title: Risk factors for development of hemolytic uremic syndrome in a cohort of adult patients with STEC 0104:H4 infection.
abstract: The outbreak of Shiga toxin producing E.coli O104:H4 in northern Germany in 2011 was one of the largest worldwide and involved mainly adults. Post-diarrheal hemolytic uremic syndrome (HUS) occurred in 22% of STEC positive patients. This study's aim was to assess risk factors for HUS in STEC-infected patients and to develop a score from routine hospital parameters to estimate patient risks for developing HUS. In a cohort analysis, adult patients with STEC infection were included in five participating hospitals in northern Germany between May and July 2011. Clinical data were obtained from questionnaires and medical records, laboratory data were extracted from hospitals' electronic data systems. HUS was defined as thrombocytopenia, hemolytic anemia and acute renal dysfunction. Random forests and multivariate logistic regression were used to identify risk factors for HUS and develop a score using the estimated coefficients as weights. Among 259 adults with STEC infection, vomiting (OR 3.48,95%CI 1.88-6.53), visible blood in stools (OR 3.91,95%CI1.20-16.01), age above 75 years (OR 3.27, 95%CI 1.12-9.70) and elevated leukocyte counts (OR 1.20, 95%CI 1.10-1.31, per 1000 cells/mm(3)) were identified as independent risk factors for HUS. A score using these variables has an area under the ROC curve of 0.74 (95%CI 0.68-0.80). Vomiting, visible blood in stools, higher leukocyte counts, and higher age indicate increased risk for developing HUS. A score using these variables might help to identify high risk patients who potentially benefit from aggressive pre-emptive treatment to prevent or mitigate the devastating consequences of HUS.
authors.affiliation: Department of Medicine I (Gastroenterology and Hepatology, Infectious Diseases and Tropical Medicine), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. a.zoufaly@uke.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Zoufaly
authors.forename: Jakob P
authors.initials: JP
authors.lastname: Cramer
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Sayk
authors.forename: Jan P
authors.initials: JP
authors.lastname: Bremer
authors.forename: Irmtraut
authors.initials: I
authors.lastname: Koop
authors.forename: Andreas
authors.initials: A
authors.lastname: de Weerth
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmiedel
authors.forename: Sabine
authors.initials: S
authors.lastname: Jordan
authors.forename: Katharina
authors.initials: K
authors.lastname: Fraedrich
authors.forename: Niels H
authors.initials: NH
authors.lastname: Asselborn
authors.forename: Martin
authors.initials: M
authors.lastname: Nitschke
authors.forename: Christine
authors.initials: C
authors.lastname: Neumann-Grutzeck
authors.forename: Tim
authors.initials: T
authors.lastname: Magnus
authors.forename: Christoph
authors.initials: C
authors.lastname: Rüther
authors.forename: Klaus
authors.initials: K
authors.lastname: Fellermann
authors.forename: Rolf K
authors.initials: RK
authors.lastname: Stahl
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
mesh_terms: D000328:Adult; D004927:Escherichia coli Infections / Q000150:complications*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors