Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin-producing Escherichia coli-infected Children.
Shiga-toxigenic Escherichia coli
child
emergency service
hemolytic uremic syndrome
renal replacement therapy
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
10 04 2020
10 04 2020
Historique:
received:
01
04
2019
accepted:
23
05
2019
pubmed:
28
5
2019
medline:
7
1
2021
entrez:
25
5
2019
Statut:
ppublish
Résumé
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. 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. 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]). 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.
Sections du résumé
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.
Identifiants
pubmed: 31125419
pii: 5498369
doi: 10.1093/cid/ciz432
pmc: PMC7931832
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1643-1651Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK052574
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Gastroenterol Clin North Am. 2018 Dec;47(4):793-812
pubmed: 30337033
PLoS One. 2013 Nov 14;8(11):e78180
pubmed: 24244292
J Pediatr. 2017 Jan;180:184-190.e1
pubmed: 27745751
J Infect Dis. 2002 Jan 15;185(2):214-9
pubmed: 11807695
Pediatr Emerg Care. 2018 Feb;34(2):138-144
pubmed: 29189589
J Pediatr. 2015 Apr;166(4):1022-9
pubmed: 25661408
Clin Exp Nephrol. 2017 Oct;21(5):889-894
pubmed: 28074307
Clin Infect Dis. 2006 Oct 1;43(7):807-13
pubmed: 16941358
Emerg Infect Dis. 2005 Dec;11(12):1955-7
pubmed: 16485489
J Infect Dis. 2002 Jul 1;186(1):57-63
pubmed: 12089662
J Pediatr. 2002 Aug;141(2):172-7
pubmed: 12183710
Clin Infect Dis. 2012 Jul;55(1):33-41
pubmed: 22431799
Arch Pediatr. 2018 Feb;25(2):118-125
pubmed: 29395881
Clin Infect Dis. 2004 May 1;38(9):1298-303
pubmed: 15127344
JAMA. 2003 Sep 10;290(10):1360-70
pubmed: 12966129
Int J Med Microbiol. 2018 Dec;308(8):1121-1127
pubmed: 30466555
Pediatr Int. 2009 Apr;51(2):216-9
pubmed: 19405919
Pediatr Nephrol. 2018 Oct;33(10):1791-1798
pubmed: 29961127
Eur J Intern Med. 2014 Feb;25(2):e29
pubmed: 24360866
Pediatr Nephrol. 2008 Aug;23(8):1303-8
pubmed: 18465151
Pediatrics. 2016 Jan;137(1):
pubmed: 26644486
Clin Infect Dis. 2009 Nov 15;49(10):1480-5
pubmed: 19827953
Arch Pediatr Adolesc Med. 2011 Oct;165(10):884-9
pubmed: 21784993
Dis Markers. 2015;2015:635670
pubmed: 26819490
Pediatr Nephrol. 2015 Feb;30(2):345-52
pubmed: 25149851
Behav Brain Res. 2001 Nov 1;125(1-2):279-84
pubmed: 11682119
Lancet. 2005 Mar 19-25;365(9464):1073-86
pubmed: 15781103
J Pediatr. 1998 May;132(5):777-82
pubmed: 9602185
BMJ. 2009 Jun 29;338:b2393
pubmed: 19564179
Pediatrics. 2005 Jun;115(6):e673-80
pubmed: 15930195
Clin Infect Dis. 2001 Oct 1;33(7):923-31
pubmed: 11528561
Biomed Res Int. 2015;2015:480680
pubmed: 26539499
J Pediatr Gastroenterol Nutr. 2014 Sep;59(3):327-33
pubmed: 24796805
Pediatrics. 2010 Dec;126(6):1074-83
pubmed: 21098155
Pediatr Infect Dis J. 2012 Jan;31(1):20-4
pubmed: 21829137
Clin Infect Dis. 2016 May 15;62(10):1251-1258
pubmed: 26917812
Kidney Int. 2007 May;71(10):1028-35
pubmed: 17396113
Pediatr Emerg Care. 2014 Sep;30(9):591-7
pubmed: 25162689
JAMA Pediatr. 2017 Jan 1;171(1):68-76
pubmed: 27893870