Predictors of fatality in postdiarrheal hemolytic uremic syndrome.
OBJECTIVE
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 Two died because treatment was withdrawn based on their preexisting conditions, and 1 died because of iatrogenic cardiac tamponade; they were excluded from analysis.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.
Oakes
Robert S
RS
Pediatric Nephrology, University of Utah School of Medicine, Salt Lake City, Utah, USA. Robert.Oakes@ihc.com
Siegler
Richard L
RL
McReynolds
Markham A
MA
Pysher
Theodore
T
Pavia
Andrew T
AT
D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications*; D005260:Female; D006400:Hematocrit; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009846:Oliguria / Q000150:complications; D012307:Risk Factors