Factors associated with sclerema in infants with diarrhoeal disease: a matched case-control study

Aim: To identify clinical and biochemical factors associated with sclerema in infants with diarrhoeal illness, and their outcome.
Methods: In this case-control study, we enrolled 30 infants with clinical sepsis with sclerema (cases) and another 60, age- and sex-matched infants with clinical sepsis but without sclerema (controls) from among those admitted to the special care unit (SCU) and longer stay unit (LSU) of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) for their diarrhoeal illness from May 2005 through April 2006. Sclerema as the dependant variable while hypoxia, hypothermia, C-reactive protein (CRP) level, serum total protein and prealbumin level were the major independent variables compared in the analysis. Differences in proportions were compared by the chi-square test and differences of mean were compared by Student's t -test or Mann–Whitney test, as appropriate.
Results: The case-fatality was significantly higher among the cases than the controls (30% vs. 2%, CI 2.9–565.5). After adjusting for confounders, infants with sclerema were more likely to be hypothermic (OR 11.6, 95% CI 1.1–126.5), and have lower serum total protein (OR 1.12, 95% CI 1.04–1.21) and prealbumin (OR 1.5, 95% CI 1.1–2.3).
Conclusion: Diarrhoeal infants having clinical sepsis presenting with hypothermia, lower serum protein and prealbumin are prone to be associated with sclerema.