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Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children
Abstract Background Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. Methods We conducted a multicenter, historical cohort study to identify features associa...
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| Published in: | Clinical infectious diseases 2020-04, Vol.70 (8), p.1643-1651 |
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| creator | McKee, Ryan S Schnadower, David Tarr, Phillip I Xie, Jianling Finkelstein, Yaron Desai, Neil Lane, Roni D Bergmann, Kelly R Kaplan, Ron L Hariharan, Selena Cruz, Andrea T Cohen, Daniel M Dixon, Andrew Ramgopal, Sriram Rominger, Annie Powell, Elizabeth C Kilgar, Jennifer Michelson, Kenneth A Beer, Darcy Bitzan, Martin Pruitt, Christopher M Yen, Kenneth Meckler, Garth D Plint, Amy C Bradin, Stuart Abramo, Thomas J Gouin, Serge Kam, April J Schuh, Abigail Balamuth, Fran Hunley, Tracy E Kanegaye, John T Jones, Nicholas E Avva, Usha Porter, Robert Fein, Daniel M Louie, Jeffrey P Freedman, Stephen B |
| description | Abstract
Background
Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care.
Methods
We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged |
| doi_str_mv | 10.1093/cid/ciz432 |
| format | article |
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Background
Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care.
Methods
We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible.
Results
Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69–.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42–4.54]), higher hematocrit (1.83 [1.21–2.77] per 5% increase) and serum creatinine (10.82 [1.49–78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02–3.60]), lower serum sodium (1.12 [1.02–1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14–5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54–.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14–4.50]), younger age (0.83 [.74–.92] per year), lower serum sodium (1.15 [1.04–1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17–4.72]) and creatinine (7.75 [1.20–50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18–6.21]).
Conclusions
The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
Among Shiga toxin–producing Escherichia coli–infected children without hemolytic uremic syndrome (HUS) brought for emergency department evaluation, 14% developed HUS. Younger age; elevated white blood cell count, hematocrit, and creatinine; early presentation; and delayed intravenous fluid administration predicted HUS.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciz432</identifier><identifier>PMID: 31125419</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adolescent ; and Commentaries ; Child ; Cohort Studies ; Diarrhea - epidemiology ; Escherichia coli Infections - epidemiology ; Female ; Hemolytic-Uremic Syndrome - epidemiology ; Hemolytic-Uremic Syndrome - therapy ; Humans ; Renal Replacement Therapy ; Shiga-Toxigenic Escherichia coli</subject><ispartof>Clinical infectious diseases, 2020-04, Vol.70 (8), p.1643-1651</ispartof><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-6147998259f39282432d8f9046c42aa1486a23b1e164128c8340a58ddc973fe73</citedby><cites>FETCH-LOGICAL-c408t-6147998259f39282432d8f9046c42aa1486a23b1e164128c8340a58ddc973fe73</cites><orcidid>0000-0003-2319-6192</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31125419$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McKee, Ryan S</creatorcontrib><creatorcontrib>Schnadower, David</creatorcontrib><creatorcontrib>Tarr, Phillip I</creatorcontrib><creatorcontrib>Xie, Jianling</creatorcontrib><creatorcontrib>Finkelstein, Yaron</creatorcontrib><creatorcontrib>Desai, Neil</creatorcontrib><creatorcontrib>Lane, Roni D</creatorcontrib><creatorcontrib>Bergmann, Kelly R</creatorcontrib><creatorcontrib>Kaplan, Ron L</creatorcontrib><creatorcontrib>Hariharan, Selena</creatorcontrib><creatorcontrib>Cruz, Andrea T</creatorcontrib><creatorcontrib>Cohen, Daniel M</creatorcontrib><creatorcontrib>Dixon, Andrew</creatorcontrib><creatorcontrib>Ramgopal, Sriram</creatorcontrib><creatorcontrib>Rominger, Annie</creatorcontrib><creatorcontrib>Powell, Elizabeth C</creatorcontrib><creatorcontrib>Kilgar, Jennifer</creatorcontrib><creatorcontrib>Michelson, Kenneth A</creatorcontrib><creatorcontrib>Beer, Darcy</creatorcontrib><creatorcontrib>Bitzan, Martin</creatorcontrib><creatorcontrib>Pruitt, Christopher M</creatorcontrib><creatorcontrib>Yen, Kenneth</creatorcontrib><creatorcontrib>Meckler, Garth D</creatorcontrib><creatorcontrib>Plint, Amy C</creatorcontrib><creatorcontrib>Bradin, Stuart</creatorcontrib><creatorcontrib>Abramo, Thomas J</creatorcontrib><creatorcontrib>Gouin, Serge</creatorcontrib><creatorcontrib>Kam, April J</creatorcontrib><creatorcontrib>Schuh, Abigail</creatorcontrib><creatorcontrib>Balamuth, Fran</creatorcontrib><creatorcontrib>Hunley, Tracy E</creatorcontrib><creatorcontrib>Kanegaye, John T</creatorcontrib><creatorcontrib>Jones, Nicholas E</creatorcontrib><creatorcontrib>Avva, Usha</creatorcontrib><creatorcontrib>Porter, Robert</creatorcontrib><creatorcontrib>Fein, Daniel M</creatorcontrib><creatorcontrib>Louie, Jeffrey P</creatorcontrib><creatorcontrib>Freedman, Stephen B</creatorcontrib><creatorcontrib>Pediatric Emergency Medicine Collaborative Research Committee and Pediatric Emergency Research Canada</creatorcontrib><title>Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care.
Methods
We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible.
Results
Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69–.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42–4.54]), higher hematocrit (1.83 [1.21–2.77] per 5% increase) and serum creatinine (10.82 [1.49–78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02–3.60]), lower serum sodium (1.12 [1.02–1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14–5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54–.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14–4.50]), younger age (0.83 [.74–.92] per year), lower serum sodium (1.15 [1.04–1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17–4.72]) and creatinine (7.75 [1.20–50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18–6.21]).
Conclusions
The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
Among Shiga toxin–producing Escherichia coli–infected children without hemolytic uremic syndrome (HUS) brought for emergency department evaluation, 14% developed HUS. Younger age; elevated white blood cell count, hematocrit, and creatinine; early presentation; and delayed intravenous fluid administration predicted HUS.</description><subject>Adolescent</subject><subject>and Commentaries</subject><subject>Child</subject><subject>Cohort Studies</subject><subject>Diarrhea - epidemiology</subject><subject>Escherichia coli Infections - epidemiology</subject><subject>Female</subject><subject>Hemolytic-Uremic Syndrome - epidemiology</subject><subject>Hemolytic-Uremic Syndrome - therapy</subject><subject>Humans</subject><subject>Renal Replacement Therapy</subject><subject>Shiga-Toxigenic Escherichia coli</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kctKxDAUhoMojreNDyDZuBGqubVNNoIMoyMIijOzLjFJp5E2KWlHHFfiK_iGPomR0UE3LpITOF--cPIDcIjRKUaCnimr43phlGyAHZzSPMlSgTfjGaU8YZzyAdjtukeEMOYo3QYDijFJGRY74O0uGG1Vb90cjk3j62VvFZwF08QyWTodfGOgdBreGyfruLe1VKYxrofTygTZLqF1cFLZuYRT_2zdx-t7G7xeqC_lqFMRsqqyEipf29i0rjSqNxoOK1vrYNw-2Cpl3ZmD77oHZpej6XCc3NxeXQ8vbhLFEO-TDLNcCE5SUVJBOInjal4KxDLFiJSY8UwS-oANzhgmXHHKkEy51krktDQ53QPnK2-7eGiMVnGEIOuiDbaRYVl4aYu_HWerYu6filxQzCmJgpOVQAXfdcGU67sYFV9JFDGJYpVEhI9-v7ZGf74-AscrwC_a_0SfoZeWTw</recordid><startdate>20200410</startdate><enddate>20200410</enddate><creator>McKee, Ryan S</creator><creator>Schnadower, David</creator><creator>Tarr, Phillip I</creator><creator>Xie, Jianling</creator><creator>Finkelstein, Yaron</creator><creator>Desai, Neil</creator><creator>Lane, Roni D</creator><creator>Bergmann, Kelly R</creator><creator>Kaplan, Ron L</creator><creator>Hariharan, Selena</creator><creator>Cruz, Andrea T</creator><creator>Cohen, Daniel M</creator><creator>Dixon, Andrew</creator><creator>Ramgopal, Sriram</creator><creator>Rominger, Annie</creator><creator>Powell, Elizabeth C</creator><creator>Kilgar, Jennifer</creator><creator>Michelson, Kenneth A</creator><creator>Beer, Darcy</creator><creator>Bitzan, Martin</creator><creator>Pruitt, Christopher M</creator><creator>Yen, Kenneth</creator><creator>Meckler, Garth D</creator><creator>Plint, Amy C</creator><creator>Bradin, Stuart</creator><creator>Abramo, Thomas J</creator><creator>Gouin, Serge</creator><creator>Kam, April J</creator><creator>Schuh, Abigail</creator><creator>Balamuth, Fran</creator><creator>Hunley, Tracy E</creator><creator>Kanegaye, John T</creator><creator>Jones, Nicholas E</creator><creator>Avva, Usha</creator><creator>Porter, Robert</creator><creator>Fein, Daniel M</creator><creator>Louie, Jeffrey P</creator><creator>Freedman, Stephen B</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2319-6192</orcidid></search><sort><creationdate>20200410</creationdate><title>Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children</title><author>McKee, Ryan S ; Schnadower, David ; Tarr, Phillip I ; Xie, Jianling ; Finkelstein, Yaron ; Desai, Neil ; Lane, Roni D ; Bergmann, Kelly R ; Kaplan, Ron L ; Hariharan, Selena ; Cruz, Andrea T ; Cohen, Daniel M ; Dixon, Andrew ; Ramgopal, Sriram ; Rominger, Annie ; Powell, Elizabeth C ; Kilgar, Jennifer ; Michelson, Kenneth A ; Beer, Darcy ; Bitzan, Martin ; Pruitt, Christopher M ; Yen, Kenneth ; Meckler, Garth D ; Plint, Amy C ; Bradin, Stuart ; Abramo, Thomas J ; Gouin, Serge ; Kam, April J ; Schuh, Abigail ; Balamuth, Fran ; Hunley, Tracy E ; Kanegaye, John T ; Jones, Nicholas E ; Avva, Usha ; Porter, Robert ; Fein, Daniel M ; Louie, Jeffrey P ; Freedman, Stephen B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-6147998259f39282432d8f9046c42aa1486a23b1e164128c8340a58ddc973fe73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>and Commentaries</topic><topic>Child</topic><topic>Cohort Studies</topic><topic>Diarrhea - epidemiology</topic><topic>Escherichia coli Infections - epidemiology</topic><topic>Female</topic><topic>Hemolytic-Uremic Syndrome - epidemiology</topic><topic>Hemolytic-Uremic Syndrome - therapy</topic><topic>Humans</topic><topic>Renal Replacement Therapy</topic><topic>Shiga-Toxigenic Escherichia coli</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McKee, Ryan S</creatorcontrib><creatorcontrib>Schnadower, David</creatorcontrib><creatorcontrib>Tarr, Phillip I</creatorcontrib><creatorcontrib>Xie, Jianling</creatorcontrib><creatorcontrib>Finkelstein, Yaron</creatorcontrib><creatorcontrib>Desai, Neil</creatorcontrib><creatorcontrib>Lane, Roni D</creatorcontrib><creatorcontrib>Bergmann, Kelly R</creatorcontrib><creatorcontrib>Kaplan, Ron L</creatorcontrib><creatorcontrib>Hariharan, Selena</creatorcontrib><creatorcontrib>Cruz, Andrea T</creatorcontrib><creatorcontrib>Cohen, Daniel M</creatorcontrib><creatorcontrib>Dixon, Andrew</creatorcontrib><creatorcontrib>Ramgopal, Sriram</creatorcontrib><creatorcontrib>Rominger, Annie</creatorcontrib><creatorcontrib>Powell, Elizabeth C</creatorcontrib><creatorcontrib>Kilgar, Jennifer</creatorcontrib><creatorcontrib>Michelson, Kenneth A</creatorcontrib><creatorcontrib>Beer, Darcy</creatorcontrib><creatorcontrib>Bitzan, Martin</creatorcontrib><creatorcontrib>Pruitt, Christopher M</creatorcontrib><creatorcontrib>Yen, Kenneth</creatorcontrib><creatorcontrib>Meckler, Garth D</creatorcontrib><creatorcontrib>Plint, Amy C</creatorcontrib><creatorcontrib>Bradin, Stuart</creatorcontrib><creatorcontrib>Abramo, Thomas J</creatorcontrib><creatorcontrib>Gouin, Serge</creatorcontrib><creatorcontrib>Kam, April J</creatorcontrib><creatorcontrib>Schuh, Abigail</creatorcontrib><creatorcontrib>Balamuth, Fran</creatorcontrib><creatorcontrib>Hunley, Tracy E</creatorcontrib><creatorcontrib>Kanegaye, John T</creatorcontrib><creatorcontrib>Jones, Nicholas E</creatorcontrib><creatorcontrib>Avva, Usha</creatorcontrib><creatorcontrib>Porter, Robert</creatorcontrib><creatorcontrib>Fein, Daniel M</creatorcontrib><creatorcontrib>Louie, Jeffrey P</creatorcontrib><creatorcontrib>Freedman, Stephen B</creatorcontrib><creatorcontrib>Pediatric Emergency Medicine Collaborative Research Committee and Pediatric Emergency Research Canada</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McKee, Ryan S</au><au>Schnadower, David</au><au>Tarr, Phillip I</au><au>Xie, Jianling</au><au>Finkelstein, Yaron</au><au>Desai, Neil</au><au>Lane, Roni D</au><au>Bergmann, Kelly R</au><au>Kaplan, Ron L</au><au>Hariharan, Selena</au><au>Cruz, Andrea T</au><au>Cohen, Daniel M</au><au>Dixon, Andrew</au><au>Ramgopal, Sriram</au><au>Rominger, Annie</au><au>Powell, Elizabeth C</au><au>Kilgar, Jennifer</au><au>Michelson, Kenneth A</au><au>Beer, Darcy</au><au>Bitzan, Martin</au><au>Pruitt, Christopher M</au><au>Yen, Kenneth</au><au>Meckler, Garth D</au><au>Plint, Amy C</au><au>Bradin, Stuart</au><au>Abramo, Thomas J</au><au>Gouin, Serge</au><au>Kam, April J</au><au>Schuh, Abigail</au><au>Balamuth, Fran</au><au>Hunley, Tracy E</au><au>Kanegaye, John T</au><au>Jones, Nicholas E</au><au>Avva, Usha</au><au>Porter, Robert</au><au>Fein, Daniel M</au><au>Louie, Jeffrey P</au><au>Freedman, Stephen B</au><aucorp>Pediatric Emergency Medicine Collaborative Research Committee and Pediatric Emergency Research Canada</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2020-04-10</date><risdate>2020</risdate><volume>70</volume><issue>8</issue><spage>1643</spage><epage>1651</epage><pages>1643-1651</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
Shiga toxin–producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care.
Methods
We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children aged <18 years who submitted STEC-positive specimens between January 2011 and December 2015 at a participating study institution were eligible.
Results
Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69–.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42–4.54]), higher hematocrit (1.83 [1.21–2.77] per 5% increase) and serum creatinine (10.82 [1.49–78.69] per 1 mg/dL increase), platelet count <250 × 103/μL (1.92 [1.02–3.60]), lower serum sodium (1.12 [1.02–1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14–5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54–.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14–4.50]), younger age (0.83 [.74–.92] per year), lower serum sodium (1.15 [1.04–1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17–4.72]) and creatinine (7.75 [1.20–50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18–6.21]).
Conclusions
The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring.
Among Shiga toxin–producing Escherichia coli–infected children without hemolytic uremic syndrome (HUS) brought for emergency department evaluation, 14% developed HUS. Younger age; elevated white blood cell count, hematocrit, and creatinine; early presentation; and delayed intravenous fluid administration predicted HUS.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>31125419</pmid><doi>10.1093/cid/ciz432</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2319-6192</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2020-04, Vol.70 (8), p.1643-1651 |
| issn | 1058-4838 1537-6591 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7931832 |
| source | Oxford Journals Online |
| subjects | Adolescent and Commentaries Child Cohort Studies Diarrhea - epidemiology Escherichia coli Infections - epidemiology Female Hemolytic-Uremic Syndrome - epidemiology Hemolytic-Uremic Syndrome - therapy Humans Renal Replacement Therapy Shiga-Toxigenic Escherichia coli |
| title | Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin–producing Escherichia coli–infected Children |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T12%3A46%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-oup_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Predicting%20Hemolytic%20Uremic%20Syndrome%20and%20Renal%20Replacement%20Therapy%20in%20Shiga%20Toxin%E2%80%93producing%20Escherichia%20coli%E2%80%93infected%20Children&rft.jtitle=Clinical%20infectious%20diseases&rft.au=McKee,%20Ryan%20S&rft.aucorp=Pediatric%20Emergency%20Medicine%20Collaborative%20Research%20Committee%20and%20Pediatric%20Emergency%20Research%20Canada&rft.date=2020-04-10&rft.volume=70&rft.issue=8&rft.spage=1643&rft.epage=1651&rft.pages=1643-1651&rft.issn=1058-4838&rft.eissn=1537-6591&rft_id=info:doi/10.1093/cid/ciz432&rft_dat=%3Coup_pubme%3E10.1093/cid/ciz432%3C/oup_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c408t-6147998259f39282432d8f9046c42aa1486a23b1e164128c8340a58ddc973fe73%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_id=info:pmid/31125419&rft_oup_id=10.1093/cid/ciz432&rfr_iscdi=true |