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American Academy of Pediatrics
Article

Severe Acute Neurologic Involvement in Children With Hemolytic-Uremic Syndrome

Clare C. Brown, Xiomara Garcia, Rupal T. Bhakta, Emily Sanders and Parthak Prodhan
Pediatrics March 2021, 147 (3) e2020013631; DOI: https://doi.org/10.1542/peds.2020-013631
Clare C. Brown
aHealth Policy and Management Department, Fay W. Boozman College of Public Health and
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Xiomara Garcia
bPediatric Cardiology, and Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas
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Rupal T. Bhakta
bPediatric Cardiology, and Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas
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Emily Sanders
cDepartments of Pediatrics,
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Parthak Prodhan
bPediatric Cardiology, and Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas
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Abstract

BACKGROUND AND OBJECTIVES: Acute severe neurologic involvement is the most threatening complication in children with hemolytic-uremic syndrome (HUS). Our primary study objectives were to describe the association between acute neurologic manifestations (ANMs) and in-hospital mortality among children with HUS.

METHODS: Using the Pediatric Health Information System database, in this retrospective multicenter cohort study, we identified the first HUS-related inpatient visit among children ≤18 years (years 2004–2018). Frequency of selected ANMs and combinations of ANMs, as well as the rate of mortality, was calculated. Multivariate logistic regression was used to identify the association of ANMs and the risk of in-hospital mortality.

RESULTS: Among 3915 patients included in the analysis, an ANM was noted in 10.4% (n = 409) patients. Encephalopathy was the most common ANM (n = 245). Mortality was significantly higher among patients with an ANM compared with patients without an ANM (13.9% vs 1.8%; P < .001). Individuals with any ANM had increased odds of mortality (odds ratio [OR]: 2.25; 95% confidence interval [CI]: 1.29–3.93; P = .004), with greater risk (OR: 2.60; 95% CI: 1.34–5.06; P = .005) among patients with ≥2 manifestations. Brain hemorrhage (OR: 3.09; 95% CI: 1.40–6.82; P = .005), brain infarction (OR: 2.64; 95% CI: 1.10–6.34; P = .03), anoxic brain injury (OR: 3.92; 95% CI: 1.49–10.31; P = .006), and brain edema (OR: 4.81; 95% CI: 1.82–12.71; P = .002) were independently associated with mortality.

CONCLUSIONS: In this study, the largest systematic assessment of ANMs among children with HUS to date, we identify differences in in-hospital mortality based on the type of ANM, with increased risk observed for patients with multiple ANMs.

  • Accepted November 4, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 3
1 Mar 2021
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Severe Acute Neurologic Involvement in Children With Hemolytic-Uremic Syndrome
Clare C. Brown, Xiomara Garcia, Rupal T. Bhakta, Emily Sanders, Parthak Prodhan
Pediatrics Mar 2021, 147 (3) e2020013631; DOI: 10.1542/peds.2020-013631

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Severe Acute Neurologic Involvement in Children With Hemolytic-Uremic Syndrome
Clare C. Brown, Xiomara Garcia, Rupal T. Bhakta, Emily Sanders, Parthak Prodhan
Pediatrics Mar 2021, 147 (3) e2020013631; DOI: 10.1542/peds.2020-013631
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