Prognostic factors in the hemolytic-uremic syndrome
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M Uszycka-Karcz1, E Marczak, P Mierzewski
1Pediatric Clinic of Nephrology, Gdańsk, Poland.
Insights
Hemolytic-uremic syndrome (HUS) in children has a 25.4% mortality rate, with infants most affected. Key fatal outcome predictors include severe GI symptoms, coma, and delayed dialysis.
Area of Science:
- Pediatrics
- Nephrology
- Critical Care Medicine
Background:
- Hemolytic-uremic syndrome (HUS) is a serious condition primarily affecting infants.
- A significant mortality rate has been associated with HUS, necessitating identification of risk factors.
Purpose of the Study:
- To identify risk factors associated with fatal outcomes in pediatric Hemolytic-uremic syndrome (HUS).
- To analyze long-term sequelae in HUS survivors.
Main Methods:
- Retrospective analysis of 142 children treated for HUS between 1972 and 1986.
- Computerized analysis of clinical data to determine predictors of mortality.
Main Results:
- The overall mortality rate for HUS was 25.4%, with infants comprising 73% of cases.
- Identified risk factors for fatal outcomes included severe gastrointestinal symptoms, coma, convulsions, malignant hypertension, prolonged symptoms (>7 days), hyperkalemia (>7 mmol/l), acidosis (<15 mmol/l bicarbonate), delayed dialysis (>5 days), and long transport distances (>100 km).
- The highest risk of death occurred within the first 3 weeks of onset.
Conclusions:
- Early identification of risk factors is crucial for managing pediatric HUS.
- Twelve of 106 survivors developed chronic renal failure, highlighting the need for long-term follow-up.
Abstract:
During 1972-1986, 142 children with the hemolytic-uremic syndrome were treated. Most of them were infants (73%). The total mortality rate reached 25.4%. Computer analysis revealed the following risk factors of a fatal outcome: severe gastrointestinal symptoms during the prodromal period, coma, convulsions, malignant hypertension, persistence of prodromal symptoms over 7 days, hyperkalemia over 7 mmol/l, acidosis with bicarbonate level less than 15 mmol/l, a delay of over 5 days in starting dialysis, and transport to dialysis unit of over 100 km. The greatest risk of death existed during the first 3 weeks from onset. Among 142 children, 106 survived the acute phase. They were followed up from 2 to 16 years. Nine were lost to follow-up. Twelve children developed chronic renal failure.