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Frequency of neurological involvement in patients with/without diarrhea hemolytic uremic syndrome: A Systematic
Azita Tavasoli1, Nazanin Zafaranloo1, Rozita Hoseini1
1Ali-Asghar Children Hospital, Iran University of Medical and Sciences, Tehran, Iran.
Insights
Diarrhea-associated hemolytic uremic syndrome (D+HUS) and diarrhea-negative HUS (D-HUS) frequently cause neurological complications. Seizures are the most common symptom, potentially leading to epilepsy.
Area of Science:
- Pediatric Nephrology
- Pediatric Neurology
- Infectious Diseases
Background:
- Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common HUS subtype.
- Central nervous system (CNS) involvement is a frequent extrarenal manifestation in pediatric D+HUS.
- Understanding the neurological impact of HUS is crucial for patient management.
Purpose of the Study:
- To systematically review and meta-analyze the frequency of neurological complications in patients with HUS.
- To identify the specific neurological symptoms and their prevalence in D+HUS and D-HUS.
- To highlight the potential long-term neurological sequelae.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science databases.
- Independent quality assessment and data extraction by two researchers.
- Meta-analysis using CMA v. 2.2.064. with heterogeneity assessment (I-squared test) and fixed/random-effects models.
Main Results:
- Analysis of 21 studies with 2,189 participants (median age 1.3-40 years).
- Neurological complications observed in 27.0% of D+HUS patients; seizures occurred in 20.8%.
- In D-HUS patients, 20.8% had neurological symptoms, with seizures (30.5%), coma (17.5%), and lethargy (17.2%) being most common.
Conclusions:
- Over one-fourth of both D+HUS and D-HUS patients present with neurological symptoms.
- Seizures are the most prevalent neurological manifestation in HUS.
- Prompt recognition and management of neurological symptoms are vital to prevent potential epilepsy.
Abstract:
Background: Diarrhea-associated-hemolytic-uremic-syndrome (D+HUS) is a common from of HUS. Central-nervous-system (CNS) involvement is one of the most common extrarenal organ involvements in children with D+HUS. This systematic review and meta-analysis aim to recognize the frequency of neurological complications in pts with HUS. Methods: Databases of PubMed, Embase, and Web of Science were searched systematically to find the papers on neurological involvement in HUS pts. Two researchers independently assessed the papers' quality and extracted data. CMA v. 2.2.064. was used for data analysis. Heterogeneity was evaluated using the I-squared (I2) test, and a fixed/random-effects model was used when appropriate. Results: In this review, 21 studies including 2,189 participants with a median age between 1.3-40-year-old, entered the meta-analysis. The meta-analysis in D+HUS patients indicated 27.0% with neurological complications (95% CI, 22.0%-32.6%), 25.5% of symptoms weren't categorized (95% CI, 15.9%-38.3%), 20.8% of them developed the seizures (95% CI, 2.3%-74.4%). In D-HUS pts, 20.8% of them were presented neurological symptoms (95% CI, 17.9%-24.0%), of which 29.0% weren't categorized (95% CI, 19.2%-41.2%), 17.5% of pts got into coma (95% CI, 9.6%-29.7%), 5.6 % showed hemiparesis (95% CI, 2.8%-10.9%), 17.2% experienced lethargy (95% CI, 5.2%-44.1%), 30.5% developed the seizures (95% CI, 18.2%-46.2%), 7.4% manifested speech abnormalities (95% CI, 0.2%-7.22%), 6.4% of D-HUS pts presented visual-disturbances (95% CI, 3.4%-11.6%). Conclusion: This systematic review and meta-analysis indicated more than one-fourth of both D+HUS and D-HUS patients were presented with neurological symptoms, and the most prevalent symptoms were seizures, which can lead to an epilepsy sequel.
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