Hemolytic uremic syndrome caused by Shiga toxin–producing <em>Escherichia coli</em> in children : incidence, risk factors, and clinical outcome
Ylinen, Elisa; Salmenlinna, Saara; Halkilahti, Jani; Jahnukainen, Timo; Korhonen, Linda; Virkkala, Tiia; Rimhanen-Finne, Ruska; Nuutinen, Matti; Kataja, Janne; Arikoski, Pekka; Linkosalo, Laura; Bai, Xiangning; Matussek, Andreas; Jalanko, Hannu; Saxén, Harri (2020-04-22)
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). https://doi.org/10.1007/s00467-020-04560-0
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https://urn.fi/URN:NBN:fi-fe2020091769942
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Abstract
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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