PEDIATRICS Vol. 90 No. 4 October 1992, pp. 616-621
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Risk Factors for the Central Nervous System Manifestations of Gastroenteritis-Associated Hemolytic-Uremic Syndrome

Nevio Cimolai MD, FRCP(C)1, Brenda J. Morrison PhD2, and James E. Carter MB, ChB, FRCP(C)3

1 From the Department of Pathology, University of British Columbia, Vancouver, Canada
2 From the Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
3 From the Department of Pediatrics, University of British Columbia, Vancouver, Canada

Hemolytic-uremic syndrome is usually a consequence of enteric verotoxigenic Escherichia coli infection, and a prevailing hypothesis contends that systemically absorbed verotoxins are responsible for the multiple organ involvement. In an attempt to determine whether the central nervous system (CNS) manifestations could occur owing to factors that reflect a toxin insult, the authors studied the association of clinical and laboratory variables with the development of neurological disease. Ninety-one patients with hemolytic-uremic syndrome from 1982 through 1990 were included. Twenty-seven (18 female, 9 male) had a CNS disorder; 17 of these had seizures and there were two deaths. Multivariate analyses led to the following observations: female gender (odds ratio [OR] 8.50; 95% confidence interval [CI] 2.08 to 50.0), prolonged use of an antimotility pharmacological agent (OR 8.50; 95% CI 1.69 to 42.81), and an increased hemoglobin level (OR 1.11; 95% CI 1.05 to 1.17) were associated with an increased risk for developing a neurological manifestation. Prior administration of a blood product was associated with a decreased risk (OR 0.12; 95% CI 0.02 to 0.52). The findings suggest that other mechanisms for CNS disease may exist in addition to direct toxin insult.

Key Words: hemolytic-uremic syndrome • seizure • encephalopathy

Submitted on February 20, 1992
Accepted on May 8, 1992




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