Liver Involvement in Children with Hemolytic Uremic Syndrome: Clinical Significance and Prognostic Value

Background/Objectives: Hemolytic uremic syndrome is a thrombotic microangiopathy characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. Liver involvement in pediatric hemolytic uremic syndrome is increasingly recognized, but its clinical significance remains unclear. This study aimed to evaluate the relationship between liver involvement and clinical outcomes in children with hemolytic uremic syndrome. Methods: We retrospectively analyzed 25 pediatric patients diagnosed with hemolytic uremic syndrome. Patients were grouped based on liver involvement, defined by elevated transaminase levels. Demographic, clinical, laboratory, and treatment data were collected. Associations between liver involvement, intensive care unit admission, dialysis, plasma exchange, and length of intensive care unit stay were assessed using statistical analyses. Results: Liver involvement was observed in 68% of patients. Although liver involvement was not associated with the need for dialysis, affected patients required plasma exchange and intensive care unit admission significantly more often. An AST cutoff of ≥42 U/L moderately predicted adverse outcomes (AUC: 0.619), while ALT had limited prognostic value (AUC: 0.658). Transaminase levels normalized within a mean of 3.76 ± 1.92 days. No mortality was observed in our cohort, in contrast to previously reported rates of 2-5%. Conclusions: Liver involvement in pediatric hemolytic uremic syndrome is common but generally follows a reversible and benign course. While it is associated with increased intensive care unit admission and plasma exchange, it does not independently predict disease severity. These findings emphasize the importance of supportive management and suggest that liver involvement should be interpreted in the context of the overall clinical picture.