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Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity.
Int J Med Microbiol. 2018 Dec; 308(8):1121-1127.IJ

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.

Authors+Show Affiliations

Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA. Electronic address: gillian.tarr@ahs.ca.Washington State Department of Health, 1610 NE 150th15 St., Shoreline, WA, 98155, USA. Electronic address: Hanna.Oltean@doh.wa.gov.Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA. Electronic address: ipps@uw.edu.Department of Environmental and Occupational Health Sciences and Center for One Health Research, University of Washington, Box 357234, Seattle, WA, 98195, USA. Electronic address: peterr7@uw.edu.Department of Pediatrics, Washington University in St. Louis School of Medicine, One Children's Place, St. Louis, MO, 63110, USA. Electronic address: tarr@wustl.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30466555

Citation

Tarr, Gillian A M., et al. "Case Definitions of Hemolytic Uremic Syndrome Following Escherichia Coli O157:H7 Infection Vary in Validity." International Journal of Medical Microbiology : IJMM, vol. 308, no. 8, 2018, pp. 1121-1127.
Tarr GAM, Oltean HN, Phipps AI, et al. Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity. Int J Med Microbiol. 2018;308(8):1121-1127.
Tarr, G. A. M., Oltean, H. N., Phipps, A. I., Rabinowitz, P., & Tarr, P. I. (2018). Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity. International Journal of Medical Microbiology : IJMM, 308(8), 1121-1127. https://doi.org/10.1016/j.ijmm.2018.10.002
Tarr GAM, et al. Case Definitions of Hemolytic Uremic Syndrome Following Escherichia Coli O157:H7 Infection Vary in Validity. Int J Med Microbiol. 2018;308(8):1121-1127. PubMed PMID: 30466555.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case definitions of hemolytic uremic syndrome following Escherichia coli O157:H7 infection vary in validity. AU - Tarr,Gillian A M, AU - Oltean,Hanna N, AU - Phipps,Amanda I, AU - Rabinowitz,Peter, AU - Tarr,Phillip I, Y1 - 2018/10/10/ PY - 2018/07/25/received PY - 2018/10/01/revised PY - 2018/10/05/accepted PY - 2018/11/24/entrez PY - 2018/11/24/pubmed PY - 2019/1/30/medline KW - E. coli O157:H7 KW - Hemolytic uremic syndrome KW - Shiga toxin-producing Escherichia coli KW - Surveillance SP - 1121 EP - 1127 JF - International journal of medical microbiology : IJMM JO - Int. J. Med. Microbiol. VL - 308 IS - 8 N2 - 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. SN - 1618-0607 UR - https://www.unboundmedicine.com/medline/citation/30466555/Case_definitions_of_hemolytic_uremic_syndrome_following_Escherichia_coli_O157:H7_infection_vary_in_validity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1438-4221(18)30394-1 DB - PRIME DP - Unbound Medicine ER -