{"title":"儿童溶血性尿毒症综合征：临床特征和预后因素","authors":"Shrikiran Aroor, Sahithi Teja Gajjala, Pushpa Kini, Suneel Mundkur, Ramesh Bhat Y, Sandeep Kumar","doi":"10.1016/j.cegh.2024.101715","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Hemolytic uremic syndrome (HUS) is the most common thrombotic microangiopathy (TMA) occurring in children.</p></div><div><h3>Objectives</h3><p>To study the clinico-laboratory profile and identify the potential outcome predictors in children with hemolytic uremic syndrome.</p></div><div><h3>Methodology</h3><p>A retrospective observational study was conducted at a tertiary center in South India. Children diagnosed with HUS during the study period of 10 years were included. The demographic, clinical, and laboratory details, complications, and outcomes were recorded. Predictors of mortality were analyzed.</p></div><div><h3>Results</h3><p>Among 44 children with HUS, 14 (31.8 %) children were diagnosed with D + HUS while 30 had D-HUS. The median age at diagnosis was 6.3 years. Male preponderance (55.9 %) was observed. Presenting symptoms included oliguria in 36 (86.4 %), followed by fever, observed in 34 (77.3 %). 12 (27.2 %) children had anuria. Seizures and altered sensorium were present in 12 (27.35) and 16 (36.4 %) children respectively. Hypertension was observed in 33 (75 %) children. Plasmapheresis was performed in 18 (13.6 %) children. 17 (38.6 %) children underwent hemodialysis, and 7 (15.9 %) underwent peritoneal dialysis. The median duration of hospital stay was 18 (9.7, 27.7) days. Complications observed during the study were CNS involvement was seen in 16 (36.4 %) children, while coagulopathy was observed in 3 (6.8 %) children. Mortality was observed in 16 children (36.4 %). Anuria at admission was more prevalent in non-survivors (10 out of 16 children; p 0.003). The median albumin and C3 levels were significantly low in non-survivors (p-value <0.001 and 0.008 respectively). A total leucocyte count >15,000 X 10<sup>9</sup> cells/L was independently associated with mortality even after adjustment with duration of symptoms before diagnosis >10 days and low C3 levels (adjusted OR [95 % CI]: 1.12 [1.02, 1.92] (p-value 0.03).</p></div><div><h3>Conclusion</h3><p>Hypoalbuminemia and hypocomplementemia were observed in higher proportions among non-survivors. Elevated leucocyte count at admission was an independent predictor of mortality.</p></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213398424002112/pdfft?md5=c2b86b892d8452c91b49de2db7a285b1&pid=1-s2.0-S2213398424002112-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Hemolytic uremic syndrome in children: Clinical characteristics and predictors of outcome\",\"authors\":\"Shrikiran Aroor, Sahithi Teja Gajjala, Pushpa Kini, Suneel Mundkur, Ramesh Bhat Y, Sandeep Kumar\",\"doi\":\"10.1016/j.cegh.2024.101715\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Hemolytic uremic syndrome (HUS) is the most common thrombotic microangiopathy (TMA) occurring in children.</p></div><div><h3>Objectives</h3><p>To study the clinico-laboratory profile and identify the potential outcome predictors in children with hemolytic uremic syndrome.</p></div><div><h3>Methodology</h3><p>A retrospective observational study was conducted at a tertiary center in South India. Children diagnosed with HUS during the study period of 10 years were included. The demographic, clinical, and laboratory details, complications, and outcomes were recorded. Predictors of mortality were analyzed.</p></div><div><h3>Results</h3><p>Among 44 children with HUS, 14 (31.8 %) children were diagnosed with D + HUS while 30 had D-HUS. The median age at diagnosis was 6.3 years. Male preponderance (55.9 %) was observed. Presenting symptoms included oliguria in 36 (86.4 %), followed by fever, observed in 34 (77.3 %). 12 (27.2 %) children had anuria. Seizures and altered sensorium were present in 12 (27.35) and 16 (36.4 %) children respectively. Hypertension was observed in 33 (75 %) children. Plasmapheresis was performed in 18 (13.6 %) children. 17 (38.6 %) children underwent hemodialysis, and 7 (15.9 %) underwent peritoneal dialysis. The median duration of hospital stay was 18 (9.7, 27.7) days. Complications observed during the study were CNS involvement was seen in 16 (36.4 %) children, while coagulopathy was observed in 3 (6.8 %) children. Mortality was observed in 16 children (36.4 %). Anuria at admission was more prevalent in non-survivors (10 out of 16 children; p 0.003). The median albumin and C3 levels were significantly low in non-survivors (p-value <0.001 and 0.008 respectively). A total leucocyte count >15,000 X 10<sup>9</sup> cells/L was independently associated with mortality even after adjustment with duration of symptoms before diagnosis >10 days and low C3 levels (adjusted OR [95 % CI]: 1.12 [1.02, 1.92] (p-value 0.03).</p></div><div><h3>Conclusion</h3><p>Hypoalbuminemia and hypocomplementemia were observed in higher proportions among non-survivors. Elevated leucocyte count at admission was an independent predictor of mortality.</p></div>\",\"PeriodicalId\":46404,\"journal\":{\"name\":\"Clinical Epidemiology and Global Health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-07-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2213398424002112/pdfft?md5=c2b86b892d8452c91b49de2db7a285b1&pid=1-s2.0-S2213398424002112-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Epidemiology and Global Health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213398424002112\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Epidemiology and Global Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213398424002112","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Hemolytic uremic syndrome in children: Clinical characteristics and predictors of outcome
Background
Hemolytic uremic syndrome (HUS) is the most common thrombotic microangiopathy (TMA) occurring in children.
Objectives
To study the clinico-laboratory profile and identify the potential outcome predictors in children with hemolytic uremic syndrome.
Methodology
A retrospective observational study was conducted at a tertiary center in South India. Children diagnosed with HUS during the study period of 10 years were included. The demographic, clinical, and laboratory details, complications, and outcomes were recorded. Predictors of mortality were analyzed.
Results
Among 44 children with HUS, 14 (31.8 %) children were diagnosed with D + HUS while 30 had D-HUS. The median age at diagnosis was 6.3 years. Male preponderance (55.9 %) was observed. Presenting symptoms included oliguria in 36 (86.4 %), followed by fever, observed in 34 (77.3 %). 12 (27.2 %) children had anuria. Seizures and altered sensorium were present in 12 (27.35) and 16 (36.4 %) children respectively. Hypertension was observed in 33 (75 %) children. Plasmapheresis was performed in 18 (13.6 %) children. 17 (38.6 %) children underwent hemodialysis, and 7 (15.9 %) underwent peritoneal dialysis. The median duration of hospital stay was 18 (9.7, 27.7) days. Complications observed during the study were CNS involvement was seen in 16 (36.4 %) children, while coagulopathy was observed in 3 (6.8 %) children. Mortality was observed in 16 children (36.4 %). Anuria at admission was more prevalent in non-survivors (10 out of 16 children; p 0.003). The median albumin and C3 levels were significantly low in non-survivors (p-value <0.001 and 0.008 respectively). A total leucocyte count >15,000 X 109 cells/L was independently associated with mortality even after adjustment with duration of symptoms before diagnosis >10 days and low C3 levels (adjusted OR [95 % CI]: 1.12 [1.02, 1.92] (p-value 0.03).
Conclusion
Hypoalbuminemia and hypocomplementemia were observed in higher proportions among non-survivors. Elevated leucocyte count at admission was an independent predictor of mortality.
期刊介绍：
Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.
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