Document Detail

Predictors of fatality in postdiarrheal hemolytic uremic syndrome.
MedLine Citation:
PMID:  16651320     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Describe the cause of deaths among patients with postdiarrheal hemolytic uremic syndrome (HUS) and identify predictors of death at the time of hospital admission. METHODS: Case-control study of 17 deaths among patients with HUS identified from the Intermountain HUS Patient Registry (1970-2003) compared against all nonfatal cases. RESULTS: Of the 17 total deaths, 15 died during the acute phase of disease. Two died because treatment was withdrawn based on their preexisting conditions, and 1 died because of iatrogenic cardiac tamponade; they were excluded from analysis. Brain involvement was the most common cause of death (8 of 12); congestive heart failure, pulmonary hemorrhage, and hyperkalemia were infrequent causes. Presence of prodromal lethargy, oligoanuria, or seizures and white blood cell count (WBC) >20 x 10(9)/L or hematocrit >23% on admission were predictive of death. In multivariate analysis, elevated WBC and elevated hematocrit were independent predictors. The combination of prodromal dehydration, oliguria, and lethargy and admission WBC values >20 x 10(9)/L and hematocrit >23% appeared in 7 of the 12 acute-phase deaths. CONCLUSIONS: Diarrheal HUS patients presenting with oligoanuria, dehydration, WBC >20 x 10(9)/L, and hematocrit >23% are at substantial risk for fatal hemolytic uremic syndrome. Such individuals should be referred to pediatric tertiary care centers.
Robert S Oakes; Richard L Siegler; Markham A McReynolds; Theodore Pysher; Andrew T Pavia
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  117     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-02     Completed Date:  2006-05-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1656-62     Citation Subset:  AIM; IM    
Pediatric Nephrology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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MeSH Terms
Cause of Death
Child, Preschool
Diarrhea / complications*
Hemolytic-Uremic Syndrome / complications,  diagnosis,  mortality*
Leukocyte Count
Oliguria / complications
Risk Factors
Comment In:
Pediatrics. 2006 Oct;118(4):1798; author reply 1798-9   [PMID:  17015579 ]
Pediatrics. 2006 Oct;118(4):1797; author reply 1798-9   [PMID:  17015578 ]

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