Abstract |
Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio ≤40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome. CONCLUSION: A BUN-to-serum Creatinine ratio can accurately identify children with D+HUS at risk for a complicated course and poor outcome. What is Known: • Oliguria is a predictor of poor long-term outcome in D+HUS What is New: • BUN-to-serum Creatinine ratio at admission is an entirely novel and accurate predictor of poor outcome and complicated clinical outcome in D+HUS • Early detection of the high risk group in D+HUS enabling early treatment and adequate monitoring.
|
Authors | Werner Keenswijk, Jill Vanmassenhove, Ann Raes, Evelyn Dhont, Johan Vande Walle |
Journal | European journal of pediatrics
(Eur J Pediatr)
Vol. 176
Issue 3
Pg. 355-360
(Mar 2017)
ISSN: 1432-1076 [Electronic] Germany |
PMID | 28078430
(Publication Type: Journal Article)
|
Chemical References |
|
Topics |
- Adolescent
- Biomarkers
(blood)
- Blood Urea Nitrogen
- Child
- Child, Preschool
- Creatinine
(analysis, blood)
- Diarrhea
(complications)
- Female
- Hemolytic-Uremic Syndrome
(blood, complications, etiology)
- Humans
- Infant
- Infant, Newborn
- Male
- Prospective Studies
- Retrospective Studies
|