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Infection in Patients with Suspected Thrombotic Microangiopathy Based on Clinical Presentation

Benjamin Thoreau1, Florent von Tokarski1, Adeline Bauvois1

  • 1Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Néphrologie Pédiatrique, Hôpital Bretonneau et Hôpital Clocheville, Centre Hospitalier Universitaire (CHU) Tours, Tours, France et French Clinical Research Network Infrastructure-Cardiovascular and Renal Clinical Trialists, Tours, France.

Clinical Journal of the American Society of Nephrology : CJASN
|September 9, 2021
PubMed
Abstract

Insights

Thrombotic microangiopathies are often caused by infections unrelated to shigatoxin-producing E. coli (STEC). These infections increase the risk of death, cardiovascular events, and dialysis, with enterobacteria and Staphylococcus aureus being common culprits.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Hematology

Background:

  • Thrombotic microangiopathies (TMA) are a group of serious conditions.
  • Shigatoxin-associated Escherichia coli (STEC) is a known cause of TMA, leading to hemolytic uremic syndrome (HUS).
  • STEC-unrelated infections causing TMA are less understood.

Purpose of the Study:

  • To investigate the epidemiology of STEC-unrelated infections in patients with TMA.
  • To analyze the outcomes associated with STEC-unrelated infections, including death, acute dialysis, and major cardiovascular events.
  • To identify common pathogens involved in STEC-unrelated TMA.

Main Methods:

  • A retrospective study was conducted across four hospitals.
  • Data from 530 patients with adjudicated thrombotic microangiopathies between 2009 and 2016 were analyzed.
  • Patients were categorized into three groups: STEC-unrelated infection, TMA without infection, and STEC-HUS.

Main Results:

  • STEC-unrelated infections were identified in 27% of TMA patients.
  • Patients with STEC-unrelated infections were older, more likely to be male, and presented with altered consciousness and lower blood pressure compared to those without infection.
  • Common pathogens included enterobacteria (41%), Staphylococcus aureus (11%), and Epstein-Barr virus (20%).
  • STEC-unrelated infections were independent risk factors for in-hospital death (OR 2.22), major cardiovascular events (OR 3.43), and acute dialysis (OR 3.48).
  • Bacterial infections, particularly enterobacteria and non-shigatoxin E. coli, were linked to a higher risk of acute dialysis.

Conclusions:

  • Infections are frequent triggers for thrombotic microangiopathies, predominantly unrelated to STEC.
  • STEC-unrelated infections significantly increase the risk of mortality and major complications in TMA patients.
  • Enterobacteria, Staphylococcus aureus, Epstein-Barr virus, and cytomegalovirus are the most frequently identified pathogens in these cases.
Keywords:
acute kidney injuryclinical epidemiologyclinical nephrologycytomegalovirusepidemiology and outcomeshemolytic uremic syndromeinfectionsthrombotic microangiopathies

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