INTRODUCTION: Shiga toxin-producing Escherichia coli (STEC) causes hemorrhagic colitis and hemolytic uremic syndrome (STEC-HUS). Understanding its prognostic factors is essential for immediate interventions. We examined early-phase unfavorable prognostic factors among patients with STEC-HUS using a nationwide database.
MATERIAL AND METHODS: This is a retrospective cohort study to analyze practice patterns and identify prognostic factors among patients with STEC-HUS. We used the Diagnosis Procedure Combination Database, which includes approximately half of the acute-care hospitalized patients in Japan. We enrolled patients who were hospitalized for STEC-HUS from July 2010 to March 2020. The composite unfavorable outcome included in-hospital death, mechanical ventilation, dialysis, and rehabilitation at discharge. Unfavorable prognostic factors were assessed using a multivariable logistic regression model.
RESULTS: We included 615 patients with STEC-HUS (median age, 7 years). Of them, 30 (4.9%) patients had acute encephalopathy and 24 (3.9%) died within 3 months of admission. Unfavorable composite outcome was observed in 124 (20.2%) patients. Significant unfavorable prognostic factors were age of 18 years or older, methylprednisolone pulse therapy, antiepileptic drug administration, and respiratory support within 2 days of admission.
DISCUSSION: Patients requiring early steroid pulse therapy, antiepileptic drugs, and respiratory support were considered to be in poor general condition; such patients should receive aggressive intervention to avoid worse outcomes.
|投稿者||Myojin, Shota; Michihata, Nobuaki; Shoji, Kensuke; Takanashi, Jun-Ichi; Matsui, Hiroki; Fushimi, Kiyohide; Miyairi, Isao; Yasunaga, Hideo|
|組織名||Division of Infectious Diseases, Department of Medical Subspecialties, National;Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo,;157-8535, Japan.;Department of Health Services Research, Graduate School of Medicine, The;University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.;157-8535, Japan. Electronic address: firstname.lastname@example.org.;Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical;Center, 477-96, Owadashinden, Yachiyo-city, Chiba, 276-8524, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.;Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1,;Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.|