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Multicenter Study
. 2020 Sep;35(9):1749-1759.
doi: 10.1007/s00467-020-04560-0. Epub 2020 Apr 22.

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

Elisa Ylinen  1 , Saara Salmenlinna  2 , Jani Halkilahti  2 , Timo Jahnukainen  3 , Linda Korhonen  4   5 , Tiia Virkkala  3 , Ruska Rimhanen-Finne  2 , Matti Nuutinen  4   5 , Janne Kataja  6 , Pekka Arikoski  7 , Laura Linkosalo  8 , Xiangning Bai  9 , Andreas Matussek  9   10 , Hannu Jalanko  3 , Harri Saxén  3
Affiliations
Multicenter Study

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

Elisa Ylinen et al. Pediatr Nephrol. 2020 Sep.

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.

Keywords: Hemolytic uremic syndrome; Kidney failure; Shiga toxin subtypes; Shiga toxins; Shiga toxin–producing E.coli (STEC).

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Incidence of STEC-HUS according to age groups of pediatric patients, Finland 2000–2016 (n = 87)
Fig. 2
Fig. 2
Serogroups of STEC isolates in pediatric patients with HUS, Finland 2000–2016. ONT O non-typeable
See this image and copyright information in PMC

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