TOP 42 - Socioeconomic drivers of health and hemolytic uremic syndrome in pediatric patients: a single-center case series

Publication Number: 1801.TOP 42

Jerome Tuttle-Roache, Inova Children's Hospital, Washington, DC, United States; Davoud Mohtat, Inova Children's Hospital, Bethesda, MD, United States; Patricia Seo-Mayer, I, Fairfax, VA, United States

Background: In the United States, the majority of hemolytic uremic syndrome (HUS) cases are secondary to diarrheal illness, often termed diarrhea positive HUS (D+HUS), with the most common pathogen identified being Shiga toxin–producing Escherichia coli (STEC) serogroup O157. STEC outbreaks are typically associated with contaminated food or direct exposure to livestock waste. Prior studies have found higher rates of STEC infection and subsequent HUS among persons of higher socioeconomic status (SES), which have been attributed to dietary and exposure patterns. Although D+HUS was once considered an isolated acute illness, growing evidence highlights long-term renal and cardiovascular sequelae. While there is a higher acute disease burden in higher SES patients, the influence of SES on long-term outcomes following D+HUS has not been well characterized.

Objective: This single-center case series aims to analyze the relationship between the long-term sequelae of D+HUS and SES in a pediatric population.

Design/Methods: We identified 39 patients < 19 years old with a new diagnosis of D+HUS admitted to a single Northern Virginia pediatric hospital between January 2016 and October 2024. Patients were identified by chart review. Inclusion required a documented HUS diagnosis at discharge and presence of diarrhea preceding, or at, presentation. A positive STEC stool sample was documented but not a prerequisite for inclusion. Patients with atypical or pneumococcal HUS were excluded. SES variables to be analyzed are age, sex, race/ethnicity, primary language, payor type, census-tract poverty level, and Childhood Opportunity Index (COI). Primary outcomes are glomerular filtration rate < 90 mL/min/1.73m², hypertension, proteinuria, and loss to follow-up. Primary outcomes will be assessed beginning 6 months after discharge and followed for up to 5 years, with data collected through July 2025. Statistical analyses will include Fisher’s exact test, t-tests (parametric and nonparametric as appropriate), chi-square tests, and multivariable regression to examine associations between SES and outcomes. Acute illness severity (e.g. dialysis use, length of stay) will be incorporated as covariates to address confounding. This study received IRB exempt status.