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Association of Lewis blood group phenotypes with urinary tract infection in children
B A Jantausch1, V R Criss, R O'Donnell
1Department of Infectious Diseases, Children's National Medical Center, Washington, D.C. 20010.
Insights
Children with the Lewis (Le) a-b- blood group phenotype have a higher risk of developing urinary tract infections (UTIs). This finding may help identify children susceptible to UTIs.
Area of Science:
- Pediatric Nephrology
- Immunology
- Genetics
Background:
- Blood group antigens on uroepithelial cells can influence bacterial adherence, potentially increasing urinary tract infection (UTI) risk.
- Understanding the role of erythrocyte antigens in pediatric UTIs is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between erythrocyte blood group phenotypes and the occurrence of UTIs in children.
- To identify specific blood group antigens or phenotypes that may predispose children to UTIs.
Main Methods:
- Erythrocyte antigen typing was performed on 62 children with UTIs and 62 age-, sex-, and race-matched healthy controls.
- Statistical analyses, including univariate tests and stepwise logistic regression, were used to compare phenotype frequencies and identify predictors of UTI.
Main Results:
- No significant differences were observed in ABO, Rh, P, Kell, Duffy, MNSs, and Kidd blood group systems between patients and controls.
- The Lewis (Le) a-b- phenotype was significantly more frequent in children with UTIs (16/50 vs 5/50, p = 0.0076).
- The Le(a-b-) phenotype was associated with a 3.2-fold increased relative risk of UTI in this pediatric cohort.
Conclusions:
- The Le(a-b-) blood group phenotype is associated with an increased risk of UTI in children.
- Identifying specific blood group phenotypes may aid in identifying pediatric populations at higher risk for UTIs.
Abstract:
Many blood group antigens, genetically controlled carbohydrate molecules, are found on the surface of uroepithelial cells and may affect bacterial adherence and increase the frequency of urinary tract infection (UTI) in adults. Sixty-two children aged 2 weeks to 17 years (mean, 2.3 years) who were hospitalized with fever in association with UTIs caused by Escherichia coli had complete (n = 50) or partial (n = 12) erythrocyte antigen typing to determine the role of erythrocyte antigens and phenotypes in UTI in children; 62 healthy children undergoing nonurologic elective surgery, matched 1 to 1 for age, sex, and race to the patient group, formed the control group. In univariate tests, patients and control subjects did not differ in ABO, Rh, P, Kell, Duffy, MNSs, and Kidd systems by the McNemar test of symmetry (p > 0.05). The frequency of the Lewis (Le) (a-b-) phenotype was higher (16/50 vs 5/50; p = 0.0076) and the frequency of the Le(a + b +) phenotype was lower (8/50 vs 16/50; p = 0.0455) in the patient population than in the control subjects. A stepwise logistic regression model to predict UTI with the explanatory variables A, B, O, M, N, S, s, Pl, Lea, and Leb showed that only the Lea and Leb antigens entered the model with p < 0.1. The Le(a-b-) phenotype was associated with UTI in this pediatric population. The relative risk of UTI in children with the Le(a-b-) phenotype was 3.2 (95% confidence interval, 1.3 to 7.9). Specific blood group phenotypes in pediatric populations may provide a means to identify children at risk of having UTI.