Risk factors for development of hemolytic uremic syndrome in a cohort of adult patients with STEC 0104:H4 infection.
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Risk factors for development of hemolytic uremic syndrome in a cohort of adult patients with STEC 0104:H4 infection. / Zoufaly, Alexander; Cramer, Jakob P; Vettorazzi, Eik; Sayk, Friedhelm; Bremer, Jan P; Koop, Irmtraut; de Weerth, Andreas; Schmiedel, Stefan; Jordan, Sabine; Zimmermann-Fraedrich, Katharina; Asselborn, Niels H; Nitschke, Martin; Neumann-Grutzeck, Christine; Magnus, Tim; Rüther, Christoph; Fellermann, Klaus; Stahl, Rolf K; Wegscheider, Karl; Lohse, Ansgar W.
in: PLOS ONE, Jahrgang 8, Nr. 3, 3, 2013, S. e59209.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Risk factors for development of hemolytic uremic syndrome in a cohort of adult patients with STEC 0104:H4 infection.
AU - Zoufaly, Alexander
AU - Cramer, Jakob P
AU - Vettorazzi, Eik
AU - Sayk, Friedhelm
AU - Bremer, Jan P
AU - Koop, Irmtraut
AU - de Weerth, Andreas
AU - Schmiedel, Stefan
AU - Jordan, Sabine
AU - Zimmermann-Fraedrich, Katharina
AU - Asselborn, Niels H
AU - Nitschke, Martin
AU - Neumann-Grutzeck, Christine
AU - Magnus, Tim
AU - Rüther, Christoph
AU - Fellermann, Klaus
AU - Stahl, Rolf K
AU - Wegscheider, Karl
AU - Lohse, Ansgar W
PY - 2013
Y1 - 2013
N2 - The outbreak of Shiga toxin producing E.coli O104:H4 in northern Germany in 2011 was one of the largest worldwide and involved mainly adults. Post-diarrheal hemolytic uremic syndrome (HUS) occurred in 22% of STEC positive patients. This study's aim was to assess risk factors for HUS in STEC-infected patients and to develop a score from routine hospital parameters to estimate patient risks for developing HUS. In a cohort analysis, adult patients with STEC infection were included in five participating hospitals in northern Germany between May and July 2011. Clinical data were obtained from questionnaires and medical records, laboratory data were extracted from hospitals' electronic data systems. HUS was defined as thrombocytopenia, hemolytic anemia and acute renal dysfunction. Random forests and multivariate logistic regression were used to identify risk factors for HUS and develop a score using the estimated coefficients as weights. Among 259 adults with STEC infection, vomiting (OR 3.48,95%CI 1.88-6.53), visible blood in stools (OR 3.91,95%CI1.20-16.01), age above 75 years (OR 3.27, 95%CI 1.12-9.70) and elevated leukocyte counts (OR 1.20, 95%CI 1.10-1.31, per 1000 cells/mm(3)) were identified as independent risk factors for HUS. A score using these variables has an area under the ROC curve of 0.74 (95%CI 0.68-0.80). Vomiting, visible blood in stools, higher leukocyte counts, and higher age indicate increased risk for developing HUS. A score using these variables might help to identify high risk patients who potentially benefit from aggressive pre-emptive treatment to prevent or mitigate the devastating consequences of HUS.
AB - The outbreak of Shiga toxin producing E.coli O104:H4 in northern Germany in 2011 was one of the largest worldwide and involved mainly adults. Post-diarrheal hemolytic uremic syndrome (HUS) occurred in 22% of STEC positive patients. This study's aim was to assess risk factors for HUS in STEC-infected patients and to develop a score from routine hospital parameters to estimate patient risks for developing HUS. In a cohort analysis, adult patients with STEC infection were included in five participating hospitals in northern Germany between May and July 2011. Clinical data were obtained from questionnaires and medical records, laboratory data were extracted from hospitals' electronic data systems. HUS was defined as thrombocytopenia, hemolytic anemia and acute renal dysfunction. Random forests and multivariate logistic regression were used to identify risk factors for HUS and develop a score using the estimated coefficients as weights. Among 259 adults with STEC infection, vomiting (OR 3.48,95%CI 1.88-6.53), visible blood in stools (OR 3.91,95%CI1.20-16.01), age above 75 years (OR 3.27, 95%CI 1.12-9.70) and elevated leukocyte counts (OR 1.20, 95%CI 1.10-1.31, per 1000 cells/mm(3)) were identified as independent risk factors for HUS. A score using these variables has an area under the ROC curve of 0.74 (95%CI 0.68-0.80). Vomiting, visible blood in stools, higher leukocyte counts, and higher age indicate increased risk for developing HUS. A score using these variables might help to identify high risk patients who potentially benefit from aggressive pre-emptive treatment to prevent or mitigate the devastating consequences of HUS.
KW - Adult
KW - Humans
KW - Male
KW - Female
KW - Middle Aged
KW - Risk Factors
KW - Escherichia coli Infections/complications
KW - Hemolytic-Uremic Syndrome/etiology
KW - Adult
KW - Humans
KW - Male
KW - Female
KW - Middle Aged
KW - Risk Factors
KW - Escherichia coli Infections/complications
KW - Hemolytic-Uremic Syndrome/etiology
U2 - 10.1371/journal.pone.0059209
DO - 10.1371/journal.pone.0059209
M3 - SCORING: Journal article
C2 - 23533606
VL - 8
SP - e59209
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 3
M1 - 3
ER -
