BACKGROUND: Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia 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.
BACKGROUND:Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia 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.
Authors: Tracy Lackraj; Kathene Johnson-Henry; Philip M Sherman; Steve D Goodman; Anca M Segall; Debora Barnett Foster Journal: Microbiology Date: 2016-07-13 Impact factor: 2.777
Authors: Ryan S McKee; David Schnadower; Phillip I Tarr; Jianling Xie; Yaron Finkelstein; Neil Desai; Roni D Lane; Kelly R Bergmann; Ron L Kaplan; Selena Hariharan; Andrea T Cruz; Daniel M Cohen; Andrew Dixon; Sriram Ramgopal; Annie Rominger; Elizabeth C Powell; Jennifer Kilgar; Kenneth A Michelson; Darcy Beer; Martin Bitzan; Christopher M Pruitt; Kenneth Yen; Garth D Meckler; Amy C Plint; Stuart Bradin; Thomas J Abramo; Serge Gouin; April J Kam; Abigail Schuh; Fran Balamuth; Tracy E Hunley; John T Kanegaye; Nicholas E Jones; Usha Avva; Robert Porter; Daniel M Fein; Jeffrey P Louie; Stephen B Freedman Journal: Clin Infect Dis Date: 2020-04-10 Impact factor: 9.079
Authors: Chu Yang Lin; Jianling Xie; Stephen B Freedman; Ryan S McKee; David Schnadower; Phillip I Tarr; Yaron Finkelstein; Neil M Desai; Roni D Lane; Kelly R Bergmann; Ron L Kaplan; Selena Hariharan; Andrea T Cruz; Daniel M Cohen; Andrew Dixon; Sriram Ramgopal; Elizabeth C Powell; Jennifer Kilgar; Kenneth A Michelson; Martin Bitzan; Kenneth Yen; Garth D Meckler; Amy C Plint; Fran Balamuth; Stuart Bradin; Serge Gouin; April J Kam; James A Meltzer; Tracy E Hunley; Usha Avva; Robert Porter; Daniel M Fein; Jeffrey P Louie; Gillian A M Tarr Journal: J Pediatr Date: 2021-01-05 Impact factor: 4.406