Full Citation
Title: Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity
Citation Type: Journal Article
Publication Year: 2018
ISBN:
ISSN: 16180607
DOI: 10.1016/j.ijmm.2018.10.002
NSFID:
PMCID:
PMID: 30466555
Abstract: Background: 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. Methods: 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. Results: 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%). Conclusions: 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.
Url: https://pubmed.ncbi.nlm.nih.gov/30466555/
User Submitted?: No
Authors: Tarr, Gillian A.M.; Oltean, Hanna N.; Phipps, Amanda I.; Rabinowitz, Peter; Tarr, Phillip I.
Periodical (Full): International Journal of Medical Microbiology
Issue: 8
Volume: 308
Pages: 1121-1127
Countries: