Corentin Tanné1,2, Etienne Javouhey3,4, Olivia Boyer5,6, Morgan Recher7, Emma Allain-Launay8, Catherine Monet-Didailler9,10, Caroline Rouset-Rouvière11, Amélie Ryckewaert12, François Nobili13, Francine Arfbez Gindre14, Jérôme Rambaud15, Anita Duncan1, Julien Berthiller16, Justine Bacchetta1,4, Anne-Laure Sellier-Leclerc17. 1. Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France. 2. Service de Pédiatrie Et Néonatalogie, Hôpitaux du Pays du Mont Blanc, Sallanches, France. 3. Pediatric Intensive Care Unit, Hôpital Femme Mère Enfants, Hospices Civils of Lyon, Lyon, France. 4. Université de Lyon, Lyon, France. 5. Service de Néphrologie Pédiatrique, Centres de Référence MARHEA Et MAT, Hôpital Necker-Enfants Maladies, Assistance Publique-Hôpitaux de Paris, Paris, France. 6. Institut IMAGINE, INSERM U1163, Université de Paris, Paris, France. 7. CHU Lille, Department of Paediatric Intensive Care Unit, Jeanne de Flandre Hospital, 59000, Lille, France. 8. Néphrologie Pédiatrique, CHU Nantes, France. 9. Service de Pédiatrie, Unité de Néphrologie Pédiatrique, CHU de Bordeaux, France. 10. Service de Pédiatrie, Centre Hospitalier de La Côte Basque, Bayonne, France. 11. Service de Pédiatrie Multidisciplinaire, Hôpital Timone Enfants, CHU Marseille, France. 12. Service de Pédiatrie, CHU Rennes, France. 13. Service de Pédiatrie, CHU de Besançon, France. 14. Service d'anatomie Pathologique, CHU de Besançon, France. 15. Service de Réanimation Pédiatrique Et Néonatal, Hôpital Armand-Trousseau, assistance publique des Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France. 16. Service d'Epidémiologie Et de Recherche Clinique. Pôle de Santé Publique Des Hospices Civils de Lyon, Lyon, France. 17. Department of Pediatric Nephrology, Hopital Femme-Mere-Enfant, Lyon, France. anne-laure.sellier-leclerc@chu-lyon.fr.
Abstract
BACKGROUND: Cardiac involvement is a known but rare complication of pediatric hemolytic uremic syndrome (HUS). We conducted a nationwide observational, retrospective case-control study describing factors associated with the occurrence of myocarditis among HUS patients. METHODS: Cases were defined as hospitalized children affected by any form of HUS with co-existent myocarditis in 8 French Pediatric Intensive Care Units (PICU) between January 2007 and December 2018. Control subjects were children, consecutively admitted with any form of HUS without coexistent myocarditis, at a single PICU in Lyon, France, during the same time period. RESULTS: A total of 20 cases of myocarditis were reported among 8 PICUs, with a mean age of 34.3 ± 31.9 months; 66 controls were identified. There were no differences between the two groups concerning the season and the typical, Shiga toxin-producing Escherichia coli (STEC-HUS), or atypical HUS (aHUS). Maximal leukocyte count was higher in the myocarditis group (29.1 ± 16.3G/L versus 21.0 ± 9.9G/L, p = 0.04). The median time between admission and first cardiac symptoms was of 3 days (range 0-19 days), and 4 patients displayed myocarditis at admission. The fatality rate in the myocarditis group was higher than in the control group (40.0% versus 1.5%, p < 0.001). Thirteen (65%) children from the myocarditis group received platelet transfusion compared to 19 (29%) in the control group (p = 0.03). CONCLUSION: Our study confirms that myocarditis is potentially lethal and identifies higher leukocyte count and platelet transfusion as possible risk factors of myocarditis. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Cardiac involvement is a known but rare complication of pediatric hemolytic uremic syndrome (HUS). We conducted a nationwide observational, retrospective case-control study describing factors associated with the occurrence of myocarditis among HUS patients. METHODS: Cases were defined as hospitalized children affected by any form of HUS with co-existent myocarditis in 8 French Pediatric Intensive Care Units (PICU) between January 2007 and December 2018. Control subjects were children, consecutively admitted with any form of HUS without coexistent myocarditis, at a single PICU in Lyon, France, during the same time period. RESULTS: A total of 20 cases of myocarditis were reported among 8 PICUs, with a mean age of 34.3 ± 31.9 months; 66 controls were identified. There were no differences between the two groups concerning the season and the typical, Shiga toxin-producing Escherichia coli (STEC-HUS), or atypical HUS (aHUS). Maximal leukocyte count was higher in the myocarditis group (29.1 ± 16.3G/L versus 21.0 ± 9.9G/L, p = 0.04). The median time between admission and first cardiac symptoms was of 3 days (range 0-19 days), and 4 patients displayed myocarditis at admission. The fatality rate in the myocarditis group was higher than in the control group (40.0% versus 1.5%, p < 0.001). Thirteen (65%) children from the myocarditis group received platelet transfusion compared to 19 (29%) in the control group (p = 0.03). CONCLUSION: Our study confirms that myocarditis is potentially lethal and identifies higher leukocyte count and platelet transfusion as possible risk factors of myocarditis. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: H T Aretz; M E Billingham; W D Edwards; S M Factor; J T Fallon; J J Fenoglio; E G Olsen; F J Schoen Journal: Am J Cardiovasc Pathol Date: 1987-01