Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome

被引:74
作者
Ardissino, Gianluigi [1 ]
Tel, Francesca [1 ]
Possenti, Ilaria [1 ]
Testa, Sara [1 ]
Consonni, Dario [2 ]
Paglialonga, Fabio [1 ]
Salardi, Stefania [3 ]
Borsa-Ghiringhelli, Nicolo [3 ]
Salice, Patrizia [4 ]
Tedeschi, Silvana [3 ]
Castorina, Pierangela [1 ]
Colombo, Rosaria Maria [5 ]
Arghittu, Milena [5 ]
Daprai, Laura [5 ]
Monzani, Alice [6 ]
Tozzoli, Rosangela [7 ]
Brigotti, Maurizio [8 ]
Torresani, Erminio [5 ]
机构
[1] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Ctr HUS Control Prevent & Management, V Commenda 9, I-20122 Milan, Italy
[2] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Epidemiol Unit, Milan, Italy
[3] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Lab Med Genet, Milan, Italy
[4] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Pediat Cardiol Unit, Milan, Italy
[5] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Microbiol Unit, Milan, Italy
[6] Univ Piemonte Orientale, Dept Hlth Sci, Div Pediat, Novara, Italy
[7] Ist Super Sanita, Viale Regina Elena 299, I-00161 Rome, Italy
[8] Univ Bologna, Bologna, Italy
关键词
ESCHERICHIA-COLI O157-H7; ANTIBIOTIC-TREATMENT; CHILDREN; RISK; ECULIZUMAB; INVOLVEMENT; PREDICTORS; OUTBREAK;
D O I
10.1542/peds.2015-2153
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BACKGROUND: Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia abstract coli (STEC-HUS) is a severe acute illness without specific treatment except supportive care; fluid management is concentrated on preventing fluid overload for patients, who are often oligoanuric. Hemoconcentration at onset is associated with more severe disease, but the benefits of volume expansion after hemolytic uremic syndrome (HUS) onset have not been explored. METHODS: All the children with STEC-HUS referred to our center between 2012 and 2014 received intravenous infusion targeted at inducing an early volume expansion (+10% of working weight) to restore circulating volume and reduce ischemic or hypoxic tissue damage. The short-and long-term outcomes of these patients were compared with those of 38 historical patients referred to our center during the years immediately before, when fluid intake was routinely restricted. RESULTS: Patients undergoing fluid infusion soon after diagnosis showed a mean increase in body weight of 12.5% (vs 0%), had significantly better short-term outcomes with a lower rate of central nervous system involvement (7.9% vs 23.7%, P = .06), had less need for renal replacement therapy (26.3% vs 57.9%, P = .01) or intensive care support (2.0 vs. 8.5 days, P = .02), and needed fewer days of hospitalization (9.0 vs 12.0 days, P = .03). Long-term outcomes were also significantly better in terms of renal and extrarenal sequelae (13.2% vs 39.5%, P = .01). CONCLUSIONS: Patients with STEC-HUS had great benefit from early volume expansion. It is speculated that early and generous fluid infusions can reduce thrombus formation and ischemic organ damage, thus having positive effects on both short-and long-term disease outcomes.
引用
收藏
页数:9
相关论文
共 32 条
[1]   Relative nephroprotection during Escherichia coli O157:H7 infections:: Association with intravenous volume expansion [J].
Ake, JA ;
Jelacic, S ;
Ciol, MA ;
Watkins, SL ;
Murray, KF ;
Christie, DL ;
Klein, EJ ;
Tarr, PI .
PEDIATRICS, 2005, 115 (06) :E673-E680
[2]   Hemoconcentration: a major risk factor for neurological involvement in hemolytic uremic syndrome [J].
Ardissino, Gianluigi ;
Dacco, Valeria ;
Testa, Sara ;
Civitillo, Cristina Felice ;
Tel, Francesca ;
Possenti, Ilaria ;
Belingheri, Mirco ;
Castorina, Pierangela ;
Bolsa-Ghiringhelli, Nicolo ;
Tedeschi, Silvana ;
Paglialonga, Fabio ;
Salardi, Stefania ;
Consonni, Dario ;
Zoia, Elena ;
Salice, Patrizia ;
Chidini, Giovanna .
PEDIATRIC NEPHROLOGY, 2015, 30 (02) :345-352
[3]   Co-infection in Children With Bloody Diarrhea Caused by Shiga Toxin-Producing Escherichio coli: Data of the North Italian HUS Network [J].
Ardissino, Gianluigi ;
Possenti, Ilaria ;
Salardi, Stefania ;
Tel, Francesca ;
Colombo, Elisa ;
Testa, Sara ;
Daprai, Laura ;
Picicco, Damiano ;
Colombo, Rosaria Maria ;
Torresani, Erminio .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2014, 59 (02) :218-220
[4]   Skin Involvement in Atypical Hemolytic Uremic Syndrome [J].
Ardissino, Gianluigi ;
Tel, Francesca ;
Testa, Sara ;
Marzano, Angelo Valerio ;
Lazzari, Riccardo ;
Salardi, Stefania ;
Edefonti, Alberto .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2014, 63 (04) :652-655
[5]   Time to change the definition of hemolytic uremic syndrome [J].
Ardissino, Gianluigi ;
Possenti, Ilaria ;
Tel, Francesca ;
Testa, Sara ;
Paglialonga, Fabio .
EUROPEAN JOURNAL OF INTERNAL MEDICINE, 2014, 25 (02) :E29-E29
[6]   CNS-MANIFESTATIONS OF THE HEMOLYTIC-UREMIC SYNDROME - RELATIONSHIP TO METABOLIC ALTERATIONS AND PROGNOSIS [J].
BALE, JF ;
BRASHER, C ;
SIEGLER, RL .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1980, 134 (09) :869-872
[7]   Dehydration at admission increased the need for dialysis in hemolytic uremic syndrome children [J].
Balestracci, Alejandro ;
Mariel Martin, Sandra ;
Toledo, Ismael ;
Alvarado, Caupolican ;
Eva Wainsztein, Raquel .
PEDIATRIC NEPHROLOGY, 2012, 27 (08) :1407-1410
[8]   Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections [J].
Bell, BP ;
Griffin, PM ;
Lozano, P ;
Christie, DL ;
Kobayashi, JM ;
Tarr, PI .
PEDIATRICS, 1997, 100 (01) :art. no.-e12
[9]   Clinical Relevance of Shiga Toxin Concentrations in the Blood of Patients With Hemolytic Uremic Syndrome [J].
Brigotti, Maurizio ;
Tazzari, Pier Luigi ;
Ravanelli, Elisa ;
Carnicelli, Domenica ;
Rocchi, Laura ;
Arfilli, Valentina ;
Scavia, Gaia ;
Minelli, Fabio ;
Ricci, Francesca ;
Pagliaro, Pasqualepaolo ;
Ferretti, Alfonso V. S. ;
Pecoraro, Carmine ;
Paglialonga, Fabio ;
Edefonti, Alberto ;
Procaccino, Maria Antonietta ;
Tozzi, Alberto E. ;
Caprioli, Alfredo .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2011, 30 (06) :486-490
[10]   Prothrombotic coagulation abnormalities preceding the hemolytic-uremic syndrome [J].
Chandler, WL ;
Jelacic, S ;
Boster, DR ;
Ciol, MA ;
Williams, GD ;
Watkins, SL ;
Igarashi, T ;
Tarr, PI .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (01) :23-32