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The effect of the pretreatment systemic immune-inflammatory index and C-reactive protein-to-albumin ratio on prognosis in pediatric patients with IgA vasculitis

Year 2023, Volume: 6 Issue: 2, 441 - 448, 27.03.2023

Vildan Güngörer Işık Dişçi Şükrü  Arslan

https://doi.org/10.32322/jhsm.1234037

Abstract

Aim: Indices related to blood parameters that indicate inflammation have recently started to be used in determining prognosis for many diseases. Visceral involvement is the most important factor affecting prognosis in immunoglobulin A vasculitis (IgAV). In this study, we sought to explore the value of the systemic immune-inflammation index (SII) and the C-reactive protein-to-albumin ratio (CAR) in predicting visceral involvement in IgAV.
Material and Method: Patients diagnosed with IgAV who had gastrointestinal, renal, testicular, or central nervous system involvement were considered patients with visceral involvement. All patients with IgAV were divided into two groups, those with and without visceral involvement. The effect of SII and CAR in predicting visceral involvement was evaluated by logistic regression analysis.
Results: We found that in the summertime, the percentage of patients with visceral involvement was significantly higher than those without visceral involvement (p=0.010). The rates of the recurrence of the disease, arthralgia, arthritis, and fever were significantly greater in those with visceral involvement (p=0.032, p<0.001, p=0.027, and p=0.019, respectively). SII, CAR, and neutrophil-to-lymphocyte ratio (NLR) values were significantly higher in the patients with visceral involvement (p=0.017, p=0.046, and p=0.008, respectively). The results of the univariate analysis showed that the SII and NLR were significant predictors of visceral involvement (OR: 1.001, 95% CI: 1.000-1.001, p=0.036; OR: 1.344, 95% CI: 1.053-1.715, p=0.018, respectively). We found that NLR was of greater value than SII in terms of predicting visceral involvement.
Conclusion: SII can be a valuable indicator for predicting visceral involvement in IgAV. However, CAR was not found significant in predicting visceral involvement.

Keywords

IgA vasculitis inflammation prognosis

References

  • Batu ED, Ozen S. Pediatric vasculitis. Curr Rheumatol Rep 2012; 14: 121-9.
  • López-Mejías R, Castañeda S, Genre F, et al. Genetics of immunoglobulin-A vasculitis (Henoch-Schönlein purpura): An updated review. Autoimmun Rev 2018; 17: 301-15.
  • Ekinci RMK, Balci S, Bisgin A, et al. MEFV gene variants in children with Henoch-Schönlein purpura and association with clinical manifestations: a single-center Mediterranean experience. Postgrad Med 2019; 131: 68-72.
  • Peru H, Soylemezoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period. Clin Rheumatol 2008; 27: 1087-92.
  • Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005; 35: 143-53.
  • Coppo R, Andrulli S, Amore A, et al. Predictors of outcome in Henoch-Schönlein nephritis in children and adults. Am J Kidney Dis 2006; 47: 993-1003.
  • Hočevar A, Rotar Z, Ostrovršnik J,et al. Incidence of IgA vasculitis in the adult Slovenian population. Br J Dermatol 2014; 171: 524-7.
  • Shin JI, Kim JH, Lee JS, Kim DS, Choi JY, Sul JH. Cardiac manifestations of Henoch-Schoenlein purpura: IgA mediated vasculitis or rheumatic fever? Eur J Pediatr 2007; 166: 627.
  • Cai J, Wang K, Han T, Jiang H. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore) 2018; 97: 13324.
  • Park CH, Han DS, Jeong JY, et al. The optimal cut-off value of neutrophil-to-lymphocyte ratio for predicting prognosis in adult patients with Henoch-Schönlein purpura. PLoS One 2016; 11: 0153238.
  • Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol 2014; 12: 58.
  • Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: A meta-analysis. J Cancer 2018 7; 9: 3295-302.
  • Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal 2021; 35: 23964.
  • Yorulmaz A, Hayran Y, Akpinar U, et al. Systemic immune-inflammation index (SII) predicts increased severity in psoriasis and psoriatic arthritis. Curr Health Sci J 2020; 46: 352-7.
  • Chen JB, Tang R, Zhong Y, et al. Systemic immune-inflammation index predicts a reduced risk of end-stage renal disease in Chinese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibody-associated vasculitis: A retrospective observational study. Exp Ther Med 2021; 22: 989.
  • Lapić I, Padoan A, Bozzato D, Plebani M. Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation. Am J Clin Pathol 2020; 153: 14-29.
  • Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17: 432-7.
  • Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond) 2009; 9: 30-3
  • Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015; 22: 803-10.
  • Moon JS, Ahn SS, Park YB, Lee SK, Lee SW. C-reactive protein to serum albumin ratio is an independent predictor of all-cause mortality in patients with ANCA-associated vasculitis. Yonsei Med J 2018; 59: 865-71.
  • Tanacan E, Dincer D, Erdogan FG, Gurler A. A cutoff value for the Systemic Immune-Inflammation Index in determining activity of Behçet disease. Clin Exp Dermatol 2021; 46: 286-91.
  • Prais D, Amir J, Nussinovitch M. Recurrent Henoch-Schonlein purpura in children. J Clin Rheumatol 2007; 13: 25–8.
  • Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.
  • Du L, Wang P, Liu C, Li S, Yue S, Yang Y. Multisystemic manifestations of IgA vasculitis. Clin Rheumatol 2021; 40: 43-52.
  • Fu W, Ye W, Liu X, et al. Meta-analysis of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in Henoch-Schonlein purpura and its complications. Int Immunopharmacol 2021; 94: 107454.
  • Leung AKC, Barankin B, Leong KF. Henoch-Schönlein purpura in children: an updated review. Curr Pediatr Rev 2020; 16: 265-76.
  • Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol 2017; 23: 6261-72.
  • Tian Y, Liu N, Yin H, Duan L. Relationship between C-reactive protein/serum albumin ratio, neutrophil/lymphocyte ratio, and ANCA-associated vasculitis activity: a retrospective single center cohort study. Front Med (Lausanne) 2022; 9: 855869.
  • Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW. Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton) 2019; 24: 711-7.
  • Ozen S. The spectrum of vasculitis in children. Best Pract Res Clin Rheumatol 2002; 16: 411-25.
  • Chen SY, Kong MS. Gastrointestinal manifestations and complications of Henoch-Schönlein purpura. Chang Gung Med J 2004; 27: 175-81.
  • Tabel Y, Inanc FC, Dogan DG, Elmas AT. Clinical features of children with Henoch-Schonlein purpura: risk factors associated with renal involvement. Iran J Kidney Dis 2012; 6: 269-74.
  • Chan H, Tang YL, Lv XH, et al. Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis. PLoS One 2016: 30; 11: e0167346.
  • Uppal SS, Hussain MA, Al-Raqum HA, et al. Henoch-Schönlein's purpura in adults versus children/adolescents: A comparative study. Clin Exp Rheumatol 2006; 24: 26-30.
  • Fretzayas A, Sionti I, Moustaki M, Papadimitriou A, Nicolaidou P. Henoch-Schönlein purpura: a long-term prospective study in Greek children. J Clin Rheumatol 2008; 14: 324-31.
  • Karadağ ŞG, Tanatar A, Sönmez HE, et al. The clinical spectrum of Henoch-Schönlein purpura in children: a single-center study. Clin Rheumatol 2019; 38: 1707-14.
  • Calvo-Río V, Hernández JL, Ortiz-Sanjuán F, et al. Relapses in patients with Henoch-Schönlein purpura: Analysis of 417 patients from a single center. Medicine (Baltimore) 2016; 95: 4217.
  • Demirtaş Ş, Dursun İ, Pınarbaşı AS, et al. The Factors Affecting the Occurrence of Renal Involvement in Children with IgA Vasculitis: Renal Involvement of IgA Vasculitis. J Pediatr Acad 2020; 1: 50–5.
  • Bogdanović R. Henoch-Schönlein purpura nephritis in children: risk factors, prevention and treatment. Acta Paediatr 2009; 98: 1882-9.
  • Sano H, Izumida M, Shimizu H, Ogawa Y. Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur J Pediatr 2002; 161: 196-201.  
  • Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R. Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal 2020; 34: 23259.
  • Navegantes KC, de Souza Gomes R, Pereira PAT, Czaikoski PG, Azevedo CHM, Monteiro MC. Immune modulation of some autoimmune diseases: the critical role of macrophages and neutrophils in the innate and adaptive immunity. J Transl Med 2017; 15: 36.
  • Barut K, Sahin S, Kasapcopur O. Pediatric vasculitis. Curr Opin Rheumatol 2016; 28: 29-38.
  • Özdemir ZC, Çetin N, Kar YD, Öcal HO, Bilgin M, Bör Ö. Hemotologic indices for predicting internal organ involvement in Henoch-Schönlein purpura (IgA vasculitis). J Pediatr Hematol Oncol 2020; 42: 46-49.
  • Jagroop IA, Clatworthy I, Lewin J, Mikhailidis DP. Shape change in human platelets: measurement with a channelyzer and visualisation by electron microscopy. Platelets 2000; 11: 28-32.
  • Edström Halling S, Söderberg MP, Berg UB. Predictors of outcome in Henoch-Schönlein nephritis. Pediatr Nephrol 2010; 25: 1101-8.
  • Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest 2020; 50: 13230.
  • Fois AG, Paliogiannis P, Scano V, et al. The systemic ınflammation ındex on admission predicts ın-hospital mortality in COVID-19 patients. Molecules 2020; 25: 5725. doi: 10.3390/molecules25235725.
  • Güneylioğlu MM, Güngör A, Göktuğ A, et al. Evaluation of the efficiency of the systemic immune-inflammation index in differentiating parapneumonic effusion from empyema. Pediatr Pulmonol 2022; 57: 1625-30.
  • Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One 2013; 8: 59321.
  • Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol 2017; 23: 6261-72.

Year 2023, Volume: 6 Issue: 2, 441 - 448, 27.03.2023

Vildan Güngörer Işık Dişçi Şükrü  Arslan

https://doi.org/10.32322/jhsm.1234037

Abstract

Keywords

IgA vasculitis inflammation prognosis

References

  • Batu ED, Ozen S. Pediatric vasculitis. Curr Rheumatol Rep 2012; 14: 121-9.
  • López-Mejías R, Castañeda S, Genre F, et al. Genetics of immunoglobulin-A vasculitis (Henoch-Schönlein purpura): An updated review. Autoimmun Rev 2018; 17: 301-15.
  • Ekinci RMK, Balci S, Bisgin A, et al. MEFV gene variants in children with Henoch-Schönlein purpura and association with clinical manifestations: a single-center Mediterranean experience. Postgrad Med 2019; 131: 68-72.
  • Peru H, Soylemezoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period. Clin Rheumatol 2008; 27: 1087-92.
  • Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005; 35: 143-53.
  • Coppo R, Andrulli S, Amore A, et al. Predictors of outcome in Henoch-Schönlein nephritis in children and adults. Am J Kidney Dis 2006; 47: 993-1003.
  • Hočevar A, Rotar Z, Ostrovršnik J,et al. Incidence of IgA vasculitis in the adult Slovenian population. Br J Dermatol 2014; 171: 524-7.
  • Shin JI, Kim JH, Lee JS, Kim DS, Choi JY, Sul JH. Cardiac manifestations of Henoch-Schoenlein purpura: IgA mediated vasculitis or rheumatic fever? Eur J Pediatr 2007; 166: 627.
  • Cai J, Wang K, Han T, Jiang H. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore) 2018; 97: 13324.
  • Park CH, Han DS, Jeong JY, et al. The optimal cut-off value of neutrophil-to-lymphocyte ratio for predicting prognosis in adult patients with Henoch-Schönlein purpura. PLoS One 2016; 11: 0153238.
  • Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol 2014; 12: 58.
  • Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: A meta-analysis. J Cancer 2018 7; 9: 3295-302.
  • Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal 2021; 35: 23964.
  • Yorulmaz A, Hayran Y, Akpinar U, et al. Systemic immune-inflammation index (SII) predicts increased severity in psoriasis and psoriatic arthritis. Curr Health Sci J 2020; 46: 352-7.
  • Chen JB, Tang R, Zhong Y, et al. Systemic immune-inflammation index predicts a reduced risk of end-stage renal disease in Chinese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibody-associated vasculitis: A retrospective observational study. Exp Ther Med 2021; 22: 989.
  • Lapić I, Padoan A, Bozzato D, Plebani M. Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation. Am J Clin Pathol 2020; 153: 14-29.
  • Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17: 432-7.
  • Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond) 2009; 9: 30-3
  • Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015; 22: 803-10.
  • Moon JS, Ahn SS, Park YB, Lee SK, Lee SW. C-reactive protein to serum albumin ratio is an independent predictor of all-cause mortality in patients with ANCA-associated vasculitis. Yonsei Med J 2018; 59: 865-71.
  • Tanacan E, Dincer D, Erdogan FG, Gurler A. A cutoff value for the Systemic Immune-Inflammation Index in determining activity of Behçet disease. Clin Exp Dermatol 2021; 46: 286-91.
  • Prais D, Amir J, Nussinovitch M. Recurrent Henoch-Schonlein purpura in children. J Clin Rheumatol 2007; 13: 25–8.
  • Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.
  • Du L, Wang P, Liu C, Li S, Yue S, Yang Y. Multisystemic manifestations of IgA vasculitis. Clin Rheumatol 2021; 40: 43-52.
  • Fu W, Ye W, Liu X, et al. Meta-analysis of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in Henoch-Schonlein purpura and its complications. Int Immunopharmacol 2021; 94: 107454.
  • Leung AKC, Barankin B, Leong KF. Henoch-Schönlein purpura in children: an updated review. Curr Pediatr Rev 2020; 16: 265-76.
  • Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol 2017; 23: 6261-72.
  • Tian Y, Liu N, Yin H, Duan L. Relationship between C-reactive protein/serum albumin ratio, neutrophil/lymphocyte ratio, and ANCA-associated vasculitis activity: a retrospective single center cohort study. Front Med (Lausanne) 2022; 9: 855869.
  • Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW. Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton) 2019; 24: 711-7.
  • Ozen S. The spectrum of vasculitis in children. Best Pract Res Clin Rheumatol 2002; 16: 411-25.
  • Chen SY, Kong MS. Gastrointestinal manifestations and complications of Henoch-Schönlein purpura. Chang Gung Med J 2004; 27: 175-81.
  • Tabel Y, Inanc FC, Dogan DG, Elmas AT. Clinical features of children with Henoch-Schonlein purpura: risk factors associated with renal involvement. Iran J Kidney Dis 2012; 6: 269-74.
  • Chan H, Tang YL, Lv XH, et al. Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis. PLoS One 2016: 30; 11: e0167346.
  • Uppal SS, Hussain MA, Al-Raqum HA, et al. Henoch-Schönlein's purpura in adults versus children/adolescents: A comparative study. Clin Exp Rheumatol 2006; 24: 26-30.
  • Fretzayas A, Sionti I, Moustaki M, Papadimitriou A, Nicolaidou P. Henoch-Schönlein purpura: a long-term prospective study in Greek children. J Clin Rheumatol 2008; 14: 324-31.
  • Karadağ ŞG, Tanatar A, Sönmez HE, et al. The clinical spectrum of Henoch-Schönlein purpura in children: a single-center study. Clin Rheumatol 2019; 38: 1707-14.
  • Calvo-Río V, Hernández JL, Ortiz-Sanjuán F, et al. Relapses in patients with Henoch-Schönlein purpura: Analysis of 417 patients from a single center. Medicine (Baltimore) 2016; 95: 4217.
  • Demirtaş Ş, Dursun İ, Pınarbaşı AS, et al. The Factors Affecting the Occurrence of Renal Involvement in Children with IgA Vasculitis: Renal Involvement of IgA Vasculitis. J Pediatr Acad 2020; 1: 50–5.
  • Bogdanović R. Henoch-Schönlein purpura nephritis in children: risk factors, prevention and treatment. Acta Paediatr 2009; 98: 1882-9.
  • Sano H, Izumida M, Shimizu H, Ogawa Y. Risk factors of renal involvement and significant proteinuria in Henoch-Schönlein purpura. Eur J Pediatr 2002; 161: 196-201.  
  • Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R. Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal 2020; 34: 23259.
  • Navegantes KC, de Souza Gomes R, Pereira PAT, Czaikoski PG, Azevedo CHM, Monteiro MC. Immune modulation of some autoimmune diseases: the critical role of macrophages and neutrophils in the innate and adaptive immunity. J Transl Med 2017; 15: 36.
  • Barut K, Sahin S, Kasapcopur O. Pediatric vasculitis. Curr Opin Rheumatol 2016; 28: 29-38.
  • Özdemir ZC, Çetin N, Kar YD, Öcal HO, Bilgin M, Bör Ö. Hemotologic indices for predicting internal organ involvement in Henoch-Schönlein purpura (IgA vasculitis). J Pediatr Hematol Oncol 2020; 42: 46-49.
  • Jagroop IA, Clatworthy I, Lewin J, Mikhailidis DP. Shape change in human platelets: measurement with a channelyzer and visualisation by electron microscopy. Platelets 2000; 11: 28-32.
  • Edström Halling S, Söderberg MP, Berg UB. Predictors of outcome in Henoch-Schönlein nephritis. Pediatr Nephrol 2010; 25: 1101-8.
  • Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest 2020; 50: 13230.
  • Fois AG, Paliogiannis P, Scano V, et al. The systemic ınflammation ındex on admission predicts ın-hospital mortality in COVID-19 patients. Molecules 2020; 25: 5725. doi: 10.3390/molecules25235725.
  • Güneylioğlu MM, Güngör A, Göktuğ A, et al. Evaluation of the efficiency of the systemic immune-inflammation index in differentiating parapneumonic effusion from empyema. Pediatr Pulmonol 2022; 57: 1625-30.
  • Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One 2013; 8: 59321.
  • Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol 2017; 23: 6261-72.
There are 51 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Vildan Güngörer 0000-0002-9838-2603

Işık Dişçi 0000-0002-8857-9875

Şükrü  Arslan 0000-0001-5632-8273

Publication Date March 27, 2023
Published in Issue Year 2023 Volume: 6 Issue: 2

Cite

AMA Güngörer V, Dişçi I, Arslan Ş. The effect of the pretreatment systemic immune-inflammatory index and C-reactive protein-to-albumin ratio on prognosis in pediatric patients with IgA vasculitis. J Health Sci Med / JHSM. March 2023;6(2):441-448. doi:10.32322/jhsm.1234037
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