Early predictors of dialysis at the time of hospital admission in patients with hemolytic uremic syndrome associated with diarrhea

LUCARELLI,L.; RIVERO, M.A.; ALCONCHER, L.; RODRIGUEZ, E.M.

Iguazu

Congreso; 17th Congress of the International Pediatric Nephrology Association; 2016

Pediatric Nephrology Association

To identify early predictors of dialysis atonset of postdiarrheal Hemolytic Uremic Syndrome (D+HUS). Retro-prospective, observational andtransversal study. Data of D+HUS children hospitalized between 2005-2015 werecollected through population-based surveillance. Predictors included: gender,age at onset (<1, 1-2 and ≥2 years), initial platelets and white blood cell(WBC) count (≤20000 or >20000/mm3), hematocrit (≤23 or >23%),hydration state, neurological involvement (normal, seizures, irritability,somnolence), previous antibiotics prescription and evidence of shiga-toxinproducing E.Coli (STEC) infection. Bivariate and multivariate analyses wereperformed, a p<0.05 was considered significant. 143 D+HUS patients, 88 female (61.5%), mean age 34.6 months wereincluded. Sixty nine (48%) required dialysis. Gender, hydration state, plateletcounts and antibiotics prescription were not associated with dialysis request.Seventy two percent of the patients with ˃20000 WBC required dialysis vs. 40 %of those with less counts (OR 3.20 CI 95% 1.5-6.5; p=0.001). Patients aged <2 years had a 4.4 times higher risk of dialysis request (CI 95% 1.19-16.6,p=0.02). Stool culture was available in 79 patients, 65% of STEC+ requireddialysis vs. 33% of those with negative cultures (OR 3.51, CI95% 1.43-8.66;p=0.006). Dialysis need increased 3.5 timesin somnolent patients (CI95% 1.61-7.63, p=0.0015). Sixty three percent of patients with hematocrit> 23 % required dialysis vs. 33% of those with less value (OR 3.08, CI95%1.6-5.93; p=0.0007). In the multivariable analysis, hematocrit >23 % andsomnolence were not only significant predictors of dialysis request but also oflong-term dialysis request (> 10 days). These data would be useful to predict dialysisrequest at onset of the disease. Even though WBC >20000, age <2 years andSTEC+ stool cultures were predictors of dialysis, somnolence and hematocrit> 23% were the only significant factors in the multivariate analysis