University of Oulu

Ylinen, E., Salmenlinna, S., Halkilahti, J. et al. Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children: incidence, risk factors, and clinical outcome. Pediatr Nephrol 35, 1749–1759 (2020).

Hemolytic uremic syndrome caused by Shiga toxin–producing Escherichia coli in children : incidence, risk factors, and clinical outcome

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Author: Ylinen, Elisa1; Salmenlinna, Saara2; Halkilahti, Jani2;
Organizations: 1Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, University of Helsinki and Helsinki University Hospital|, P.O. Box 347, 00029 HUS, Helsinki, Finland
2Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
3Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
4PEDEGO Research Unit, Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Medical Research Center Oulu (MRC Oulu), Oulu, Finland
5Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
6Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
7Department of Pediatrics, Tampere University Hospital, Tampere, Finland
8Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Laboratory, Stockholm, Sweden
9Division of Laboratory Medicine, Oslo University Hospital, Oslo, Norway
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2020
Publish Date: 2020-09-17


Background: Hemolytic uremic syndrome (HUS) is a multisystemic disease. In a nationwide study, we characterized the incidence, clinical course, and prognosis of HUS caused by Shiga toxin (Stx)–producing Escherichia coli (STEC) strains with emphasis on risk factors, disease severity, and long-term outcome.

Methods: The data on pediatric HUS patients from 2000 to 2016 were collected from the medical records. STEC isolates from fecal cultures of HUS and non-HUS patients were collected from the same time period and characterized by whole genome sequencing analysis.

Results: Fifty-eight out of 262 culture-positive cases developed verified (n = 58, 22%) STEC-HUS. Another 29 cases had probable STEC-HUS, the annual incidence of STEC-HUS being 0.5 per 100,000 children. Eleven different serogroups were detected, O157 being the most common (n = 37, 66%). Age under 3 years (OR 2.4), stx2 (OR 9.7), and stx2a (OR 16.6) were found to be risk factors for HUS. Fifty-five patients (63%) needed dialysis. Twenty-nine patients (33%) developed major neurological symptoms. Complete renal recovery was observed in 57 patients after a median 4.0 years of follow-up. Age under 3 years, leukocyte count over 20 × 10⁹/L, and need for dialysis were predictive factors for poor renal outcome.

Conclusions: Age under 3 years, stx2, and stx2a were risk factors for HUS in STEC-positive children. However, serogroup or stx types did not predict the renal outcome or major CNS symptoms.

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Series: Pediatric nephrology
ISSN: 0931-041X
ISSN-E: 1432-198X
ISSN-L: 0931-041X
Volume: 35
Issue: 9
Pages: 1749 - 1759
DOI: 10.1007/s00467-020-04560-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3121 General medicine, internal medicine and other clinical medicine
Funding: Open access funding provided by University of Helsinki including Helsinki University Central Hospital. This study was supported by the Päivikki and Sakari Sohlberg Foundation, Sigrid Juselius Foundation, the Pediatric Research Foundation, Helsinki University Central Hospital, and Scandinavian Society for Antimicrobial Chemotherapy Foundation research grants.
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