Cardiac Manifestation among Children with Hemolytic Uremic Syndrome

Abstract

The primary objectives of the study were to describe the association between cardiac manifestations and in-hospital mortality among children with hemolytic uremic syndrome. Using the Pediatric Health Information System database, this retrospective, multicenter, cohort study identified the first hemolytic uremic syndrome-related inpatient visit among children ≤18years (years 2004-2018). The frequency of selected cardiac manifestations and mortality rates were calculated. Multivariate analysis identified the association of specific cardiac manifestations and the risk of in-hospital mortality. Among 3915 patients in the analysis, 238 (6.1%) had cardiac manifestations. A majority of patients (82.8%; n=197) had 1 cardiac condition and 17.2% (n=41) had ≥2 cardiac conditions. The most common cardiac conditions was pericardial disease (n=102), followed by congestive heart failure (n=46) and cardiomyopathy/myocarditis (n=34). The percent mortality for patients with 0, 1, or ≥2 cardiac conditions was 2.1%, 17.3%, and 19.5%, respectively. Patients with any cardiac condition had an increased odds of mortality (OR, 9.74; P=.0001). In additional models, the presence of ≥2 cardiac conditions (OR, 9.90; P<.001), cardiac arrest (OR, 38.25; P<.001), or extracorporeal membrane oxygenation deployment (OR, 11.61; P<.001) were associated with increased risk of in-hospital mortality. This study identified differences in in-hospital mortality based on the type of cardiac manifestations, with increased risk observed for patients with multiple cardiac involvement, cardiac arrest, and extracorporeal membrane oxygenation deployments.