Best supportive care and therapeutic plasma exchange with or without eculizumab in Shiga-toxin-producing E. coli O104:H4 induced haemolytic–uraemic syndrome: an analysis of the German STEC-HUS registry
| Autor: | Uwe Kuhlmann, Eiske M. Dorresteijn, Jürgen Steinhoff, Tobias N. Meyer, Jens Nürnberger, Frank Merkel, Gernot Beutel, Wolfgang Ries, Steffen Mitzner, Miriam Abu-Tair, Ulf Panzer, Reinhard Brunkhorst, Veit Busch, Peter Gerke, Susanne Fleig, Bernd Sucke, Norbert Klause, Sabine Schnatter, Carsten Hafer, Martin Vischedyk, Sylvia Stracke, Ralf Schindler, Ola Samuelsson, Monika Wiesner, Andreas Kribben, Jan T. Kielstein, Stefan Mees, Jörn Bramstedt |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Blood transfusion medicine.medical_treatment Medizin Renal function Cutting-Edge Renal Science Antibodies Monoclonal Humanized Artificial respiration Young Adult Germany medicine Humans Registries In Focus Epidemics Escherichia coli Infections Dialysis Aged Retrospective Studies Aged 80 and over Transplantation Plasma Exchange Shiga-Toxigenic Escherichia coli business.industry Retrospective cohort study Middle Aged Eculizumab Haemolysis Treatment Outcome Nephrology Hemolytic-Uremic Syndrome Female Hemodialysis business medicine.drug |
| Zdroj: | Nephrology Dialysis Transplantation |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | BACKGROUND May 22nd marks the beginning of a Shiga-toxin-producing Escherichia coli (STEC) O104:H4 outbreak in Northern Germany. By its end on 27 July, it had claimed 53 deaths among 2987 STEC and 855 confirmed haemolytic-uraemic syndrome (HUS) cases. METHODS To describe short-term effectiveness of best supportive care (BSC), therapeutic plasma exchange (TPE) and TPE with eculizumab (TPE-Ecu) in 631 patients with suspected HUS treated in 84 hospitals in Germany, Sweden and the Netherlands using the web-based registry of the DGfN (online since 27 May). RESULTS Of 631 entries, 491 fulfilled the definition of HUS (median age 46 years; 71% females). The median (inter-quartile range) hospital stay was 22 (14-31) days. Two hundred and eighty-one (57%) patients underwent dialysis and 114 (23%) mechanical ventilation. Fifty-seven patients received BSC, 241 TPE and 193 TPE-Ecu. Treatment strategy was dependent on disease severity (laboratory signs of haemolysis, thrombocytopenia, peak creatinine level, need for dialysis, neurological symptoms, frequency of seizures) which was lower in BSC than in TPE and TPE-Ecu patients. At study endpoint (hospital discharge or death), the median creatinine was lower in BSC [1.1 mg/dL (0.9-1.3)] than in TPE [1.2 mg/dL (1.0-1.5), P < 0.05] and TPE-Ecu [1.4 mg/dL (1.0-2.2), P < 0.001], while need for dialysis was not different between BSC (0.0%, n = 0), TPE (3.7%; n = 9) and TPE-Ecu (4.7%, n = 9). Seizures were absent in BSC and rare in TPE (0.4%; n = 1) and TPE-Ecu (2.6%; n = 5) patients. Total hospital mortality in HUS patients was 4.1% (n = 20) and did not differ significantly between the TPE and TPE-Ecu groups. CONCLUSIONS Despite frequent renal impairment, advanced neurological disorders and severe respiratory failure, short-term outcome was better than expected when compared with previous reports. Within the limitations of a retrospective registry analysis, our data do not support the notion of a short-term benefit of Ecu in comparison to TPE alone in the treatment of STEC-HUS. A randomized trial comparing BSC, TPE and Ecu seems to be prudent and necessary prior to establishing new treatment guidelines for STEC-HUS. |
| Databáze: | OpenAIRE |
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