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

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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.

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Abbreviations

AKI:

Acute kidney injury

AUC:

Area under the curve

BCR:

Blood urea nitrogen to serum creatinine ratio

BUN:

Blood urea nitrogen

CI:

Confidence interval

Cr:

Creatinine

D+HUS:

Diarrhea-associated hemolytic uremic syndrome

HUS:

Hemolytic uremic syndrome

ROC:

Receiver operating characteristic

STEC:

Shiga toxin-producing enterohemorrhagic Escherichia coli

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Funding

No funding was provided to perform this study.

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Authors and Affiliations

  1. Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, CP 1270, Ciudad Autónoma de Buenos Aires, Argentina

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

Authors
  1. Alejandro Balestracci
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  2. Luciana Meni Battaglia
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  3. Ismael Toledo
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  4. Sandra Mariel Martin
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  5. Caupolican Alvarado
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Contributions

Dr. Alejandro Balestracci planned the study and wrote the initial draft of this paper; all authors were involved in gathering data, paper revision, analysis, and final approval of this paper.

Corresponding author

Correspondence to Alejandro Balestracci.

Ethics declarations

The study was performed in accordance with the ethical standards of the institutional research and ethics committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Mario Bianchetti

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Balestracci, A., Meni Battaglia, L., Toledo, I. et al. Blood urea nitrogen to serum creatinine ratio as a prognostic factor in diarrhea-associated hemolytic uremic syndrome: a validation study. Eur J Pediatr 177, 63–68 (2018). https://doi.org/10.1007/s00431-017-2999-4

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  • DOI: https://doi.org/10.1007/s00431-017-2999-4

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