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Pediatric Nephrology

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01-02-2020 | Escherichia Coli | Original Article

C3 levels and acute outcomes in Shiga toxin–related hemolytic uremic syndrome

Authors: Alejandro Balestracci, Luciana Meni Bataglia, Ismael Toledo, Laura Beaudoin, Caupolican Alvarado

Published in: Pediatric Nephrology | Issue 2/2020

Abstract

Background

The correlation between complement activation and severity of hemolytic uremic syndrome related to Shiga toxin–producing Escherichia coli (STEC-HUS) has been examined in few studies, with conflicting results. We investigated whether C3 levels on admission are associated with worse acute outcomes.

Methods

Demographic, clinical, and laboratory variables were compared between dialyzed and non-dialyzed patients and between those with or without extrarenal complications. Univariate and multivariate analyses were performed; odds ratio (OR) and 95% confidence interval (95%CI) were calculated. C3 concentrations were correlated with dialysis length (Spearman test) and ROC curves with area under the curves (AUC) were calculated to identify C3 concentrations able to discriminate patients with dialysis requirements and complicated course.

Results

Among 49 children, 33 had normal and 16 had decreased C3 concentrations. Higher hemoglobin, lactic dehydrogenase, urea and creatinine and lower albumin, sodium, and C3 and C4 concentrations at admission were associated with dialysis requirement; only creatinine remained significant (p = 0.03, OR 2.1, 95%CI 1.34–2.7) by multivariate analysis. Patients with a complicated course presented higher leukocyte count, hemoglobin and lactic dehydrogenase and lower albumin, sodium, and C3 and C4. In the multivariate analysis, leukocyte count (p = 0.02, OR 2.6, 95%CI 1.4–4.3) and C3 concentration (p = 0.039, OR 1.7, 95%CI 1.1–2.73) were independently associated with a complicated disease. C3 levels correlated with dialysis length (r = − 0.42, p = 0.002); nevertheless, they were unable to discriminate dialysis requirement (AUC = 0.25, 95%CI 0.11–0.38) and extrarenal complications (AUC = 0.24, 95%CI 0.11–0.4).

Conclusions

Our study suggests that decreased C3 levels at admission are associated with a more complicated STEC-HUS episode.

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Title: C3 levels and acute outcomes in Shiga toxin–related hemolytic uremic syndrome
Authors: Alejandro Balestracci
Luciana Meni Bataglia
Ismael Toledo
Laura Beaudoin
Caupolican Alvarado
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Escherichia Coli
Hemolytic Uremic Syndrome
Published in: Pediatric Nephrology / Issue 2/2020
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-019-04334-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

C3 levels and acute outcomes in Shiga toxin–related hemolytic uremic syndrome

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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