title: Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome.
abstract: BACKGROUND
  Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS) is a severe acute illness without specific treatment except supportive care; fluid management is concentrated on preventing fluid overload for patients, who are often oligoanuric. Hemoconcentration at onset is associated with more severe disease, but the benefits of volume expansion after hemolytic uremic syndrome (HUS) onset have not been explored.
  
  
  METHODS
  All the children with STEC-HUS referred to our center between 2012 and 2014 received intravenous infusion targeted at inducing an early volume expansion (+10% of working weight) to restore circulating volume and reduce ischemic or hypoxic tissue damage. The short- and long-term outcomes of these patients were compared with those of 38 historical patients referred to our center during the years immediately before, when fluid intake was routinely restricted.
  
  
  RESULTS
  Patients undergoing fluid infusion soon after diagnosis showed a mean increase in body weight of 12.5% (vs 0%), had significantly better short-term outcomes with a lower rate of central nervous system involvement (7.9% vs 23.7%, P = .06), had less need for renal replacement therapy (26.3% vs 57.9%, P = .01) or intensive care support (2.0 vs. 8.5 days, P = .02), and needed fewer days of hospitalization (9.0 vs 12.0 days, P = .03). Long-term outcomes were also significantly better in terms of renal and extrarenal sequelae (13.2% vs 39.5%, P = .01).
  
  
  CONCLUSIONS
  Patients with STEC-HUS had great benefit from early volume expansion. It is speculated that early and generous fluid infusions can reduce thrombus formation and ischemic organ damage, thus having positive effects on both short- and long-term disease outcomes.
authors.affiliation: Center for HUS Control, Prevention and Management, ardissino@centroseu.org.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.affiliation: Center for HUS Control, Prevention and Management.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tel
authors.affiliation: Center for HUS Control, Prevention and Management.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Possenti
authors.affiliation: Center for HUS Control, Prevention and Management.
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.affiliation: Epidemiology Unit.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Center for HUS Control, Prevention and Management.
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.affiliation: Laboratory of Medical Genetics.
authors.forename: Stefania
authors.initials: S
authors.lastname: Salardi
authors.affiliation: Laboratory of Medical Genetics.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Borsa-Ghiringhelli
authors.affiliation: Pediatric Cardiology Unit, and.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Salice
authors.affiliation: Laboratory of Medical Genetics.
authors.forename: Silvana
authors.initials: S
authors.lastname: Tedeschi
authors.affiliation: Center for HUS Control, Prevention and Management.
authors.forename: Pierangela
authors.initials: P
authors.lastname: Castorina
authors.affiliation: Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
authors.forename: Rosaria Maria
authors.initials: RM
authors.lastname: Colombo
authors.affiliation: Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
authors.forename: Milena
authors.initials: M
authors.lastname: Arghittu
authors.affiliation: Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
authors.forename: Laura
authors.initials: L
authors.lastname: Daprai
authors.affiliation: Division of Pediatrics, Department of Health Science, University of Piemonte Orientale, Novara, Italy;
authors.forename: Alice
authors.initials: A
authors.lastname: Monzani
authors.affiliation: Istituto Superiore di Sanità, Roma, Italy; and.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Tozzoli
authors.affiliation: Univerità di Bologna, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Brigotti
authors.affiliation: Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
authors.forename: Erminio
authors.initials: E
authors.lastname: Torresani
mesh_terms: D002648:Child; D002675:Child, Preschool; D061345:Early Medical Intervention; D005260:Female; D005440:Fluid Therapy; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D054323:Shiga-Toxigenic Escherichia coli; D016896:Treatment Outcome