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- Title
Duration of prodromal phase and severity of hemolytic uremic syndrome.
- Authors
Balestracci, Alejandro; Meni Battaglia, Luciana; Toledo, Ismael; Martin, Sandra Mariel; Beaudoin, Laura
- Abstract
Background: Some data have recognized an association between shorter prodromal phase and severe episode of Shiga toxin-producing Escherichia coli-related hemolytic uremic syndrome (STEC-HUS). Our aims were to confirm such association and analyze characteristics of STEC-HUS patients according to duration of the prodromal phase. Methods: Patients treated from 2000 to 2022 were compared according to the presence of severe (> 10 days of dialysis and/or extra-renal complications) or non-severe disease. Association between prodromal phase duration and disease severity was assessed by ROC curve and by classifying the cohort in 3 groups according to time to diagnosis. Results: Non-severe (n = 145) and severe (n = 71) cases were compared. The latter had shorter prodromal phase, higher leukocyte count, hemoglobin, lactic dehydrogenase, liver enzymes, C-reactive protein, urea and creatinine, and lower albumin and sodium; only prodromal phase duration (p = 0.02) and leukocyte count (p = 0.02) remained significant in multivariate analysis. By ROC curve analysis, time to diagnosis resulted in a poor predictor of outcomes (AUC = 0.27). Since prodromal phase duration was 5 days (IQR 3–7), we divided the cohort into Groups A (1–2 days), B (3–7 days), and C (≥ 8 days). Rates of severe disease were 75.8%, 29.6%, and 11.4%, respectively. Taking Group B as reference, Group A patients had higher risk of complications (p = 0.00001; OR 7.4, 95% CI: 2.98–18.7) while Group C ones had significantly less risk (p = 0.02; OR 0.3, 95% CI: 0.1–0.91). Conclusions: This study found that duration of prodromal phase is an independent predictor of complicated STEC-HUS and confirms that shorter prodromal phase is associated with worse prognosis.
- Subjects
ESCHERICHIA coli; C-reactive protein; STATISTICS; ALBUMINS; HEMOGLOBINS; CONFIDENCE intervals; UREA; TIME; MULTIVARIATE analysis; SODIUM; MANN Whitney U Test; SEVERITY of illness index; COMPARATIVE studies; LEUKOCYTE count; DESCRIPTIVE statistics; CHI-squared test; HEMOLYTIC-uremic syndrome; BACTERIAL toxins; RECEIVER operating characteristic curves; OXIDOREDUCTASES; STATISTICAL models; LOGISTIC regression analysis; LONGITUDINAL method; CREATININE; DISEASE risk factors; SYMPTOMS; EVALUATION; CHILDREN
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 1, p213
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-023-06104-8