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Clin Infect Dis. 2019 May 24. pii: ciz432. doi: 10.1093/cid/ciz432. [Epub ahead of print]

Predicting Hemolytic Uremic Syndrome and Renal Failure in Shiga Toxin-Producing Escherichia coli Infected Children.

Author information

1
Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
2
Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
3
Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
4
Section of Pediatric Emergency Medicine, Department of Pediatric, Alberta Children Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
5
Divisions of Emergency Medicine and Clinical Pharmacology & Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario.
6
Division of Pediatric Emergency Medicine, Department of Pediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba.
7
Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT.
8
Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN.
9
Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA.
10
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati OH.
11
Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, TX.
12
Division of Emergency Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
13
Division of Pediatric Emergency Medicine, Department of Pediatrics, Stollery Children's Hospital, Women and Children's Research Institute, University of Alberta, Edmonton, Alberta.
14
Division of Pediatric Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.
15
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY.
16
Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
17
Department or Pediatrics & Division of Emergency Medicine, Children's Hospital, Schulich School of Medicine and Dentistry, Western University, London, Ontario.
18
Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
19
Previous: Division of Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec; New: Kidney Centre of Excellence, Al Jalila Children's Hospital, Dubai, U.A.E.
20
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
21
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Southwestern, Children's Health, Dallas, TX.
22
Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, British Columbia.
23
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario.
24
Departments of Pediatrics and Emergency Medicine, The University of Michigan Health System, Ann Arbor, MI.
25
Departments of Pediatrics and Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital Research Institute, Little Rock, AR.
26
Departments of Pediatric Emergency Medicine and Pediatrics, Université de Montréal, Montreal, Quebec.
27
Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario.
28
Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
29
University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
30
Division of Pediatric Nephrology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
31
University of California San Diego School of Medicine, Department of Pediatrics, La Jolla, California; Rady Children's Hospital San Diego, San Diego, CA.
32
Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
33
Hackensack Meridian School of Medicine at Seton Hall, Division of Pediatric Emergency Medicine, Department of Pediatrics, Joseph M Sanzari Children's Hospital, Hackensack, NJ.
34
Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador.
35
Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
36
University of Minnesota, Masonic Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, Minneapolis, MN.
37
Section of Pediatric Emergency Medicine, Department of Pediatric, Alberta Children Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta.

Abstract

BACKGROUND:

Shiga toxin-producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care.

METHODS:

We conducted a multicenter, historical-cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible.

RESULTS:

Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors of HUS included younger age (OR: 0.77; 95%CI: 0.69, 0.85/year), leukocyte count ≥13.0x103/μL (2.54; 1.42, 4.54), higher hematocrit (1.83; 1.21, 2.77/5% increase) and serum creatinine (10.82; 1.49, 78.69/1 mg/dL increase), platelet count <250 ×103/μL (1.92; 1.02, 3.60), lower serum sodium (1.12; 1.02, 1.23/1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50; 1.14, 5.46). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (0.70; 0.54, 0.90). RRT predictors included female sex (2.27; 1.14, 4.50), younger age (0.83; 0.74, 0.92/year), lower serum sodium (1.15; 1.04, 1.27/mmol/L decrease), higher leukocyte count ≥13.0x103/μL (2.35; 1.17, 4.72) and creatinine (7.75; 1.20, 50.16/1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71; 1.18, 6.21).

CONCLUSIONS:

The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.

KEYWORDS:

Child; Emergency Service; Hemolytic-Uremic Syndrome; Hospital; Renal Replacement Therapy; Shiga-Toxigenic Escherichia coli

PMID:
31125419
DOI:
10.1093/cid/ciz432

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