Richard Baptiste, Preka Evgenia, Grapin Mathilde, Nobili François, Bourdat-Michel Guylhène, Lahoche Annie, Cailliez Mathilde, Fila Marc, Parmentier Cyrielle, Jay Nadine, Hauet Quentin, Belhadjer Zahra, Sellier Anne-Laure, Boyer Olivia, Roussey Gwenaëlle
Service de Néphrologie Pédiatrique, Hôpital Mère-Enfant, CHU Nantes, Nantes, France.
Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), CNR MAT, Université Paris Cité, Institut Imagine, Paris, France.
Pediatr Nephrol. 2025 Jul 22. doi: 10.1007/s00467-025-06877-0.
Extra-renal complications are severe in Shiga toxin-producing E. coli hemolytic uremic syndrome (STEC-HUS), with pericardial effusion being rare and inadequately characterized. This study aimed to describe the clinical and biological data, management strategies, and risk factors associated with pericardial effusion in children with STEC-HUS.
This multicentric retrospective study included all consecutive children under 18 years who developed pericardial effusion during STEC-HUS in France between 2017 and 2022. Paired comparisons were made with control children presenting STEC-HUS in the same centres, before and after the index cases.
A total of 15 cases were identified. The pericardial effusion group exhibited significantly more extra-renal manifestations compared to 30 control cases. Leukocyte counts were higher in the pericardial effusion group (22.2 G/L vs. 14.5 G/L, p = 0.002), as were hematocrit levels (30.1% vs. 24.2%, p = 0.02). Fourteen children received eculizumab, and 8 out of 15 required pericardial drainage. Two patients died from non-cardiac causes. Myopericarditis was identified in 5 cases, and 5 of the 14 patients had normal troponin levels during the initial phase.
Children with pericardial effusion during STEC-HUS exhibited more extra-renal manifestations and biological markers indicative of severe HUS at presentation. These findings suggest that patients with severe STEC-HUS and extra-renal manifestations requiring intensive care should be routinely screened for pericardial effusion.
产志贺毒素大肠杆菌溶血尿毒综合征（STEC-HUS）的肾外并发症严重，心包积液罕见且特征描述不足。本研究旨在描述STEC-HUS患儿心包积液的临床和生物学数据、管理策略及相关危险因素。
这项多中心回顾性研究纳入了2017年至2022年期间在法国STEC-HUS期间出现心包积液的所有18岁以下连续儿童。与同一中心在索引病例前后出现STEC-HUS的对照儿童进行配对比较。
共确定了15例病例。与30例对照病例相比，心包积液组的肾外表现明显更多。心包积液组的白细胞计数更高（22.2 G/L对14.5 G/L，p = 0.002），血细胞比容水平也更高（30.1%对24.2%，p = 0.02）。14名儿童接受了依库珠单抗治疗，15名中有8名需要心包引流。2例患者死于非心脏原因。5例确诊为心肌心包炎，14例患者中有5例在初始阶段肌钙蛋白水平正常。
STEC-HUS期间有心包积液的儿童在发病时表现出更多的肾外表现和提示严重HUS的生物学标志物。这些发现表明，对于患有严重STEC-HUS和需要重症监护的肾外表现的患者，应常规筛查心包积液。
