title: Associations Between Hydration Status, Intravenous Fluid Administration, and Outcomes of Patients Infected With Shiga Toxin-Producing Escherichia coli: A Systematic Review and Meta-analysis.
abstract: The associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli (STEC) remain unclear.
  
  
  
  To determine the relationship between hydration status, the development and severity of hemolytic uremic syndrome (HUS), and adverse outcomes in STEC-infected individuals.
  
  
  
  MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials via the OvidSP platform, PubMed via the National Library of Medicine, CINAHL Plus with full text, Scopus, Web of Science, ClinicalTrials.gov, reference lists, and gray literature were systematically searched.
  
  
  
  Two reviewers independently identified studies that included patients with hydration status documentation, proven or presumed STEC infection, and some form of HUS that developed. No language restrictions were applied.
  
  
  
  Two reviewers independently extracted individual study data, including study characteristics, population, and outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale; strength of evidence was adjudicated using the Grading of Recommendations Assessment, Development, and Evaluation method. Meta-analyses were conducted using random-effects models.
  
  
  
  Development of HUS, complications (ie, oligoanuric renal failure, involvement of the central nervous system, or death), and interventions (ie, renal replacement therapy).
  
  
  
  Eight studies comprising 1511 patients (all children) met eligibility criteria. Unpublished data were provided by the authors of 7 published reports. The median risk-of-bias score was 7.5 (range, 6-9). No studies evaluated the effect of hydration during STEC infections on the risk for HUS. A hematocrit value greater than 23% as a measure of hydration status at presentation with HUS was associated with the development of oligoanuric HUS (OR, 2.38 [95% CI, 1.30-4.35]; I2 = 2%), renal replacement therapy (OR, 1.90 [95% CI, 1.25-2.90]; I2 = 17%), and death (OR, 5.13 [95% CI, 1.50-17.57]; I2 = 55%). Compared with putatively hydrated patients, clinically dehydrated patients had an OR of death of 3.71 (95% CI, 1.25-11.03; I2 = 0%). Intravenous fluid administration up to the day of HUS diagnosis was associated with a decreased risk of renal replacement therapy (OR, 0.26 [95% CI, 0.11-0.60]).
  
  
  
  Two predictors of poor outcomes for STEC-infected children were identified: (1) the lack of intravenous fluid administration prior to establishment of HUS and (2) a higher hematocrit value at presentation. These findings point to an association between dehydration and adverse outcomes for children with HUS.
authors.affiliation: Section of Pediatric Nephrology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Silviu
authors.initials: S
authors.lastname: Grisaru
authors.affiliation: Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jianling
authors.initials: J
authors.lastname: Xie
authors.affiliation: Section of Pediatric Nephrology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Samuel
authors.affiliation: Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: David
authors.initials: D
authors.lastname: Schnadower
authors.affiliation: Alberta Children's Hospital Research Institute, Section of Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada7Alberta Children's Hospital Research Institute, Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
mesh_terms: D002648:Child; D003681:Dehydration / Q000150:complications*; D005440:Fluid Therapy / Q000379:methods*; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology* / Q000628:therapy*; D006801:Humans; D054323:Shiga-Toxigenic Escherichia coli / Q000472:pathogenicity*