A simple prognostic index for Shigatoxin-related hemolytic uremic syndrome at onset: data from the ItalKid-HUS network
| Autor: | Rosaria Colombo, Laura Martelli, Francesca Tel, Dario Consonni, Selena Longhi, Giovanna Chidini, Laura Daprai, Damiano Picicco, Stefano Scalia Catenacci, Sara Testa, Milena Arghittu, Fabio Paglialonga, Isabella Cropanese, Silvia Consolo, Gianluigi Ardissino, Michela Perrone, Antonella Dodaro |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Thrombotic microangiopathy Scoring system Anemia 030232 urology & nephrology Severity of Illness Index Gastroenterology Shiga Toxin Hemoglobins 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine 030225 pediatrics Internal medicine medicine Humans Child Escherichia coli Infections Creatinine Shiga-Toxigenic Escherichia coli Receiver operating characteristic business.industry Infant Prognosis medicine.disease Hemoconcentration Organ damage ROC Curve chemistry Area Under Curve Child Preschool Hemolytic-Uremic Syndrome Pediatrics Perinatology and Child Health Female Hemoglobin business |
| Zdroj: | European Journal of Pediatrics. 177:1667-1674 |
| ISSN: | 1432-1076 0340-6199 |
| Popis: | Shigatoxin Escherichia coli-related hemolytic uremic syndrome (eHUS) is a severe thrombotic microangiopathy (TMA) burdened by life-threatening complications and long-term sequelae. Since hemoconcentration is associated with worse outcome, we tried to develop a reliable and easy-to-calculate index for predicting complications and sequelae based on hemoglobin (Hb) at presentation. The first laboratory examinations with signs of TMA in eHUS patients were analyzed in relation to the outcomes with the receiver operating characteristic curves and their areas under the curve (AUC) for Hb and creatinine (sCr). A total of 197 eHUS patients were identified of whom 24% did not have anemia at presentation. Hb level was the best predictor of a poor outcome (AUC 0.67) but the combination of Hb with sCr, in the formula [(Hb in g/dL + (sCr in mg/dL × 2)], showed an even better AUC of 0.75. The described scoring system was also strongly associated and predictive of all complications and health care needs (8% of patients with scoring 13 died or entered a permanent vegetative state compared with 0% of those with ≤ 13).Conclusion: The presented score is a simple and early predictor of both short- and long-term outcomes and identifies patients who should undergo rapid volume expansion to counteract hemoconcentration, the spreading of microvascular thrombosis, and the consequent increased organ damage. What is Known: • In eHUS, hemoconcentration is associated with worse short- and long-term outcome. • A prognostic index to identify patients at higher risk for complications at presentation is not available. What is New: • We developed a simple and early prognostic index for eHUS outcome with the combination of Hb and sCr at onset, in the following formula [(Hb in g/dL + (sCr in mg/dL × 2)]. • The proposed HUS Severity Score can promptly identify patients with good outcome and those with high risk of worse short- and long-term outcome. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|