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

Elisa Ylinen, Saara Salmenlinna, Jani Halkilahti, Timo Jahnukainen, Linda Korhonen, Tiia Virkkala, Ruska Rimhanen-Finne, Matti Nuutinen, Janne Kataja, Pekka Arikoski, Laura Linkosalo, Xiangning Bai, Andreas Matussek, Hannu Jalanko, Harri Saxén

    Research output: Contribution to journalArticleScientificpeer-review

    49 Citations (Scopus)
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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.

    Original languageEnglish
    Pages (from-to)1749-1759
    Number of pages11
    JournalPEDIATRIC NEPHROLOGY
    Volume35
    Issue number9
    DOIs
    Publication statusPublished - 22 Apr 2020
    Publication typeA1 Journal article-refereed

    Keywords

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

    Publication forum classification

    • Publication forum level 2

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Nephrology

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