M Oualha1, S Pierrepont2, P Krug2, C Gitiaux3, P Hubert4, F Lesage4, R Salomon2. 1. Pediatric intensive care unit, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France. Electronic address: mehdi.oualha@aphp.fr. 2. Pediatric nephrology department, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France. 3. Pediatric neurology department, hôpital Necker-Enfants-Malades, Assistance publique-hôpitaux de Paris, faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France. 4. Pediatric intensive care unit, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, faculté de médecine, université Paris-Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France.
Abstract
AIM: Identifying early clinical and biological factors associated with severe forms of postdiarrheal hemolytic uremic syndrome (D+HUS) that may help practitioners determine appropriate treatment. METHODS: This retrospective study was conducted in 49 children with D+HUS between 2001 and 2011. Severe forms were defined as occurrence of one of the following conditions: death, major neurological involvement, cardiovascular involvement, and/or the presence of sequelae (neurological, cardiovascular, pancreatic, or renal). RESULTS: During the acute phase, 35 children exhibited at least one type of extrarenal involvement including 13 severe forms with a median delayed occurrence after admission of 4.5 days (range: 1-8) for comatose children and 5 days (range: 2-6) for cardiovascular involvement; 32 children required dialysis and three died. In multivariate analysis, (i) major neurological involvement (n=13), (ii) dialysis (n=32), and (iii) sequelae (n=12) were associated with (i) fever during the prodromal phase requiring dialysis at admission, (ii) C-reactive protein level (CRP) >22mg/L at admission, and (iii) major neurological involvement and a white blood cell count (WBC)>20×103/mm3 during the acute stage, respectively. CONCLUSIONS: D+HUS is a multiorgan disease with a delayed occurrence of life-threatening extrarenal organ involvement. Severe forms appear to be associated with early biological and clinical inflammatory parameters.
AIM: Identifying early clinical and biological factors associated with severe forms of postdiarrheal hemolytic uremic syndrome (D+HUS) that may help practitioners determine appropriate treatment. METHODS: This retrospective study was conducted in 49 children with D+HUS between 2001 and 2011. Severe forms were defined as occurrence of one of the following conditions: death, major neurological involvement, cardiovascular involvement, and/or the presence of sequelae (neurological, cardiovascular, pancreatic, or renal). RESULTS: During the acute phase, 35 children exhibited at least one type of extrarenal involvement including 13 severe forms with a median delayed occurrence after admission of 4.5 days (range: 1-8) for comatosechildren and 5 days (range: 2-6) for cardiovascular involvement; 32 children required dialysis and three died. In multivariate analysis, (i) major neurological involvement (n=13), (ii) dialysis (n=32), and (iii) sequelae (n=12) were associated with (i) fever during the prodromal phase requiring dialysis at admission, (ii) C-reactive protein level (CRP) >22mg/L at admission, and (iii) major neurological involvement and a white blood cell count (WBC)>20×103/mm3 during the acute stage, respectively. CONCLUSIONS: D+HUS is a multiorgan disease with a delayed occurrence of life-threatening extrarenal organ involvement. Severe forms appear to be associated with early biological and clinical inflammatory parameters.
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