Skip to main content
Top
Published in: European Journal of Pediatrics 1/2018

01-01-2018 | Original Article

Blood urea nitrogen to serum creatinine ratio as a prognostic factor in diarrhea-associated hemolytic uremic syndrome: a validation study

Authors: Alejandro Balestracci, Luciana Meni Battaglia, Ismael Toledo, Sandra Mariel Martin, Caupolican Alvarado

Published in: European Journal of Pediatrics | Issue 1/2018

Login to get access

Abstract

Identifying those children with complicated forms of diarrhea-associated hemolytic uremic syndrome (D+HUS) on admission can optimize their management. Recently, the blood urea nitrogen to serum creatinine ratio (BCR) at admission has been proposed as a novel and accurate predictor of complicated clinical outcome in D+HUS; therefore, we performed this retrospective study aimed to validate such observation in a larger series of patients. A complicated course was defined as developing one or more of the following: severe neurological or bowel injury, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, hemorrhage, and death. Data from 161 children were reviewed, 50 of them with a complicated disease including five deaths. Those with worse evolution presented a lower admission BCR than those with good outcome (22.5 vs. 30.8; p = 0.005). BCR at admission showed a limited ability to identify children at risk of a complicated course, with an AUC of 0.63 (95% CI 0.58–0.71) and an optimal cutoff point of ≤ 26.7, which achieves a sensitivity of 70% (95% CI 55.2–81.7) and a specificity of 56.7% (95% CI 47–66).
Conclusion: In this validation study, the BCR at admission provided a limited value to predict severe forms of D+HUS.
What is Known:
BCR at admission has been proposed as an accurate predictor of complicated clinical course in children with D+HUS.
What is New:
In a larger series of children with D+HUS, we were unable to confirm the usefulness of the admission BCR to early identify those at risk of complicated forms of the disease.
Further research is warranted to improve the optimal detection of these high-risk patients.
Literature
7.
go back to reference Grisaru S, Xie J, Samuel S, Hartling L, Tarr PI, Schnadower D, Freedman SB (2017) Alberta Provincial Pediatric Enteric Infection Team. Associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli: a systematic review and meta-analysis. JAMA Pediatr 171(1):68–76. doi:https://doi.org/10.1001/jamapediatrics.2016.2952 CrossRefPubMed Grisaru S, Xie J, Samuel S, Hartling L, Tarr PI, Schnadower D, Freedman SB (2017) Alberta Provincial Pediatric Enteric Infection Team. Associations between hydration status, intravenous fluid administration, and outcomes of patients infected with Shiga toxin-producing Escherichia coli: a systematic review and meta-analysis. JAMA Pediatr 171(1):68–76. doi:https://​doi.​org/​10.​1001/​jamapediatrics.​2016.​2952 CrossRefPubMed
13.
go back to reference National high blood pressure education program working group on high blood pressure in children and adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 Suppl 4th Report):555–576CrossRef National high blood pressure education program working group on high blood pressure in children and adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 Suppl 4th Report):555–576CrossRef
17.
Metadata
Title
Blood urea nitrogen to serum creatinine ratio as a prognostic factor in diarrhea-associated hemolytic uremic syndrome: a validation study
Authors
Alejandro Balestracci
Luciana Meni Battaglia
Ismael Toledo
Sandra Mariel Martin
Caupolican Alvarado
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 1/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-017-2999-4

Other articles of this Issue 1/2018

European Journal of Pediatrics 1/2018 Go to the issue