Predicting Adverse Outcomes for Shiga Toxin–Producing Escherichia coli Infections in Emergency Departments

Lin, Chu Yang; Xie, Jianling; Freedman, Stephen B.; McKee, Ryan S; Schnadower, David; Tarr, Phillip I.; Finkelstein, Yaron; Desai, Neil; Lane, Roni D.; Bergmann, Kelly R.; Kaplan, Ron L.; Hariharan, Selena; Cruz, Andrea T.; Cohen, Daniel M.; Dixon, Andrew; Ramgopal, Sriram; Powell, Elizabeth C.; Kilgar, Jennifer; Michelson, Kenneth A.; Bitzan, Martin; Yen, Kenneth; Meckler, Garth; Plint, Amy C.; Balamuth, Fran; Bradin, Stuart; Gouin, Serge; Kam, April J.; Meltzer, James A.; Hunley, Tracy E.; Avva, Usha; Porter, Robert; Fein, Daniel M.; Louie, Jeffrey P.; Tarr, Gillian A.M.; Rominger, Annie; Beer, Darcy; Pruitt, Christopher M.; Abramo, Thomas J.; Schuh, A.; Kanegaye, John T.; Jones, Nicholas E.

doi:10.1016/j.jpeds.2020.12.077

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…We found a good prediction with an AUC of 0.87. This was even better than in the recent study published by Lin et al in 155 patients, in which they calculated a AUC of 0.71 using similar end-points to our study [21].…”

Section: Discussioncontrasting

confidence: 54%

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

Loos

Loo

et al. 2021

Pediatr Nephrol

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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

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Section: Discussioncontrasting

confidence: 54%

“…The score was moderately predictive for a complicated course of HUS (AUC 0.75, 95% CI 0.67-0.85), defined by the outcome death or CKD stage 2-5 [18]. Recently, Lin et al validated the score for the end-points dialysis, neurologic complications, respiratory failure, and death (AUC 0.77, 95% CI 0.68-0.87) [21].…”

Section: Introductionmentioning

confidence: 99%