title: Need for long-term follow-up in enterohemorrhagic Escherichia coli-associated hemolytic uremic syndrome due to late-emerging sequelae.
abstract: BACKGROUND
  The aim of this study was to evaluate the long-term prognosis of children with hemolytic uremic syndrome (HUS).
  
  
  METHODS
  Over a 6-year period, 619 pediatric patients with the clinical diagnosis of HUS were registered in Austria and Germany, and a subset (n = 274) was prospectively followed up for 5 years.
  
  
  RESULTS
  Infection with enterohemorrhagic Escherichia coli (EHEC) was confirmed in 79% of cases. Five years after diagnosis, 70% of EHEC-infected patients (95% confidence interval [CI], .63-.76) were fully recovered. The remaining 30% had persistent hypertension (9%), neurological symptoms (4%), decreased glomerular filtration rate (7%), and/or proteinuria (18%). Hypertension and proteinuria developed in a total of 18% of patients who had no sequelae 1 year after the acute phase (95% CI, 12-26). Multivariate logistic regression analysis demonstrated an association between the use of plasma therapy during acute phase and poor long-term outcome (odds ratio, 2.9-13; 95% CI, 2.4-33; P < .05), but this treatment was also used more frequently in severe cases. In contrast, the use of antibiotic therapy in the diarrheal phase and other established risk factors for developing HUS, such as Shiga toxin 2 and EHEC serotypes traditionally considered to be "high risk," were not associated with adverse long-term outcome. In particular, there was no difference between O157 and non-O157 EHEC.
  
  
  CONCLUSIONS
  This study identified an association between the use of plasma treatment and poor long-term outcome and confirms already known risk factors for poor prognosis. Follow-up investigations for at least 5 years are recommended to detect late-emerging sequelae.
authors.affiliation: Department of Pediatrics, Innsbruck Medical University, Austria.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Rosales
authors.forename: Johannes
authors.initials: J
authors.lastname: Hofer
authors.forename: Lothar-Bernd
authors.initials: LB
authors.lastname: Zimmerhackl
authors.forename: Therese C
authors.initials: TC
authors.lastname: Jungraithmayr
authors.forename: Magdalena
authors.initials: M
authors.lastname: Riedl
authors.forename: Thomas
authors.initials: T
authors.lastname: Giner
authors.forename: Alexander
authors.initials: A
authors.lastname: Strasak
authors.forename: Dorothea
authors.initials: D
authors.lastname: Orth-Höller
authors.forename: Reinhard
authors.initials: R
authors.lastname: Würzner
authors.forename: Helge
authors.initials: H
authors.lastname: Karch
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001317:Austria / Q000453:epidemiology; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D054324:Enterohemorrhagic Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000150:complications* / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents