Sociodemographic and clinical risk factors for paediatric typical haemolytic uraemic syndrome: Retrospective cohort study

Natalie Adams, Lisa Byrne, Tanith Rose, Bob Adak, Claire Jenkins, Andre Charlett, Mara Violato, Sarah O'Brien, Margaret Whitehead, Benjamin Barr*, David Taylor-Robinson, Jeremy Hawker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Objectives Haemolytic uraemic syndrome (HUS) following Shiga toxin-producing Escherichia coli (STEC) infection is the the most common cause of acute renal failure among children in the UK. This study explored differential progression from STEC to HUS by social, demographic and clinical risk factors. Methods We undertook a retrospective cohort study linking two datasets. We extracted data on paediatric STEC and HUS cases identified in the Public Health England National Enhanced Surveillance System for STEC and British Paediatric Surveillance Unit HUS surveillance from 1 October 2011 to 31 October 2014. Using logistic regression, we estimated the odds of HUS progression by risk factors. Results 1059 paediatric STEC cases were included in the study, of which 207 (19.55%, 95% CI 17% to 22%) developed HUS. In the fully adjusted model, the odds of progression to HUS were highest in those aged 1-4 years (OR 4.93, 95% CI 2.30 to 10.56, compared with 10-15 years), were infected with an Shiga toxin (stx) 2-only strain (OR 5.92, 95% CI 2.49 to 14.10), were prescribed antibiotics (OR 8.46, 95% CI 4.71 to 15.18) and had bloody diarrhoea (OR 3.56, 95% CI 2.04 to 6.24) or vomiting (OR 4.47, 95% CI 2.62 to 7.63), but there was no association with progression to HUS by socioeconomic circumstances or rurality. Conclusion Combining data from an active clinical surveillance system for HUS with the national enhanced STEC surveillance system suggests that 20% of diagnosed paediatric STEC infections in England resulted in HUS. No relationship was found with socioeconomic status or rurality of cases, but differences were demonstrated by age, stx type and presenting symptoms.

Original languageEnglish
Article numbere000465
JournalBMJ Paediatrics Open
Issue number1
Publication statusPublished - 17 Dec 2019

Bibliographical note

Funding Information:
Funding The research was funded by the National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool in partnership with Public Health England, in collaboration with University of East Anglia, University of Oxford and the Quadram Institute. NA is based at the University of Liverpool and Public Health England.

Funding Information:
those of the National Health Service, the National Institute for Health Research, the Department of Health and Social Care or Public Health England.

Publisher Copyright:
© © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.


  • epidemiology
  • infectious diseases


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