A novel scoring system for the prediction of disease severity in STEC‐HUS

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BACKGROUND: Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a life-threatening condition complicated by acute kidney injury, acute respiratory distress syndrome, and central nervous system disorders. The early identification of high-risk patients is required to facilitate timely and appropriate treatment. METHODS: The medical records of patients with STEC-HUS treated at 11 hospitals in Hokkaido, Japan, were reviewed retrospectively. A multi-institutional retrospective analysis was performed in which patients were divided into two groups according to the presence or absence of severe complications requiring blood purification therapy or encephalopathy. We compared the laboratory values at diagnosis between the severe and mild groups. To identify patients at high risk of developing severe complications, a scoring system, referred to as the "STEC-HUS severity (STEC-HUSS) score," was constructed based on the parameters showing significant differences. RESULTS: Of the 41 patients with STEC-HUS, 11 were classified into the severe group and 30 into the mild group. Significant differences were observed between the groups in terms of white blood cell count, activated partial thromboplastin time, fibrinogen, D-dimer, total protein, aspartate transaminase, alanine transaminase, lactate dehydrogenase, creatinine, and C-reactive protein levels. The STEC-HUSS score was calculated on a scale of 0-10 by summing the number of test items that demonstrated abnormal values. The STEC-HUSS score, when the cut-off value was 4, showed a sensitivity of 100% and a specificity of 91% in the severe group. CONCLUSION: We developed a novel scoring system to identify patients at high risk of severe STEC-HUS.