title: Postdiarrheal hemolytic uremic syndrome in United States children: clinical spectrum and predictors of in-hospital death.
abstract: OBJECTIVE
  To assess the clinical spectrum of postdiarrheal hemolytic uremic syndrome (D(+)HUS) hospitalizations and sought predictors of in-hospital death to help identify children at risk of poor outcomes.
  
  
  METHODS
  We assessed clinical variables collected through population-based surveillance of D(+)HUS in children <18 years old hospitalized in 10 states during 1997-2012 as predictors of in-hospital death by using tree modeling.
  
  
  RESULTS
  We identified 770 cases. Of children with information available, 56.5% (430 of 761) required dialysis, 92.6% (698 of 754) required a transfusion, and 2.9% (22 of 770) died; few had a persistent dialysis requirement (52 [7.3%] of 716) at discharge. The tree model partitioned children into 5 groups on the basis of 3 predictors (highest leukocyte count and lowest hematocrit value during the 7 days before to 3 days after the diagnosis of hemolytic uremic syndrome, and presence of respiratory tract infection [RTI] within 3 weeks before diagnosis). Patients with greater leukocyte or hematocrit values or a recent RTI had a greater probability of in-hospital death. The largest group identified (n = 533) had none of these factors and had the lowest odds of death. Many children with RTI had recent antibiotic treatment for nondiarrheal indications.
  
  
  CONCLUSIONS
  Most children with D(+)HUS have good hospitalization outcomes. Our findings support previous reports of increased leukocyte count and hematocrit as predictors of death. Recent RTI could be an additional predictor, or a marker of other factors such as antibiotic exposure, that may warrant further study.
authors: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Rajal K
authors: RK
authors: Mody
authors: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Weidong
authors: W
authors: Gu
authors: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Patricia M
authors: PM
authors: Griffin
authors: Tennessee Department of Health, Nashville, TN.
authors: Timothy F
authors: TF
authors: Jones
authors: Minnesota Department of Health, Saint Paul, MN.
authors: Josh
authors: J
authors: Rounds
authors: Oregon Public Health Division, Portland, OR.
authors: Beletshachew
authors: B
authors: Shiferaw
authors: Georgia Department of Public Health, Atlanta, GA.
authors: Melissa
authors: M
authors: Tobin-D'Angelo
authors: New York State Emerging Infections Program, Albany, NY.
authors: Glenda
authors: G
authors: Smith
authors: New York State Emerging Infections Program, Albany, NY.
authors: Nancy
authors: N
authors: Spina
authors: Connecticut Emerging Infections Program, New Haven, CT.
authors: Sharon
authors: S
authors: Hurd
authors: New Mexico Emerging Infections Program, Albuquerque, NM.
authors: Sarah
authors: S
authors: Lathrop
authors: Maryland Department of Health and Mental Hygiene, Baltimore, MD.
authors: Amanda
authors: A
authors: Palmer
authors: Tennessee Department of Health, Nashville, TN.
authors: Effie
authors: E
authors: Boothe
authors: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Ruth E
authors: RE
authors: Luna-Gierke
authors: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Robert M
authors: RM
authors: Hoekstra
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications* / Q000628:therapy; D004927:Escherichia coli Infections / Q000150:complications / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents