Тромбоз, гемостаз и реология

Tromboz, Gemostaz I Reologiya
scientific and practical journal

ISSN 2078–1008 (Print); ISSN 2687-1483 (online)
2022, Original papers
2022

Obstetric atypical hemolytic uremic syndrome and sepsis: is there a relationship? 616-005.6:616.151:616-036

Original papers
Published 2022-10-07
Yulia V. Korotchaeva
Sechenov University; 8 bldg. 2, Trubetskaya Str., Moscow 119991, Russia; Eramishantsev City Clinical Hospital, Moscow Healthcare Department; 15 Lenskaya Str., Moscow 129327, Russia; 3
ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Россия, 119991 Москва, ул. Трубецкая, 8, стр. 2; ГБУЗ «Городская клиническая больница имени А.К. Ерамишанцева Департамента здравоохранения города Москвы»; Россия, 129327 Москва, ул. Ленская, 15;
https://orcid.org/0000-0002-0880-6346 (unauthenticated)
Natalia L. Kozlovskaya
Eramishantsev City Clinical Hospital, Moscow Healthcare Department; 15 Lenskaya Str., Moscow 129327, Russia; 3 People’s Friendship University of Russia; 6 Miklukho-Maklaya Str., Moscow 117198, Russia;
ГБУЗ «Городская клиническая больница имени А.К. Ерамишанцева Департамента здравоохранения города Москвы»; Россия, 129327 Москва, ул. Ленская, 15; ФГАОУ ВО «Российский университет дружбы народов»; Россия, 117198 Москва, ул. Миклухо-Маклая, 6;
https://orcid.org/0000-0002-4275-0315 (unauthenticated)
Efim M. Shifman
Vladimirsky Moscow Regional Research and Clinical Institute; 61/2 Shchepkina Str., Моscow 129110, Russia
ГБУЗ Московской области «Московский областной научно-исследовательский клинический институт имени М.Ф. Владимирского»; Россия, 129110 Москва, ул. Щепкина, 61/2
https://orcid.org/0000-0002-6113-8498 (unauthenticated)
Тромбоз, гемостаз и реология. — 2022. — №3

Keywords

thrombotic microangiopathy
pregnancy
sepsis
obstetric atypical hemolytic uremic syndrome
eculizumab
  Full Text

Abstract

Summary. Background. Atypical hemolytic uremic syndrome (aHUS) and sepsis represent the most severe forms of obstetric thrombotic microangiopathy (TMA). At the same time, the differential diagnosis between sepsis and aHUS in obstetric practice is extremely difficult, especially considering the possibility of their combination. Objective: to assess the peculiarities of the course and prognosis of aHUS in combination with sepsis in the postpartum period. Patients/Methods. The uncontrolled non-randomized retrospective study included 98 patients with obstetric aHUS: group 1 — 78 patients with “pure” obstetric aHUS (“aHUS”

group), group 2 — 20 patients with a combination of aHUS and sepsis (“aHUS + sepsis” group). The laboratory parameters accepted in general clinical practice (general, biochemical, immunological blood tests, coagulogram, D-dimer level) were determined. Results. Complement-activating conditions were identified in all patients, among which the frequency of urinary and obstetric infections was significantly higher in group 2 (p < 0.05). Patients of “aHUS + sepsis” group, in addition to TMA signs, had pronounced neutrophilic leukocytosis (25.0 [19.5; 28.0]×109/L), increased levels of procalcitonin (10.0 [5.4; 10.5] ng/ml), presepsin (1992.0 [167.0; 3000.0] pg/ml), C-reactive protein (61.0 [23.0; 111.0] mg/L) and more expressed than in patients of “aHUS” group, coagulopathy: low fibrinogen level (1.1 [1.0; 1.9] g/L vs. 3.5 [2.7; 4.2] g/L; p=0.005) with increased D-dimer level (over 0.5 μg/ml). In addition to antibacterial and plasma therapy, 49 out of 78 (62.8%) patients in “aHUS” group and 11 out of 20 (55.0%) in “aHUS + sepsis” group received eculizumab at a dose of 900 mg once a week for 4 weeks, on the 5th week — 1200 mg once a week, followed by a transition to a maintenance regimen (1200 mg every 2 weeks). Survival in “aHUS + sepsis” group was almost twice as low (55.0% vs. 84.7%) as in “aHUS” group. Conclusions. The prognosis of obstetric aHUS in combination with sepsis is extremely unfavorable, necessitating timely detection and treatment of infectious complications in pregnant women and puerperas. Taking into account the role of complement activation in the pathogenesis of sepsis, the appointment of eculizumab after the infection has been controlled can be discussed.

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