Pediatric Nephrology Unit, Pediatric Department, Hospital Dr. José Penna, Lainez 2401, (8000), Bahía Blanca, Argentina.
Department of Pediatrics Hospital Italiano Ciudad Autónoma de Buenos Aires (CABA), Pediatric Nephrology Division, Buenos Aires, Argentina.
Pediatr Nephrol. 2018 Oct;33(10):1791-1798. doi: 10.1007/s00467-018-3991-6. Epub 2018 Jun 30.
(1) Evaluate mortality rate in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, (2) determine the leading causes of death, and (3) identify predictors of mortality at hospital admission.
We conducted a multicentric, observational, retrospective, cross-sectional study. It included patients under 18 years old with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome hospitalized between January 2005 and June 2016. Clinical and laboratory data were obtained from the Argentine National Epidemiological Surveillance System of Hemolytic Uremic Syndrome. Clinical and laboratory variables were compared between deceased and non-deceased patients. Univariate and multivariate analyses were performed. ROC curves and area under the curve were obtained.
Seventeen (3.65%) out of the 466 patients died, being central nervous system involvement the main cause of death. Predictors of death were central nervous system involvement, the number of days since the beginning of diarrhea to hospitalization, hyponatremia, high hemoglobin, high leukocyte counts, and low bicarbonate concentration on admission. In the multivariate analysis, central nervous system involvement, sodium concentration, and hemoglobin were independent predictors. The best cut off for sodium was ≤ 128 meq/l and for hemoglobin ≥ 10.8 g/dl.
Mortality was low in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, being central nervous system involvement the main cause of death. The best mortality predictors found were central nervous system involvement, hemoglobin, and sodium concentration. Hyponatremia may be a new Shiga toxin-producing Escherichia coli hemolytic uremic syndrome mortality predictor.
（1）评估产志贺毒素大肠埃希氏菌溶血尿毒症综合征患者的死亡率，（2）确定主要死亡原因，（3）确定入院时死亡的预测因素。
我们进行了一项多中心、观察性、回顾性、横断面研究。它包括 2005 年 1 月至 2016 年 6 月期间住院的年龄在 18 岁以下的产志贺毒素大肠埃希氏菌溶血尿毒症综合征患者。临床和实验室数据来自阿根廷国家溶血尿毒症综合征流行病学监测系统。比较了死亡和非死亡患者的临床和实验室数据。进行了单变量和多变量分析。获得了 ROC 曲线和曲线下面积。
在 466 例患者中，有 17 例（3.65%）死亡，中枢神经系统受累是主要死亡原因。死亡的预测因素是中枢神经系统受累、腹泻开始至住院的天数、低钠血症、高血红蛋白、白细胞计数高和入院时碳酸氢盐浓度低。在多变量分析中，中枢神经系统受累、钠浓度和血红蛋白是独立的预测因素。钠的最佳截断值为≤128 meq/l，血红蛋白为≥10.8 g/dl。
产志贺毒素大肠埃希氏菌溶血尿毒症综合征患儿死亡率低，中枢神经系统受累是主要死亡原因。发现的最佳死亡率预测因素是中枢神经系统受累、血红蛋白和钠浓度。低钠血症可能是产志贺毒素大肠埃希氏菌溶血尿毒症综合征新的死亡率预测因素。
