Predicting Adverse Outcomes in Children with Shiga Toxin-Producing E. Coli (STEC) Using a Novel Prognostic Index

Student Researcher:
Chu Yang Lin

Supervisor / Principle Investigator:
Stephen Freedman

Additional Authors:
Gillian A Tarr

MD Class of 2021


Introduction: Nearly 15% of pediatric patients (<10 years of age) infected with Shiga-toxin producing Escherichia coli will develop hemolytic uremic syndrome (HUS), a severe renal complication. Other potential complications include neurological sequelae, respiratory failure and death. A prognostic index was recently developed by the ITALKID HUS Group to assess patients’ outcomes after developing HUS, but the utility of the prognostic index prior to HUS development has not been explored. The present study aims to assess the clinical performance of this simple prognostic index in predicting adverse outcomes in all STEC patients before HUS diagnosis.

Methods: The prognostic index consists of a severity score, calculated as [hemoglobin (g/dL) + serum creatinine (mg/dL)*2]. Scores were calculated using data from a novel cohort of 913 children with STEC infections from across 37 emergency departments in North America, from 2011 to 2017. Dichotomized scores (with cut-off of 13) were used to calculate sensitivity and specificity of score in predicting adverse outcomes due to STEC infections.

Results: A total of 654 children had sufficient laboratory values to calculate the clinical severity score. 80.7% of children had scores >13, and these children were more likely to have bloody diarrhea than children with scores ≤13. This prognostic index has a sensitivity of 79.3% for predicting undesirable outcomes such as central lines, dialysis and transfusion requirement. However, the prognostic index had a notable 100% sensitivity for predicting seizure, death and pancreatitis – all severe complications.

Conclusion: This score may aid physicians in identifying children at low-risk for severe adverse events and thus perhaps do not require hospital admission.