Long-term outcome and prognostic indicators in the hemolytic-uremic syndrome

AbstractOur objective was to establish the rate of neurological involvement in Shiga toxin-producing Escherichia coli–hemolytic uremic syndrome (STEC-HUS) and describe the clinical presentation, management and outcome. A retrospective chart review of children aged ≤ 16 years with STEC-HUS in Children’s Health Ireland from 2005 to 2018 was conducted. Laboratory confirmation of STEC infection was required for inclusion. Neurological involvement was defined as encephalopathy, focal neurological deficit, and/or seizure activity. Data on clinical presentation, management, and outcome were collected. We identified 240 children with HUS; 202 had confirmed STEC infection. Neurological involvement occurred in 22 (11%). The most common presentation was seizures (73%). In the neurological group, 19 (86%) were treated with plasma exchange and/or eculizumab. Of the 21 surviving children with neurological involvement, 19 (91%) achieved a complete neurological recovery. A higher proportion of children in the neurological group had renal sequelae (27% vs. 12%, P = .031). One patient died from multi-organ failure.Conclusion: We have identified the rate of neurological involvement in a large cohort of children with STEC-HUS as 11%. Neurological involvement in STEC-HUS is associated with good long-term outcome (complete neurological recovery in 91%) and a low case-fatality rate (4.5%) in our cohort. What is Known:• HUS is associated with neurological involvement in up to 30% of cases.• Neurological involvement has been reported as predictor of poor outcome, with associated increased morbidity and mortality. What is New:• The incidence of neurological involvement in STEC-HUS is 11%.• Neurological involvement is associated with predominantly good long-term outcome (90%) and a reduced case-fatality rate (4.5%) compared to older reports.

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Evaluation of Clinical, Laboratory and Ultrasonography Variables as Prognostic Indicators in Equine Colic Surgery

Indian Journal of Animal Research ◽

10.18805/ijar.b-4264 ◽

2021 ◽

Author(s):

Gurpal Singh ◽

Vandana Sangwan ◽

Arun Anand ◽

Jasmeet Singh Khosa ◽

Simrat Sagar Singh ◽

...

Keyword(s):

Wheat Straw ◽

Prognostic Indicators ◽

Peritoneal Cytology ◽

Polymorphonuclear Cells ◽

Intestinal Histology ◽

Term Outcome ◽

Long Term Outcome ◽

Post Surgery ◽

Equine Colic

Background: Equine colic surgery is an expensive procedure and availability of reliable prognostic indicators aid in decision making process. This study aimed to evaluate clinical, hemato-biochemistry, ultrasonography, surgery and peritoneal cytology / intestinal histology as prognostic indicators (based on strangulating vs non-strangulating lesion) for equine colic surgery. Methods: Fifteen equines {13 females and 2 males; 5 Thoroughbred, 9 Marwari and one mule} operated for intestinal colic were investigated. The feeding history, pre and post-surgery clinical, hematological and biochemical findings were recorded. Pre and post-surgery ultrasonography, peritoneal cytology and intestinal histology were done. Three equine were euthanized intra-operatively and 12 were followed for short and long term outcome. Result: On surgery, three equine were diagnosed for strangulating (right dorsal displacement of large colon, large colon volvulus and small colon strangulation) and 12 for non-strangulating colic {impaction (3), fecalith (5), sand colic (2), foreign body (1) and small intestine ileus (1)}. Detection of polymorphonuclear cells alone or with lymphocytes on peritoneal fluid cytology was indicator of good prognosis. Feeding of wheat straw is major predisposing factor for non-strangulating colic in Marwari breed but had favorable surgical prognosis (7/9=77.78%). While Thoroughbreds, not on wheat straw, are susceptible to strangulating colic that require early referral for favorable surgical outcome. Prolonged capillary refill time, injected mucous membranes, absent borborygymi, high serum creatine kinase and glucose are poor prognostic indicators for colic surgery. Thoroughbred equine with severe pain, elevated levels of Hb, neutrophils, packed cell volume (PCV), serum glucose and low peritoneal total protein are indicators of strangulating lesion. The equine colic surgery bears a very good short term (10/12=83.33%) and excellent (10/10=100%) long term outcome.

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Successful long-term outcome after renal transplantation in a patient with atypical haemolytic uremic syndrome with combined membrane cofactor protein CD46 and complement factor I mutations

Pediatric Nephrology ◽

10.1007/s00467-013-2450-7 ◽

2013 ◽

Vol 28 (7) ◽

pp. 1141-1144 ◽

Cited By ~ 3

Author(s):

Werner Lukas Pabst ◽

Thomas J. Neuhaus ◽

Samuel Nef ◽

Elena Bresin ◽

Andrea Zingg-Schenk ◽

...

Keyword(s):

Renal Transplantation ◽

Complement Factor ◽

Membrane Cofactor Protein ◽

Term Outcome ◽

Long Term Outcome ◽

Haemolytic Uremic Syndrome ◽

Factor I ◽

Complement Factor I ◽

Uremic Syndrome

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Renal function at hospital admission as a prognostic factor in adult hemolytic uremic syndrome. The Italian Registry of Haemolytic Uremic Syndrome.

Journal of the American Society of Nephrology ◽

10.1681/asn.v2111640 ◽

1992 ◽

Vol 2 (11) ◽

pp. 1640-1644 ◽

Cited By ~ 1

Author(s):

A Schieppati ◽

P Ruggenenti ◽

R P Cornejo ◽

F Ferrario ◽

G Gregorini ◽

...

Keyword(s):

Renal Function ◽

Hemolytic Uremic Syndrome ◽

Acute Phase ◽

Renal Involvement ◽

Laboratory Data ◽

Elevated Serum ◽

Long Term Outcome ◽

Uremic Syndrome ◽

Clinical Records

The clinical records of adult patients with a diagnosis of hemolytic uremic syndrome were retrospectively reviewed with the aim of evaluating the long-term outcome of renal function. The setting is the Italian Registry of Haemolytic Uraemic Syndrome, with which 13 Nephrology Centers have participated. Clinical and laboratory data of 43 patients with hemolytic uremic syndrome were evaluated. The mean age at onset was 34.3 +/- 18.3 yr. Men and women were equally affected. No seasonal trend in presentation was observed. In 20 patients, hemolytic uremic syndrome was primitive, whereas in 23, it was associated with another disease (cancer, preeclampsia, malignant hypertension, vasculitides). Gastrointestinal symptoms were the most frequently observed prodromes. Thirty (70%) patients required dialysis during the acute phase of the disease. Six patients died during the acute phase of the disease, and one died later after discharge (overall mortality, 16%). After 1 yr of follow-up, 11 (26%) patients had recovered a normal renal function, 14 (33%) had hypertension and/or renal insufficiency, and 11 (26%) were on regular dialysis. When prognostic factors of survival and recovery of renal function were considered, it was found that older age was associated with higher mortality in the acute phase, whereas severe renal involvement at the onset of the disease (as expressed by elevated serum creatinine) was associated with a long-term unfavorable prognosis.

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