Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. Using data from the Global Enteric Multicenter Study of children 0–23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model. Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50–90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was − 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12–23 months old, those 0–6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6–12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%). Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.

中文翻译：

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全球肠内多中心研究显示，中度至重度腹泻儿童的线性生长步履蹒跚

生命的头2年中度至重度腹泻（MSD）可能会损害线型生长。我们试图确定线性增长步履蹒跚的危险因素，并建立一种临床预测工具来识别最有可能在MSD发作后经历生长步履蹒跚的儿童。使用来自非洲和亚洲0-23个月患有MSD的儿童的全球肠内多中心研究的数据，我们进行了对数二项回归分析，以确定与严重的线性增长步履蹒跚有关的临床和社会人口统计学因素（长度≥0.5的损失≥年龄z分数[LAZ]）。使用线性回归来估计与ΔLAZ的关联。使用后向消除潜在变量和Akaike信息准则开发了一种临床预测工具，以选择最佳拟合模型。在5902名儿童中，平均年龄为10个月，女性为43.2％。在50-90天的随访期内，24.2％的儿童出现严重的线性增长动摇，且随访期间的平均ΔLAZ为− 0.17（标准差[SD] 0.54）。调整年龄，基线LAZ和部位后，一些因素与LAZ下降有关：年轻，急性营养不良，就诊时住院，非痢疾性腹泻，卫生条件未得到改善，财富减少，发烧，合并症或IMCI危险标志。与12至23个月大的儿童相比，0至6个月的儿童更有可能经历严重的线性增长动摇（患病率[aPR] 1.97 [95％CI 1.70，2.28]），以及6至12个月的儿童（aPR 1.72 [95％CI 1.51，1.95]）。预测模型包括年龄，消瘦，发育迟缓，发烧，并且带有IMCI危险信号的提示的ROC（AUC）下的面积为0.67（95％CI 0.64，0.69）。风险评分范围从0到37，最高为21（最大灵敏度）（60.7％）和特异性（63.5％）。年龄较小，急性营养不良，MSD严重程度和社会人口统计学因素与MSD后短期线性增长恶化有关。MSD常规获取的数据可能有助于预测可能受益于干预措施而处于生长恶化风险的儿童。