Need for Long-term Follow-up in Enterohemorrhagic Escherichia coli—Associated Hemolytic Uremic Syndrome Due to Late-Emerging Sequelae
Background. The aim of this study was to evaluate the long-term prognosis of children with hemolytic uremic syndrome (HUS). Methods. Over a 6-year period, 619 pediatric patients with the clinical diagnosis of HUS were registered in Austria and Germany, and a subset (n = 274) was prospectively follow...
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| Veröffentlicht in: | Clinical infectious diseases 2012-05, Vol.54 (10), p.1413-1421 |
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| creator | Karch, Helga Rosales, Alejandra Hofer, Johannes Zimmerhackl, Lothar-Bernd Jungraithmayr, Therese C. Riedl, Magdalena Giner, Thomas Strasak, Alexander Orth-Höller, Dorothea Würzner, Reinhard Karch, Helge |
| description | Background. The aim of this study was to evaluate the long-term prognosis of children with hemolytic uremic syndrome (HUS). Methods. Over a 6-year period, 619 pediatric patients with the clinical diagnosis of HUS were registered in Austria and Germany, and a subset (n = 274) was prospectively followed up for 5 years. Results. Infection with enterohemorrhagic Escherichia coli (EHEC) was confirmed in 79% of cases. Five years after diagnosis, 70% of EHEC-infected patients (95% confidence interval [CI], .63—.76) were fully recovered. The remaining 30% had persistent hypertension (9%), neurological symptoms (4%), decreased glomerular filtration rate (7%), and/or proteinuria (18%). Hypertension and proteinuria developed in a total of 18% of patients who had no sequelae 1 year after the acute phase (95% CI, 12—26). Multivariate logistic regression analysis demonstrated an association between the use of plasma therapy during acute phase and poor long-term outcome (odds ratio, 2.9—13; 95% CI, 2.4—33; P < .05), but this treatment was also used more frequently in severe cases. In contrast, the use of antibiotic therapy in the diarrheal phase and other established risk factors for developing HUS, such as Shiga toxin 2 and EHEC serotypes traditionally considered to be "high risk," were not associated with adverse long-term outcome. In particular, there was no difference between O157 and non-O157 EHEC. Conclusions. This study identified an association between the use of plasma treatment and poor long-term outcome and confirms already known risk factors for poor prognosis. Follow-up investigations for at least 5 years are recommended to detect late-emerging sequelae. |
| doi_str_mv | 10.1093/cid/cis196 |
| format | Article |
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The aim of this study was to evaluate the long-term prognosis of children with hemolytic uremic syndrome (HUS). Methods. Over a 6-year period, 619 pediatric patients with the clinical diagnosis of HUS were registered in Austria and Germany, and a subset (n = 274) was prospectively followed up for 5 years. Results. Infection with enterohemorrhagic Escherichia coli (EHEC) was confirmed in 79% of cases. Five years after diagnosis, 70% of EHEC-infected patients (95% confidence interval [CI], .63—.76) were fully recovered. The remaining 30% had persistent hypertension (9%), neurological symptoms (4%), decreased glomerular filtration rate (7%), and/or proteinuria (18%). Hypertension and proteinuria developed in a total of 18% of patients who had no sequelae 1 year after the acute phase (95% CI, 12—26). Multivariate logistic regression analysis demonstrated an association between the use of plasma therapy during acute phase and poor long-term outcome (odds ratio, 2.9—13; 95% CI, 2.4—33; P < .05), but this treatment was also used more frequently in severe cases. In contrast, the use of antibiotic therapy in the diarrheal phase and other established risk factors for developing HUS, such as Shiga toxin 2 and EHEC serotypes traditionally considered to be "high risk," were not associated with adverse long-term outcome. In particular, there was no difference between O157 and non-O157 EHEC. Conclusions. This study identified an association between the use of plasma treatment and poor long-term outcome and confirms already known risk factors for poor prognosis. Follow-up investigations for at least 5 years are recommended to detect late-emerging sequelae.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/cis196</identifier><identifier>PMID: 22412065</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Anti-Bacterial Agents - therapeutic use ; ARTICLES AND COMMENTARIES ; Austria - epidemiology ; Bacterial infections ; Biological and medical sciences ; Blood plasma ; Child, Preschool ; Clinical outcomes ; Delayed Diagnosis - statistics & numerical data ; Dialysis ; E coli ; Enterohemorrhagic Escherichia coli - isolation & purification ; Escherichia coli ; Escherichia coli Infections - complications ; Escherichia coli Infections - microbiology ; Escherichia coli Infections - therapy ; Female ; Follow-Up Studies ; Germany - epidemiology ; Hematologic and hematopoietic diseases ; Hemolytic uremic syndrome ; Hemolytic-Uremic Syndrome - diagnosis ; Hemolytic-Uremic Syndrome - epidemiology ; Humans ; Hypertension ; Infant ; Infections ; Infectious diseases ; Male ; Medical disorders ; Medical prognosis ; Medical sciences ; Medical treatment ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Neurologic manifestations ; Pediatrics ; Platelet diseases and coagulopathies ; Predisposing factors ; Prospective Studies ; Proteinuria ; Renal failure ; Risk factors ; Transfusion Reaction ; Treatment Outcome</subject><ispartof>Clinical infectious diseases, 2012-05, Vol.54 (10), p.1413-1421</ispartof><rights>Copyright © 2012 Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>2015 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press May 15, 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-437c09e4c2f75fd6717c56ca5b41926e98b727c790c89983f2d88f7c962cfc6b3</citedby><cites>FETCH-LOGICAL-c403t-437c09e4c2f75fd6717c56ca5b41926e98b727c790c89983f2d88f7c962cfc6b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/23213294$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/23213294$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25905988$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22412065$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karch, Helga</creatorcontrib><creatorcontrib>Rosales, Alejandra</creatorcontrib><creatorcontrib>Hofer, Johannes</creatorcontrib><creatorcontrib>Zimmerhackl, Lothar-Bernd</creatorcontrib><creatorcontrib>Jungraithmayr, Therese C.</creatorcontrib><creatorcontrib>Riedl, Magdalena</creatorcontrib><creatorcontrib>Giner, Thomas</creatorcontrib><creatorcontrib>Strasak, Alexander</creatorcontrib><creatorcontrib>Orth-Höller, Dorothea</creatorcontrib><creatorcontrib>Würzner, Reinhard</creatorcontrib><creatorcontrib>Karch, Helge</creatorcontrib><creatorcontrib>German-Austrian HUS Study Group</creatorcontrib><creatorcontrib>German-Austrian HUS Study Group</creatorcontrib><creatorcontrib>for the German-Austrian HUS Study Group</creatorcontrib><title>Need for Long-term Follow-up in Enterohemorrhagic Escherichia coli—Associated Hemolytic Uremic Syndrome Due to Late-Emerging Sequelae</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Background. The aim of this study was to evaluate the long-term prognosis of children with hemolytic uremic syndrome (HUS). Methods. Over a 6-year period, 619 pediatric patients with the clinical diagnosis of HUS were registered in Austria and Germany, and a subset (n = 274) was prospectively followed up for 5 years. Results. Infection with enterohemorrhagic Escherichia coli (EHEC) was confirmed in 79% of cases. Five years after diagnosis, 70% of EHEC-infected patients (95% confidence interval [CI], .63—.76) were fully recovered. The remaining 30% had persistent hypertension (9%), neurological symptoms (4%), decreased glomerular filtration rate (7%), and/or proteinuria (18%). Hypertension and proteinuria developed in a total of 18% of patients who had no sequelae 1 year after the acute phase (95% CI, 12—26). Multivariate logistic regression analysis demonstrated an association between the use of plasma therapy during acute phase and poor long-term outcome (odds ratio, 2.9—13; 95% CI, 2.4—33; P < .05), but this treatment was also used more frequently in severe cases. In contrast, the use of antibiotic therapy in the diarrheal phase and other established risk factors for developing HUS, such as Shiga toxin 2 and EHEC serotypes traditionally considered to be "high risk," were not associated with adverse long-term outcome. In particular, there was no difference between O157 and non-O157 EHEC. Conclusions. This study identified an association between the use of plasma treatment and poor long-term outcome and confirms already known risk factors for poor prognosis. Follow-up investigations for at least 5 years are recommended to detect late-emerging sequelae.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Austria - epidemiology</subject><subject>Bacterial infections</subject><subject>Biological and medical sciences</subject><subject>Blood plasma</subject><subject>Child, Preschool</subject><subject>Clinical outcomes</subject><subject>Delayed Diagnosis - statistics & numerical data</subject><subject>Dialysis</subject><subject>E coli</subject><subject>Enterohemorrhagic Escherichia coli - isolation & purification</subject><subject>Escherichia coli</subject><subject>Escherichia coli Infections - complications</subject><subject>Escherichia coli Infections - microbiology</subject><subject>Escherichia coli Infections - therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Germany - epidemiology</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hemolytic uremic syndrome</subject><subject>Hemolytic-Uremic Syndrome - diagnosis</subject><subject>Hemolytic-Uremic Syndrome - epidemiology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Infant</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical disorders</subject><subject>Medical prognosis</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Neurologic manifestations</subject><subject>Pediatrics</subject><subject>Platelet diseases and coagulopathies</subject><subject>Predisposing factors</subject><subject>Prospective Studies</subject><subject>Proteinuria</subject><subject>Renal failure</subject><subject>Risk factors</subject><subject>Transfusion Reaction</subject><subject>Treatment Outcome</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0c9rFDEUB_BBFFurF-9KoAgijOb3j2OpWysseqg9D9k3md0sM5M1mUH25s1_oH9h_xKf7GrBQ3gh-eS9wLeqXjL6nlEnPkBscRXm9KPqlClhaq0ce4x7qmwtrbAn1bNStpQyZql6Wp1wLhmnWp1Wv76E0JIuZbJM47qeQh7IVer79KOedySOZDHiWdqEIeW88esIZFFgE3KETfQEUh_vf95dlJIg-glbXaPs9xO62xwGLDf7sc1pCOTjHMiUyBJZvRhCXsdxTW7C9zn0PjyvnnS-L-HFsZ5Vt1eLb5fX9fLrp8-XF8saJBVTLYUB6oIE3hnVtdowA0qDVyvJHNfB2ZXhBoyjYJ2zouOttZ0Bpzl0oFfirHp76LvLCSeXqRligdD3fgxpLg2jzAopOeVIz_-j2zTnEX-HimvHpbES1buDgpxKyaFrdjkOPu8RNX_iaTCe5hAP4tfHlvNqCO0_-jcPBG-OwBfwfZf9iE8fnHJUOWvRvTq4bZlSfrgXnAnupPgN2WqjtQ</recordid><startdate>20120515</startdate><enddate>20120515</enddate><creator>Karch, Helga</creator><creator>Rosales, Alejandra</creator><creator>Hofer, Johannes</creator><creator>Zimmerhackl, Lothar-Bernd</creator><creator>Jungraithmayr, Therese C.</creator><creator>Riedl, Magdalena</creator><creator>Giner, Thomas</creator><creator>Strasak, Alexander</creator><creator>Orth-Höller, Dorothea</creator><creator>Würzner, Reinhard</creator><creator>Karch, Helge</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20120515</creationdate><title>Need for Long-term Follow-up in Enterohemorrhagic Escherichia coli—Associated Hemolytic Uremic Syndrome Due to Late-Emerging Sequelae</title><author>Karch, Helga ; Rosales, Alejandra ; Hofer, Johannes ; Zimmerhackl, Lothar-Bernd ; Jungraithmayr, Therese C. ; Riedl, Magdalena ; Giner, Thomas ; Strasak, Alexander ; Orth-Höller, Dorothea ; Würzner, Reinhard ; Karch, Helge</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-437c09e4c2f75fd6717c56ca5b41926e98b727c790c89983f2d88f7c962cfc6b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Austria - epidemiology</topic><topic>Bacterial infections</topic><topic>Biological and medical sciences</topic><topic>Blood plasma</topic><topic>Child, Preschool</topic><topic>Clinical outcomes</topic><topic>Delayed Diagnosis - statistics & numerical data</topic><topic>Dialysis</topic><topic>E coli</topic><topic>Enterohemorrhagic Escherichia coli - isolation & purification</topic><topic>Escherichia coli</topic><topic>Escherichia coli Infections - complications</topic><topic>Escherichia coli Infections - microbiology</topic><topic>Escherichia coli Infections - therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Germany - epidemiology</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hemolytic uremic syndrome</topic><topic>Hemolytic-Uremic Syndrome - diagnosis</topic><topic>Hemolytic-Uremic Syndrome - epidemiology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Infant</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical disorders</topic><topic>Medical prognosis</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Neurologic manifestations</topic><topic>Pediatrics</topic><topic>Platelet diseases and coagulopathies</topic><topic>Predisposing factors</topic><topic>Prospective Studies</topic><topic>Proteinuria</topic><topic>Renal failure</topic><topic>Risk factors</topic><topic>Transfusion Reaction</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karch, Helga</creatorcontrib><creatorcontrib>Rosales, Alejandra</creatorcontrib><creatorcontrib>Hofer, Johannes</creatorcontrib><creatorcontrib>Zimmerhackl, Lothar-Bernd</creatorcontrib><creatorcontrib>Jungraithmayr, Therese C.</creatorcontrib><creatorcontrib>Riedl, Magdalena</creatorcontrib><creatorcontrib>Giner, Thomas</creatorcontrib><creatorcontrib>Strasak, Alexander</creatorcontrib><creatorcontrib>Orth-Höller, Dorothea</creatorcontrib><creatorcontrib>Würzner, Reinhard</creatorcontrib><creatorcontrib>Karch, Helge</creatorcontrib><creatorcontrib>German-Austrian HUS Study Group</creatorcontrib><creatorcontrib>German-Austrian HUS Study Group</creatorcontrib><creatorcontrib>for the German-Austrian HUS Study Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karch, Helga</au><au>Rosales, Alejandra</au><au>Hofer, Johannes</au><au>Zimmerhackl, Lothar-Bernd</au><au>Jungraithmayr, Therese C.</au><au>Riedl, Magdalena</au><au>Giner, Thomas</au><au>Strasak, Alexander</au><au>Orth-Höller, Dorothea</au><au>Würzner, Reinhard</au><au>Karch, Helge</au><aucorp>German-Austrian HUS Study Group</aucorp><aucorp>German-Austrian HUS Study Group</aucorp><aucorp>for the German-Austrian HUS Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Need for Long-term Follow-up in Enterohemorrhagic Escherichia coli—Associated Hemolytic Uremic Syndrome Due to Late-Emerging Sequelae</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2012-05-15</date><risdate>2012</risdate><volume>54</volume><issue>10</issue><spage>1413</spage><epage>1421</epage><pages>1413-1421</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. The aim of this study was to evaluate the long-term prognosis of children with hemolytic uremic syndrome (HUS). Methods. Over a 6-year period, 619 pediatric patients with the clinical diagnosis of HUS were registered in Austria and Germany, and a subset (n = 274) was prospectively followed up for 5 years. Results. Infection with enterohemorrhagic Escherichia coli (EHEC) was confirmed in 79% of cases. Five years after diagnosis, 70% of EHEC-infected patients (95% confidence interval [CI], .63—.76) were fully recovered. The remaining 30% had persistent hypertension (9%), neurological symptoms (4%), decreased glomerular filtration rate (7%), and/or proteinuria (18%). Hypertension and proteinuria developed in a total of 18% of patients who had no sequelae 1 year after the acute phase (95% CI, 12—26). Multivariate logistic regression analysis demonstrated an association between the use of plasma therapy during acute phase and poor long-term outcome (odds ratio, 2.9—13; 95% CI, 2.4—33; P < .05), but this treatment was also used more frequently in severe cases. In contrast, the use of antibiotic therapy in the diarrheal phase and other established risk factors for developing HUS, such as Shiga toxin 2 and EHEC serotypes traditionally considered to be "high risk," were not associated with adverse long-term outcome. In particular, there was no difference between O157 and non-O157 EHEC. Conclusions. This study identified an association between the use of plasma treatment and poor long-term outcome and confirms already known risk factors for poor prognosis. Follow-up investigations for at least 5 years are recommended to detect late-emerging sequelae.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>22412065</pmid><doi>10.1093/cid/cis196</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2012-05, Vol.54 (10), p.1413-1421 |
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| source | Electronic Journals Library; Jstor Complete Legacy; Oxford University Press Journals; MEDLINE; Alma/SFX Local Collection |
| subjects | Anti-Bacterial Agents - therapeutic use ARTICLES AND COMMENTARIES Austria - epidemiology Bacterial infections Biological and medical sciences Blood plasma Child, Preschool Clinical outcomes Delayed Diagnosis - statistics & numerical data Dialysis E coli Enterohemorrhagic Escherichia coli - isolation & purification Escherichia coli Escherichia coli Infections - complications Escherichia coli Infections - microbiology Escherichia coli Infections - therapy Female Follow-Up Studies Germany - epidemiology Hematologic and hematopoietic diseases Hemolytic uremic syndrome Hemolytic-Uremic Syndrome - diagnosis Hemolytic-Uremic Syndrome - epidemiology Humans Hypertension Infant Infections Infectious diseases Male Medical disorders Medical prognosis Medical sciences Medical treatment Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Neurologic manifestations Pediatrics Platelet diseases and coagulopathies Predisposing factors Prospective Studies Proteinuria Renal failure Risk factors Transfusion Reaction Treatment Outcome |
| title | Need for Long-term Follow-up in Enterohemorrhagic Escherichia coli—Associated Hemolytic Uremic Syndrome Due to Late-Emerging Sequelae |
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