Volume 27, Number 7—July 2021
Shiga Toxin–Associated Hemolytic Uremic Syndrome in Adults, France, 2009–2017
|Bloody diarrhea||47/96 (49.0)|
|Median time between symptom onset and hospitalization, d (IQR)†
|Median serum creatinine level, μmol/L (IQR)‡||221.5 (145–391)|
|Acute kidney injury§||96/96 (100.0)|
|KDIGO stage 1||3/96 (3.1)|
|KDIGO stage 2||17/96 (17.7)|
|KDIGO stage 3||74/96 (77.1)|
|Median time before dialysis, d¶||3 (1–6)|
|Proteinuria (i.e., >0.5 g/L)
|Any neurologic sign||73/96 (76.0)|
|Focal deficiency||25/96 (26.0)|
|Abnormal brain imaging#||23/58 (39.7)|
|Abnormal computed tomographic scan||5/38 (13.2)|
|Abnormal magnetic resonance imaging||20/42 (47.6)|
|Stroke, coma, or seizure
|Required mechanical ventilation
|Any cardiac event||41/96 (42.7)|
|High troponin level||26/43 (60.5)|
|Acute coronary syndrome||4/96 (4.2)|
|New onset of heart arrhythmia||4/96 (4.2)|
|Acute heart failure||16/96 (16.7)|
|Recovered from cardiac arrest
|Median leukocyte count, 109 cells/L (IQR)||10.5 (8.05–13.8)|
|Median platelet count, 109 cells/L (IQR)**||56 (36–120)|
|Platelet count <30, 109 cells/L**||19/96 (19.8)|
|Platelet count <30, 109 cells/L and serum creatinine <200 μmol/L**||5/96 (5.2)|
|Median hemoglobin, g/dL (IQR)**||10.4 (8.90–12.4)|
|Elevated lactate deshydrogenase (i.e., >250 IU/L)||78/79 (98.7)|
|C-reactive protein, mg/L (IQR)††||48 (22–120)|
|Elevated lipase (i.e., >210 U/L)||5/32 (15.6)|
|Low CH50 (i.e., <70%)||26/67 (38.8)|
|Low C3 (i.e., <0.660 g/L)||5/69 (7.2)|
|Low C4 (i.e., <0.093 g/L)||3/69 (4.3)|
|Low complement factor H (i.e., <70%)||3/69 (4.3)|
|Low complement factor I (i.e., <70%)||1/69 (1.4)|
|Low CD46 (i.e., <13 µg/L)||23/35 (65.7)|
|Anti-FH antibody (>150 arbitrary units)‡‡
|Shiga toxin genotype||96/96 (100)|
|Escherichia coli serogroup|
|Minor serogroups§§||25/67 (37.3)|
|Blood culture||4/96 (4.2)|
*Values are no. with characteristic/total no. patients (%) except as indicated. KDIGO, Kidney Disease Improving Global Outcomes (15). †Time of symptom onset was the first reported day of diarrhea (for patients with diarrhea) or fever, confusion, abdominal pain, or nausea/vomiting (for patients without diarrhea). ‡Out of 90 patients; samples taken at admission. §Two patients had proteinuria (i.e., >1 g/L) but not elevation of serum creatinine. ¶Out of 60 patients requiring dialysis. #Recent brain lesions on magnetic resonance imaging, computed tomographic scan, or both. Fourteen patients had stroke lesions, 3 had posterior reversible encephalopathy syndrome lesions, 4 had intracerebral bleeds, and 12 had white matter lesions consistent with thrombotic microangiopathies. **Samples taken at admission. ††Out of 52 patients. ‡‡One patient had 242 arbitrary units and 1 had 800 arbitrary units. §§Four patients had strains belonging to O106, 3 to O128, 3 to O174, 2 to O113, 1 to O100, 1 to O126, 1 to O148, 1 to O177, 1 to O78, 1 to O84, and 7 to an O serogroup not typable at the time of identification. ¶¶Two patients had E. coli in urine and stool samples, 2 had E. coli in stool and blood samples, and 1 had E. coli in blood and urine samples.
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1These first authors contributed equally to this article.
2Members of this group are listed at the end of this article.