Markers of systemic inflammation as predictors of the severity of typical hemolytic uremic syndrome in children

Typical hemolytic-uremic syndrome is a severe disease of thrombotic microangiopathies. Its pathogenesis is associated with Stx-induced damage to the endothelium and the release of pro-inflammatory and prosclerotic cytokines by activated leukocytes and macrophages. Markers of systemic inflammation, in particular, proinflammatory cytokines and their soluble receptors, may have prognostic value for tHUS as predictors of disease severity. Objective: to determine serum concentrations of TNFα and rTN, IL-6 and rIL-6, IL-10 in children with the acute phase of tHUS and to evaluate their informativeness as predictors of the disease’s severity and duration. Materials and methods: The serum concentration of the above cytokines and their receptors was measured by ELISA in 30 patients in the acute phase of tHUS. The comparison group consisted of 21 children in the follow-up period of tHUS. Results: serum concentration of TNFα and rTNF, IL-6 and rIL-6, IL-10 was significantly higher in children with acute-phase tHUS than in the follow-up group. In the subgroup of patients with severe tHUS, the serum concentration of IL-6 was significantly higher, as well as leukocytosis, the serum concentration of CRP and LDH, and the level of complement component C3 was lower. A statistically significant relationship with tHUS course was found for leukocytosis more than 13.5×109/L (OR 13.75, 95% CI 1.45-130.25), CRP level >9 mg/L (OR 7.80, 95% CI 1.48-41.22), a decrease in C3 <90 mg/L (OR 28.60, 95% CI 2.89-283.07), as well as increase in the level of any of the cytokines IL-6, IL-10, rTNF (OR 7.86, 95% CI 1.41-47.04). Conclusion: prominent leukocytosis and increased CRP level, low C3 level, as well as increased levels of IL-6 and/or IL-10 and / or rTNF in patients with tHUS were statistically significantly associated with the severe course of the disease, which allows us to consider these factors as predictors of the severity of tHUS.

гемолитико-уремический синдром, дети, интерлейкин-6, интерлейкин-10, фактор некроза опухоли альфа, hemolityc-uremic syndrome, children, interleukin-6, interleukin-10, tumor necrosis factor alfa

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