Poster Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Predictors of Clinical Outcomes in Acute Rheumatic Fever in the Contemporary Era: The Role of Erythrocyte Sedimentation Rate (#20)

Renata Mendoza 1 2 3 , Leticia Leao de Oliveira 3 , Jose Luiz Padilha da Silva 4 , Bernando Mendoza 3 , Paulo Henrique M. Melo 5 , Jose Augusto Almeida Barbosa 1 , Géssica Silva Santana 3 , Airandes de Sousa Pinto 3 , Andrea Beaton 6 , Maria do Carmo Pereira Nunes 1 5
  1. Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Minas Gerais Federal University, Belo Horizonte, MG, Brazil
  2. Feira de Santana State University, Feira de Santana, Bahia, Brazil
  3. State Children’s Hospital, Feira de Santana, Feira De Santana, Brazil
  4. Department of Statistics, Parana Federal University, Curitiba, Parana, Brazil
  5. Clinical Hospital, School of Medicine, Minas Gerais Federal University, Belo Horizonte, MG, Brazil
  6. Department of Pediatrics, University of Cincinnati, School of Medicine, Cincinnati, OH, United States

Background:

The prognosis of acute rheumatic fever (ARF) is closely tied to the severity of valvular regurgitation. Identifying high-risk children is crucial for optimizing treatment and surgical decisions. This study evaluates clinical outcomes in children with ARF in a high-endemic region of Brazil.

Methods:
A retrospective analysis was conducted on 151 children treated for ARF at a pediatric hospital in Feira de Santana, Bahia, Brazil, between August 2010 and October 2023. The primary outcome was a composite measure of cardiac surgery or death.

Results:
The median age was 9 years (IQR: 7–12), with 46% being female. Carditis, primarily mitral valve involvement, was the most common manifestation (76%), followed by arthritis (52%), chorea (33%), and fever (56%). Over a median follow-up of 17.5 months (IQR: 5.0–51.5), 18 patients underwent cardiac surgery, and 2 died (13% adverse outcome rate). Multivariate analysis identified the absence of fever (OR 0.28, 95% CI: 0.10–0.78, P = 0.012), elevated erythrocyte sedimentation rate (ESR) (OR 1.02, 95% CI: 1.02–1.04, P = 0.006), and low hematocrit (OR 0.91, 95% CI: 0.83–0.99, P = 0.021) as predictors of adverse outcomes (C-statistic: 0.822). Adding ESR improved the model’s predictive performance (NRI: 0.79, P = 0.005; IDI: 0.11, P = 0.032).

Conclusions:
In ARF, the absence of fever, elevated ESR, and low hematocrit were linked to adverse outcomes. ESR, a simple and cost-effective marker, may enhance risk stratification in resource-limited settings.