期刊
JOURNAL OF PEDIATRICS
卷 166, 期 4, 页码 1022-1029出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jpeds.2014.12.064
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资金
- Centers for Disease Control and Prevention
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. Study design 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. Conclusion 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.
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