Risk Factor Analysis for Recurrence of Subacute Necrotizing Lymphadenitis in Children

Yali Wu,1,* Yini Wen,1,* Yuan Long,2,* Yujun Chen,3 Yan Ding1 1Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, People’s Republic of China; 2Department of Emergency, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, People’s Republic of China; 3Department of Pharmacy, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan Ding, Department of Rheumatology and Immunology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, People’s Republic of China, Email [email protected] Yujun Chen, Department of Pharmacy, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, People’s Republic of China, Email [email protected]: To analyze the clinical features of subacute necrotizing lymphadenitis (SNL) in children and to explore the risk factors for recurrence.Methods: A retrospective case–control method was used to analyze 91 children with SNL admitted to Wuhan Children’s Hospital from June 2016 to December 2024. A total of 91 children diagnosed with SNL were included, including 8 cases with recurrence and 83 without recurrence. Sixty-seven of the 91 children with SNL included underwent lymph node pathology, and 24 did not undergo lymph node biopsy. The 91 clinically diagnosed SNL patients were divided into a recurrence group and a non-recurrence group. The 67 SNL cases that underwent lymph node pathological examination were also divided into recurrence and non-recurrence groups. Baseline information, clinical manifestations, and laboratory data were compared between the two groups, and univariate analysis was performed on the difference indicators. Binary logistic regression analysis was then used to explore the risk factors for recurrent SNL.Results: Analyze of 91 SNL patients revealed significant differences in age at onset (p=0.032), fever duration (p=0.01), IL-4 (p=0.037), and complement C3 (p=0.01) levels between recurrent and non-recurrent groups. Multivariate analysis identified older age (OR=1.32, CI: 1.04– 1.69, p=0.025) and elevated complement C3 (OR=41.96, CI: 1.68– 1049.04, p=0.023) as independent recurrence risk factors. In a distinct cohort of 67 children with pathologically confirmed SNL, significant differences emerged between recurrent and non-recurrent cases for age (p=0.023), fever duration (p=0.027), IL-4 (p=0.012), complement C3 (p=0.023), and serum creatinine (p=0.043). Here, multivariate analysis demonstrated that elevated complement C3 (OR=45.23, CI: 1.46– 1402.72, p=0.030) at diagnosis was an independent risk factor for recurrence.Conclusion: Older age of onset and elevated complement C3 may be risk factors for recurrence of SNL, with particular attention to elevated complement C3, and clinical follow-up is needed for this group of children.Keywords: subacute necrotizing lymphadenitis, recurrence, risk factor