TY - JOUR
T1 - Predicting hemolytic uremic syndrome and renal replacement therapy in Shiga toxin-producing Escherichia coli-infected children
AU - Pediatric Emergency Medicine Collaborative Research Committee and Pediatric Emergency Research Canada
AU - McKee, Ryan S.
AU - Schnadower, David
AU - Tarr, Phillip I.
AU - Xie, Jianling
AU - Finkelstein, Yaron
AU - Desai, Neil
AU - Lane, Roni D.
AU - Bergmann, Kelly R
AU - Kaplan, Ron L.
AU - Hariharan, Selena
AU - Cruz, Andrea T.
AU - Cohen, Daniel M.
AU - Dixon, Andrew
AU - Ramgopal, Sriram
AU - Rominger, Annie
AU - Powell, Elizabeth C.
AU - Kilgar, Jennifer
AU - Michelson, Kenneth A.
AU - Beer, Darcy
AU - Bitzan, Martin
AU - Pruitt, Christopher M.
AU - Yen, Kenneth
AU - Meckler, Garth D.
AU - Plint, Amy C.
AU - Bradin, Stuart
AU - Abramo, Thomas J.
AU - Gouin, Serge
AU - Kam, April J.
AU - Schuh, Abigail
AU - Balamuth, Fran
AU - Hunley, Tracy E.
AU - Kanegaye, John T.
AU - Jones, Nicholas E.
AU - Avva, Usha
AU - Porter, Robert
AU - Fein, Daniel M.
AU - Louie, Jeffrey P.
AU - Freedman, Stephen B.
N1 - Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
PY - 2020/4/15
Y1 - 2020/4/15
N2 - 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 aged <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 (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 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 (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 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.
AB - 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 aged <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 (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 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 (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 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.
KW - Child
KW - Emergency service
KW - Hemolytic uremic syndrome
KW - Renal replacement therapy
KW - Shiga-toxigenic Escherichia coli
KW - Diarrhea/epidemiology
KW - Humans
KW - Renal Replacement Therapy
KW - Hemolytic-Uremic Syndrome/epidemiology
KW - Escherichia coli Infections/epidemiology
KW - Adolescent
KW - Shiga-Toxigenic Escherichia coli
KW - Female
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85083182259&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083182259&partnerID=8YFLogxK
U2 - 10.1093/cid/ciz432
DO - 10.1093/cid/ciz432
M3 - Article
C2 - 31125419
AN - SCOPUS:85083182259
SN - 1058-4838
VL - 70
SP - 1643
EP - 1651
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -
