{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:03:36Z","timestamp":1791378216899,"version":"4.3.2"},"reference-count":16,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title><jats:p>Acute severe neurologic involvement is the most threatening complication in children with hemolytic-uremic syndrome (HUS). Our primary study objectives were to describe the association between acute neurologic manifestations (ANMs) and in-hospital mortality among children with HUS.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>Using the Pediatric Health Information System database, in this retrospective multicenter cohort study, we identified the first HUS-related inpatient visit among children \u226418 years (years 2004\u20132018). Frequency of selected ANMs and combinations of ANMs, as well as the rate of mortality, was calculated. Multivariate logistic regression was used to identify the association of ANMs and the risk of in-hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Among 3915 patients included in the analysis, an ANM was noted in 10.4% (n = 409) patients. Encephalopathy was the most common ANM (n = 245). Mortality was significantly higher among patients with an ANM compared with patients without an ANM (13.9% vs 1.8%; P &amp;lt; .001). Individuals with any ANM had increased odds of mortality (odds ratio [OR]: 2.25; 95% confidence interval [CI]: 1.29\u20133.93; P = .004), with greater risk (OR: 2.60; 95% CI: 1.34\u20135.06; P = .005) among patients with \u22652 manifestations. Brain hemorrhage (OR: 3.09; 95% CI: 1.40\u20136.82; P = .005), brain infarction (OR: 2.64; 95% CI: 1.10\u20136.34; P = .03), anoxic brain injury (OR: 3.92; 95% CI: 1.49\u201310.31; P = .006), and brain edema (OR: 4.81; 95% CI: 1.82\u201312.71; P = .002) were independently associated with mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>In this study, the largest systematic assessment of ANMs among children with HUS to date, we identify differences in in-hospital mortality based on the type of ANM, with increased risk observed for patients with multiple ANMs.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2020-013631","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T09:27:00Z","timestamp":1613122020000},"source":"Crossref","is-referenced-by-count":16,"title":["Severe Acute Neurologic Involvement in Children With Hemolytic-Uremic Syndrome"],"prefix":"10.1542","volume":"147","author":[{"given":"Clare C.","family":"Brown","sequence":"first","affiliation":[{"name":"Health Policy and Management Department, Fay W. Boozman College of Public Health and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiomara","family":"Garcia","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, and Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children\u2019s Hospital, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupal T.","family":"Bhakta","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, and Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children\u2019s Hospital, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Sanders","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parthak","family":"Prodhan","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, and Pediatric Critical Care, University of Arkansas for Medical Sciences and Arkansas Children\u2019s Hospital, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2021,3,1]]},"reference":[{"issue":"6","key":"2021120906273464900_B1","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/S0031-3955(16)40096-9","article-title":"The hemolytic uremic syndrome","volume":"42","author":"Siegler","year":"1995","journal-title":"Pediatr Clin North Am"},{"issue":"3","key":"2021120906273464900_B2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1136\/archdischild-2016-311377","article-title":"Treatment and management of children with haemolytic uraemic syndrome","volume":"103","author":"Walsh","year":"2018","journal-title":"Arch Dis Child"},{"issue":"8","key":"2021120906273464900_B3","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s00467-018-3933-3","article-title":"Extra-renal manifestations of atypical hemolytic uremic syndrome in children","volume":"33","author":"Fidan","year":"2018","journal-title":"Pediatr Nephrol"},{"issue":"11","key":"2021120906273464900_B4","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1038\/nrneph.2012.196","article-title":"Renal and neurological involvement in typical Shiga toxin-associated HUS","volume":"8","author":"Trachtman","year":"2012","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"2021120906273464900_B5","first-page":"32","article-title":"Chronic neurological complications in hemolytic uremic syndrome in children","volume":"13","author":"Tavasoli","year":"2019","journal-title":"Iran J Kidney Dis"},{"issue":"9","key":"2021120906273464900_B6","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1007\/s00467-014-2803-x","article-title":"Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome","volume":"29","author":"Bauer","year":"2014","journal-title":"Pediatr Nephrol"},{"issue":"7","key":"2021120906273464900_B7","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.2215\/CJN.08921209","article-title":"Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome","volume":"5","author":"Nathanson","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"issue":"10","key":"2021120906273464900_B8","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1007\/s00467-014-2817-4","article-title":"An audit analysis of a guideline for the investigation and initial therapy of diarrhea negative (atypical) hemolytic uremic syndrome","volume":"29","author":"Johnson","year":"2014","journal-title":"Pediatr Nephrol"},{"issue":"12","key":"2021120906273464900_B9","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1007\/s00467-018-4033-0","article-title":"Outbreak of Shiga toxin-producing Escherichia-coli-associated hemolytic uremic syndrome in Istanbul in 2015: outcome and experience with eculizumab","volume":"33","author":"A\u011fba\u015f","year":"2018","journal-title":"Pediatr Nephrol"},{"issue":"4","key":"2021120906273464900_B10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1055\/s-0042-108444","article-title":"Extrarenal manifestations in Shigatoxin-associated haemolytic uremic syndrome","volume":"228","author":"Matthies","year":"2016","journal-title":"Klin Padiatr"},{"issue":"10","key":"2021120906273464900_B11","first-page":"22","article-title":"Achieving data quality. 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