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Selected risk factors for mortality in children with HUS - a single-center analysis
Ewelina Jarosz-Wójcik1, Mateusz Zajączkowski2, Dorota Drożdż1
1Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Kraków, Poland; Department of Pediatric Nephrology and Hypertension, University Children's Hospital, Kraków, Poland.
Purpose:
The aim of the study was to describe clinical and laboratory characteristics of hemolytic-uremic syndrome (HUS), and identify prognostic factors, including risk factors for mortality and complications.
Materials And Methods:
It is a retrospective study of 74 pediatric patients (69 survivors and 5 non-survivors) with the first episode of HUS who were hospitalized in our tertiary reference center during 10-year period.
Results:
Compared to survivors, non-survivors significantly more frequently developed neurological symptoms (100% vs. 31.9%), suffered from respiratory tract infections (80% vs. 27.5%), respiratory insufficiency (100% vs. 21.7%), circulatory failure (80% vs. 2.9%), and more often required renal replacement therapy (100% vs. 52.2%). In this group, there was a significant reduction in complement C3c and C4 components (0.67 vs. 0.97, 0.08 vs. 0.18, respectively). Elevated PCT, CRP, D-dimers, APTT, lipase, AST, GGTP and reduced C3c and C4 were associated with increased mortality risk. Severe neurological and ophthalmological complications, as well as circulatory insufficiency were the strongest predictors of death. Overall mortality rate was 6.8%.
Conclusions:
Neurological (ischemic stroke, ophthalmological anomalies) and systemic (circulatory failure) complications may represent important determinants of outcome in pediatric HUS. Mortality also appears to be associated with systemic inflammatory activation and coagulopathy.