Hemoconcentration and predictors in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS)

Abstract

Background Hemoconcentration has been identified as a risk factor for a complicated course in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS). This single-center study assesses hemoconcentration and predictors at presentation in STEC-HUS treated from 2009–2017. Methods Data of 107 pediatric patients with STEC-HUS were analyzed retrospectively. Patients with mild HUS (mHUS, definition: max. serum creatinine < 1.5 mg/dL and no major neurological symptoms) were compared to patients with severe HUS (sHUS, definition: max. serum creatinine ≥ 1.5 mg/dL ± major neurological symptoms). Additionally, predictors of complicated HUS (dialysis ± major neurological symptoms) were analyzed. Results Sixteen of one hundred seven (15%) patients had mHUS. Admission of patients with sHUS occurred median 2 days earlier after the onset of symptoms than in patients with mHUS. On admission, patients with subsequent sHUS had significantly higher median hemoglobin (9.5 g/dL (3.6–15.7) vs. 8.5 g/dL (4.2–11.5), p = 0.016) than patients with mHUS. The product of hemoglobin (g/dL) and LDH (U/L) (cutoff value 13,302, sensitivity 78.0%, specificity of 87.5%) was a predictor of severe vs. mild HUS. Creatinine (AUC 0.86, 95% CI 0.79–0.93) and the previously published score hemoglobin (g/dL) + 2 × creatinine (mg/dL) showed a good prediction for development of complicated HUS (AUC 0.87, 95% CI 0.80–0.93). Conclusions At presentation, patients with subsequent severe STEC-HUS had a higher degree of hemoconcentration. This underlines that fluid loss or reduced fluid intake/administration may be a risk factor for severe HUS. The good predictive value of the score hemoglobin (g/dL) + 2 × creatinine (mg/dL) for complicated HUS could be validated in our cohort. Graphical abstract

A decrease in the incidence of Shiga toxin‐related hemolytic uremic syndrome as a cause of kidney transplantation at an argentine referral center

“…Short‐term mortality in the acute phase of STEC HUS is 2%–3%, 15,16–24 while more than a third of patient develops chronic kidney disease (CKD) 5 and appearance or increase in proteinuria with or without arterial hypertension 25 …”

Acute Kidney Injury and Hemolytic Uremic Syndrome in Severe Pneumococcal Pneumonia—A Retrospective Analysis in Pediatric Intensive Care Unit

“…Hemoconcentration at presentation was recognized as a major predictor for the development of STEC-HUS, 30 and this reflects the severity of dehydration and gastroenteritis in patients with STEC infections. Nonetheless, this does not remain true for cases of pneumococcal HUS, which are primarily related to pulmonary infections and meningitis.…”

“…29 Since sodium and bicarbonate levels can be easily obtained from point-of-care testing (POCT), these test results may provide rapid and invaluable information in predicting the risks of AKI before formal blood tests are available. Hemoconcentration at presentation was recognized as a major predictor for the development of STEC-HUS, 30 and this reflects the severity of dehydration and gastroenteritis in patients with STEC infections. Nonetheless, this does not remain true for cases of pneumococcal HUS, which are primarily related to pulmonary infections and meningitis.…”

Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections

“…Half or more children with STEC-associated HUS require renal replacement therapy (usually temporary) [9]; the HUS case fatality rate is 1-3% [10][11][12]. Children under age 10 have the greatest incidence of acquiring high-risk STEC infections and of developing HUS if infected.…”