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National Institute of Environmental Health Sciences

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Publication Detail

Title: Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity.

Authors: Tarr, Gillian A M; Oltean, Hanna N; Phipps, Amanda I; Rabinowitz, Peter; Tarr, Phillip I

Published In Int J Med Microbiol, (2018 Dec)

Abstract: Multiple case definitions for post-diarrheal hemolytic uremic syndrome (D+ HUS) associated with Shiga toxin-producing Escherichia coli (STEC) are used across public health, research, and clinical practice.To identify a single definition of D+ HUS for standardized use, we evaluated the comparability and validity of four common, heterogeneous definitions: the Council of State and Territorial Epidemiologists (CSTE) definition, hematology-focused and age-focused definitions from the literature, and hospital diagnosis. We reviewed medical records from 471 hospitalized E. coli O157:H7 cases reported in Washington State, 2005-2014. We assessed 1) reliability across definitions, 2) comparability of temporal trends, and 3) sensitivity and specificity using an omnibus reference standard, developed using a combination of definition agreement and clinical outcomes. With the standard, we classified cases as definite, borderline, or unlikely/not post-diarrheal D+ HUS.Reliability was highest between the age-focused definition and hospital diagnosis (κ = 0.84), and temporal trends were largely comparable across definitions. For definite D+ HUS cases, the age-focused definition had the highest overall validity [100% sensitivity, 95% confidence interval (CI): 94%, 100%; 96% specificity, 95% CI: 94%, 98%]. The CSTE definition had low specificity (75%, 95% CI: 70%, 79%).In this review, the CSTE definition overestimated the burden of D+ HUS, and the age-focused definition provided the best overall reliability and validity to define post-diarrheal D+ HUS. Disease monitoring and research activities should consider using the age-focused D+ HUS definition.

PubMed ID: 30466555 Exiting the NIEHS site

MeSH Terms: Diagnosis, Differential; Diarrhea/complications*; Diarrhea/epidemiology; Escherichia coli Infections/complications*; Escherichia coli O157/isolation & purification*; Female; Hemolytic-Uremic Syndrome/diagnosis*; Hemolytic-Uremic Syndrome/epidemiology; Hemolytic-Uremic Syndrome/etiology*; Humans; Incidence; Male; Practice Guidelines as Topic; Retrospective Studies; Sensitivity and Specificity; Shiga-Toxigenic Escherichia coli/isolation & purification; Washington/epidemiology

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