Title

Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin-producing Escherichia coli-infected Children.

Authors

Ryan S McKee
David Schnadower
Phillip I Tarr
Jianling Xie
Yaron Finkelstein
Neil Desai
Roni D Lane
Kelly R Bergmann
Ron L Kaplan
Selena Hariharan
Andrea T Cruz
Daniel M Cohen
Andrew Dixon
Sriram Ramgopal
Annie Rominger
Elizabeth C Powell
Jennifer Kilgar, Department of Pediatrics and Division of Emergency Medicine, Children’s Hospital, Schulich School of Medicine and Dentistry, Western University , London, Ontario, CanadaFollow
Kenneth A Michelson
Darcy Beer
Martin Bitzan
Christopher M Pruitt
Kenneth Yen
Garth D Meckler
Amy C Plint
Stuart Bradin
Thomas J Abramo
Serge Gouin
April J Kam
Abigail Schuh
Fran Balamuth
Tracy E Hunley
John T Kanegaye
Nicholas E Jones
Usha Avva
Robert Porter
Daniel M Fein
Jeffrey P Louie
Stephen B Freedman

Document Type

Article

Publication Date

4-10-2020

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Volume

70

Issue

8

First Page

1643

Last Page

1651

URL with Digital Object Identifier

https://doi.org/10.1093/cid/ciz432

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 agedeligible.

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.

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