Cardiac Involvement in Shiga Toxin-Producing Escherichia coli–Induced Hemolytic Uremic Syndrome

Background: Shiga toxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) is associated with extrarenal manifestations. This study aimed to determine the clinical characteristics of cardiac involvement in the acute phase of STEC-HUS in childhood.

Method: We retrospectively evaluated all STEC-HUS patients of a tertiary university children's hospital for possible cardiac manifestations. Clinical features, echocardiography, 12-lead electrocardiogram, cardiac enzymes, and other extrarenal manifestations were assessed.

Results: Between 2010 and 2020, n = 86 children (56 female) with a median age of 2.5 years (range: 0.7–17.8) were admitted with STEC-HUS. Of these, n = 8 (median age of 2.2 years [range: 0.8–5.0]) presented with cardiac involvement; n = 1 showed pericardial effusion with regular systolic cardiac function; n = 5 required mechanical ventilation and inotropic support up to 10 days after onset of cardiocirculatory decompensation; n = 1 needed venoarterial extracorporeal membrane oxygenation for acute cardiac failure; lacking any recovery of cardiac function the patient died from severe myocardial necrosis due to thrombotic microangiopathy; and n = 1 succumbed after unsuccessful resuscitation for acute biventricular cardiac failure with myocarditis detected by autopsy. Echocardiographic findings ranged from normal systolic cardiac function with circumferential pericardial effusion to impaired systolic cardiac function with or without atrioventricular valve regurgitation, dyskinesia and/or hyperechoic foci within subendocardial myocardium; all others without cardiac manifestations showed normal or hyperdynamic biventricular systolic function. Median peak cardiac Troponin T (986 ng/L [IQR: 407; 1673] vs. 17.1 ng/L [IQR: 10.9; 25]; p = 0.02) and NT-proBNP levels (35,000 ng/L [IQR: 35,000; 35,000] vs. 6977 [IQR: 1,376; 12,222]; p = 0.005) were significantly elevated in patients with cardiac involvement. Median peak myoglobin levels did not differ significantly between both groups (259 µg/L [IQR: 65; 1,086] vs. 74 µg/L [IQR: 31.5; 207]; p = 0.229, cardiac vs. noncardiac involvement).

Conclusion: Cardiac involvement is a potential deleterious complication affecting approximately 10% of STEC-HUS children. Cardiac troponin T and NT-proBNP might help to identify and monitor STEC-HUS children at higher risk for cardiac involvement.

Publication History

Article published online:
12 February 2022