Early Differentiation of Shiga Toxin–Associated Hemolytic Uremic Syndrome in Critically Ill Adults With Thrombotic Microangiopathy Syndromes

Objectives: Thrombotic microangiopathy syndromes are a heterogeneous group of severe diseases that often require ICU admission. Prompt initiation of targeted therapies is required for atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, whereas there is no specific consensus therapy for Shiga toxin–associated hemolytic uremic syndrome. We sought to compare the characteristics of Shiga toxin–associated hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura patients at admission in the ICU to allow early differentiation of Shiga toxin–associated hemolytic uremic syndrome from other thrombotic microangiopathy syndromes and help to tailor initial treatment. Design: Retrospective cohort study. Setting: Two ICUs part of the French reference center for thrombotic microangiopathy syndromes. Patients: Adult patients presenting with features of thrombotic microangiopathy syndromes. Other causes than Shiga toxin–associated hemolytic uremic syndrome, atypical hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura were excluded. Interventions: None. Measurements and Main Results: From September 2003 to January 2017, 236 thrombotic microangiopathy syndrome patients were admitted, including 12 Shiga toxin–associated hemolytic uremic syndrome, 21 atypical hemolytic uremic syndrome, and 91 thrombotic thrombocytopenic purpura. Shiga toxin–associated hemolytic uremic syndrome patients were older than other thrombotic microangiopathy syndromes patients (64 yr [interquartile range, 50–72 yr] vs 42 yr [31–54 yr]; p = 0.007) and presented with more frequent digestive symptoms (92% vs 42%; p

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