 95% CI 0.09-0.99). We did not find an association between oral rash (OR 1.07, 95% CI 0.82-1.39), increased leukocyte count (WMD 0.51, 95% CI - 0.05-1.06), male sex (OR 1.06, 95% CI 0.91-1.24), or living in a rural area (OR 1.39, 95% CI 0.95-2.02) and the risk of severe HFMD.


CONCLUSIONS
Duration of fever ≥ 3 days, body temperature ≥ 37.5°C, lethargy, hyperglycemia, vomiting, increased neutrophil count, EV71 infection, and young age are risk factors for severe HFMD. A confirmed diagnosis at first visit to hospital can significantly decrease the risk of severe HFMD.
From the 1 Department of Infectious Disease, Shaoxing Center for Disease Control and Prevention , Shaoxing.
Yirong
Y
Fang
Shuiping
S
Wang
Lijie
L
Zhang
Zhinan
Z
Guo
Zhaohui
Z
Huang
Chunyu
C
Tu
Bao-Ping
BP
Zhu
D000367:Age Factors; D016022:Case-Control Studies; D029821:Enterovirus A, Human / Q000276:immunology; D006232:Hand, Foot and Mouth Disease / Q000276:immunology / Q000473:pathology* / Q000821:virology; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
Hand, foot and mouth disease; complication; meta-analysis; risk factor