Objective: To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. Study design: We reviewed medical records of children <18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores >13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. Results: A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children <5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children <5 years, greatest net benefit was achieved for a threshold probability >26%. Conclusions: The HUS severity score was able to discriminate between high- and low-risk children <5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.
Bibliographical noteFunding Information:
Supported by the Cumming School of Medicine-Alberta Health Services Clinical Research Fund. S.F. is supported by the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness. P.T. is supported by the Administrative and Resource Access Core of the Washington University Digestive Diseases Research Core Center (National Institutes of health [NIH] grant number P30DK052574). K.M. was funded by award 1K08 HS026503 from the Agency for Healthcare Research and Quality. A.P. is supported by the University of Ottawa Research in Pediatric Emergency Medicine. G.T. was supported by a Canadian Institutes of Health Research Banting Postdoctoral Fellowship, Alberta Innovates Health Programs Postgraduate Fellowship, and University of Calgary Eyes High Postdoctoral Fellowship. The funder/sponsor did not participate in the work. S.F. receives in-kind research support from BioMerieux and Luminex Corporation and is a consultant to Eligo Bioscience. P.T. is an unpaid member of the Data Safety Monitoring Board of Inmunova, consultant to Takeda Pharmaceuticals on childhood digestive disorders, and a consultant to, member of the Scientific Advisory Board of, and holder of equity in MediBeacon Inc for work that is unrelated to this study. He is also an inventor of a patent for which he might receive royalties for technology that is also unrelated to this study. E.P. has received grants from the Health Resources and Services Administration Washington, Boston, Chicago Network, the NIH–Emergency Department Probiotics, and the NIH-RNA Biosignatures. The other authors declare no conflicts of interest.
© 2021 Elsevier Inc.
- hemolytic uremic syndrome
- prognostic index