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

被引：20

作者：

McKee, Ryan S. ^{[1
]}

Schnadower, David ^{[2
]}

Tarr, Phillip, I ^{[3
]}

Xie, Jianling ^{[4
]}

Finkelstein, Yaron ^{[5
,6
]}

Desai, Neil ^{[7
]}

Lane, Roni D. ^{[8
]}

Bergmann, Kelly R. ^{[9
]}

Kaplan, Ron L. ^{[10
]}

Hariharan, Selena ^{[3
]}

Cruz, Andrea T. ^{[11
,12
]}

Cohen, Daniel M. ^{[13
,14
]}

Dixon, Andrew ^{[15
]}

Ramgopal, Sriram ^{[16
]}

Rominger, Annie ^{[17
]}

Powell, Elizabeth C. ^{[18
]}

Kilgar, Jennifer ^{[19
,20
]}

Michelson, Kenneth A. ^{[21
]}

Beer, Darcy ^{[7
]}

Bitzan, Martin ^{[22
]}

Pruitt, Christopher M. ^{[23
]}

Yen, Kenneth ^{[24
]}

Meckler, Garth D. ^{[25
,26
]}

Plint, Amy C. ^{[27
]}

Bradin, Stuart ^{[28
,29
]}

Abramo, Thomas J. ^{[30
]}

Gouin, Serge ^{[31
,32
]}

Kam, April J. ^{[33
]}

Schuh, Abigail ^{[34
]}

Balamuth, Fran ^{[35
]}

Hunley, Tracy E. ^{[36
]}

Kanegaye, John T. ^{[37
,38
]}

Jones, Nicholas E. ^{[39
]}

Avva, Usha ^{[40
]}

Porter, Robert ^{[41
]}

Fein, Daniel M. ^{[42
]}

Louie, Jeffrey P. ^{[43
]}

Freedman, Stephen B. ^{[44
,45
,46
]}

机构：

[1] Univ Oklahoma, Hlth Sci Ctr, Dept Pediat, Sect Pediat Emergency Med, Oklahoma City, OK 73190 USA

[2] Univ Cincinnati, Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Emergency Med,Sch Med, Cincinnati, OH 45221 USA

[3] Washington Univ, Sch Med, Dept Pediat, Div Gastroenterol Hepatol & Nutr, St Louis, MO 63110 USA

[4] Univ Calgary, Alberta Childrens Hosp, Cumming Sch Med, Dept Pediat,Sect Pediat Emergency Med, Calgary, AB, Canada

[5] Univ Toronto, Hosp Sick Children, Div Emergency Med, Toronto, ON, Canada

[6] Univ Toronto, Hosp Sick Children, Div Clin Pharmacol & Toxicol, Toronto, ON, Canada

[7] Univ Manitoba, Max Rady Coll Med, Dept Pediat, Div Pediat Emergency Med, Winnipeg, MB, Canada

[8] Univ Utah, Sch Med, Div Pediat Emergency Med, Salt Lake City, UT USA

[9] Childrens Minnesota, Dept Emergency Med, Minneapolis, MN USA

[10] Univ Washington, Seattle Childrens Hosp, Sch Med, Dept Pediat,Div Emergency Med, Seattle, WA 98195 USA

[11] Baylor Coll Med, Sect Pediat Emergency Med, Houston, TX 77030 USA

[12] Baylor Coll Med, Sect Pediat Infect Dis, Houston, TX 77030 USA

[13] Nationwide Childrens Hosp, Div Emergency Med, Columbus, OH USA

[14] Ohio State Univ, Columbus, OH 43210 USA

[15] Univ Alberta, Stollery Childrens Hosp, Women & Childrens Res Inst, Dept Pediat,Div Pediat Emergency Med, Edmonton, AB, Canada

[16] Univ Pittsburgh, Sch Med, Dept Pediat, Div Pediat Emergency Med,Childrens Hosp, Pittsburgh, PA 15260 USA

[17] Univ Louisville, Dept Pediat, Div Pediat Emergency Med, Louisville, KY 40292 USA

[18] Northwestern Univ, Ann & Robert H Lurie Childrens Hosp, Feinberg Sch Med, Div Emergency Med, Chicago, IL 60611 USA

[19] Western Univ, Childrens Hosp, Schulich Sch Med & Dent, Dept Pediat, London, ON, Canada

[20] Western Univ, Childrens Hosp, Schulich Sch Med & Dent, Div Emergency Med, London, ON, Canada

[21] Boston Childrens Hosp, Div Emergency Med, Boston, MA USA

[22] McGill Univ, Hlth Ctr, Dept Pediat, Div Nephrol, Montreal, PQ, Canada

[23] Univ Alabama Birmingham, Dept Pediat, Div Pediat Emergency Med, Birmingham, AL USA

[24] Univ Texas Southwestern, Dept Pediat, Div Pediat Emergency Med, Childrens Hlth, Dallas, TX USA

[25] Univ British Columbia, Dept Pediat, Div Pediat Emergency Med, Vancouver, BC, Canada

[26] Univ British Columbia, Dept Emergency Med, Div Pediat Emergency Med, Vancouver, BC, Canada

[27] Univ Ottawa, Dept Pediat, Div Pediat Emergency Med, Ottawa, ON, Canada

[28] Univ Michigan Hlth Syst, Dept Pediat, Ann Arbor, MI USA

[29] Univ Michigan Hlth Syst, Dept Emergency Med, Ann Arbor, MI USA

[30] Univ Arkansas, Arkansas Childrens Hosp, Sch Med, Dept Pediat & Emergency Med,Res Inst, Little Rock, AR 72204 USA

[31] Univ Montreal, Dept Pediat Emergency Med, Montreal, PQ, Canada

[32] Univ Montreal, Dept Pediat, Montreal, PQ, Canada

[33] McMaster Univ, McMaster Childrens Hosp, Dept Pediat, Div Pediat Emergency Med, Hamilton, ON, Canada

[34] Med Coll Wisconsin, Dept Pediat, Div Pediat Emergency Med, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA

[35] Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Philadelphia, PA 19104 USA

[36] Monroe Carell Jr Childrens Hosp Vanderbilt, Div Pediat Nephrol, Nashville, TN USA

[37] Univ Calif San Diego, Sch Med, Dept Pediat, La Jolla, CA 92093 USA

[38] Rady Childrens Hosp San Diego, San Diego, CA USA

[39] Emory Univ, Dept Pediat, Div Pediat Emergency Med, Childrens Healthcare Atlanta, Atlanta, GA 30322 USA

[40] Joseph M Sanzari Childrens Hosp, Div Pediat Emergency Med, Dept Pediat, Hackensack Meridian Sch Med Seton Hall, Hackensack, NJ USA

[41] Mem Univ Newfoundland, Fac Med, Discipline Pediat, St John, NF, Canada

[42] Albert Einstein Coll Med, Childrens Hosp Montefiore, Dept Pediat, Div Pediat Emergency Med, Bronx, NY 10467 USA

[43] Univ Minnesota, Masonic Childrens Hosp, Dept Pediat, Div Emergency Med, Minneapolis, MN 55455 USA

[44] Alberta Childrens Prov Gen Hosp, Dept Pediat, Sect Pediat Emergency Med, Calgary, AB, Canada

[45] Alberta Childrens Prov Gen Hosp, Dept Pediat, Sect Gastroenterol, Calgary, AB, Canada

[46] Univ Calgary, Alberta Childrens Hosp, Cumming Sch Med, Res Inst, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada

来源：

CLINICAL INFECTIOUS DISEASES | 2020年 / 70卷 / 08期

基金：

美国国家卫生研究院;

关键词：

Shiga-toxigenic Escherichia coli; hemolytic uremic syndrome; renal replacement therapy; emergency service; child; RISK-FACTORS; RELATIVE NEPHROPROTECTION; EMERGENCY-DEPARTMENT; O157-H7; INFECTIONS; FEBRILE INFANTS; DIARRHEA; INVOLVEMENT;

D O I：

10.1093/cid/ciz432

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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 x 10(3)/mu L (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 x 10(3)/mu L (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 x 10(3)/mu L (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.

引用

页码：1643 / 1651

页数：9

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