Clinical characteristics and outcomes in critical patients with hemorrhagic fever with renal syndrome

Abstract

BackgroundHemorrhagic fever with renal syndrome (HFRS) has become an important public health concern because of the high incidence and mortality rates, and limited treatment and vaccination. Until now, clinical studies on characteristics and outcomes in critical patients with HFRS have been limited. The aim of this study was to observe the clinical characteristics and cumulative proportions surviving and explore the predictive effects and risk factors for prognosis.MethodsA detailed retrospective analysis of clinical records for critical HFRS patients was conducted. The patients enrolled were treated in the centre for infectious diseases, Tangdu Hospital, between January 2008 and August 2012. The clinical characteristics between the survivors and non-survivors were compared by Student’s t-test or Chi-square test. The risk clinical factors for prognosis were explored by logistic regression analysis. The predictive effects of prognosis in clinical and laboratory parameters were analyzed by receiver operating characteristic (ROC) curves. The cumulative proportions surviving at certain intervals in the critical patients were observed by Kaplan-Meier survival analysis.ResultsOf the 75 patients enrolled, the cumulative proportion surviving was 70.7% at the second week interval, with a 28-day mortality rate of 36.3%. The non-survivors tended to have higher frequencies of agitation, dyspnea, conjunctival hemorrhage, coma, cardiac failure, acute respiratory distress syndrome (ARDS) and encephalopathy (P < .05). ARDS, conjunctival hemorrhage and coma were risk factors for death in the critical patients with HFRS. The non-survivors were found to have lower serum creatinine (Scr) levels (P < .001) and higher incidences of prolonged prothrombin time (PT) (P = .006), activated partial thromboplastin time (APTT) (P = .003) and elevated white blood cells (WBC) levels (P = .005), and the laboratory parameters mentioned above reached statistical significance for predicting prognosis (P < .05).ConclusionThe high fatality in critical patients with HFRS underscores the importance of clinicians’ alertness to the occurrence of potentially fatal complications and changes in biochemical status to ensure that timely and systematically supportive treatment can be initiated when necessary.

Elevated Soluble CD163 Plasma Levels Are Associated with Disease Severity in Patients with Hemorrhagic Fever with Renal Syndrome

“…There was also a positive correlation observed between elevated plasma sCD163 levels and BUN and Cr levels, which was previously shown to predict kidney dysfunction in HFRS patients [25] . This suggests that sCD163 might be involved in renal dysfunction.…”

“…According to the laboratory parameters and symptoms, such as body temperature, hemorrhage, edema, blood pressure and urine volume, the degree of HFRS disease severity was classified into the four clinical types, as formerly described [25] . These types were classified as: (1) mild, which included mild renal failure without an obvious oliguric stage and hypotension; (2) moderate, which included evident uremia, effusion (bulbar conjunctiva), hemorrhage (skin and mucous membrane) and acute renal failure with an obvious oliguric stage; (3) severe, which included severe uremia, effusion (bulbar conjunctiva and either pleura or peritoneum), hemorrhage (skin and mucous membrane), and acute renal failure with oliguria (a urine output of 100–500 ml/day) for ≤5 days or anuria (a urine output of <100 ml/day) for ≤2 days; and (4) critical, which were cases with one or more of the following symptoms compared with the severe patients: refractory shock (≥2 days), visceral hemorrhage, heart failure, pulmonary edema, brain edema, severe secondary infection and severe acute renal failure with oliguria (a urine output of 50–500 ml/day) for >5 days or anuria (a urine output of <100 ml/day) for >2 days, or a blood urea nitrogen level of >42.84 mmol/L.…”

HMGB‐1 as a Novel Predictor of Disease Severity and Prognosis in Patients with Hemorrhagic Fever with Renal Syndrome

“…According to the HFRS criteria of clinical classification [ 7 ], the severity of HFRS was classified into four types: (1) mild, defined as patients who had kidney injury without oliguria and hypotension; (2) moderate, defined as patients who had uremia, effusion (bulbar conjunctiva), hypotension, hemorrhage (skin and mucous membranes), and AKI with typical oliguria; (3) severe, defined as patients who had severe uremia, effusion (bulbar conjunctiva and either peritoneum or pleura), hemorrhage (skin and mucous membranes), hypotension, and AKI with oliguria (urine output of 50–500 mL/day) for ≤5 days or anuria (urine output of <100 mL/day) for ≤2 days; and (4) critical, defined as patients who usually had one or more of the following complications compared with the severe patients: refractory shock (≥2 days), visceral hemorrhage, heart failure, pulmonary edema, brain edema, severe secondary infection, and severe AKI with oliguria (urine output of 50–500 mL/day) for >5 days or anuria (urine output of <100 mL/day) for >2 days. Considering the clinical conditions that a majority of the survival patients had been discharged before the convalescent phase and the degree of acute kidney injury (AKI) that was still severe during the early stage of the diuretic phase, the acute stage was defined as the period that included the febrile, hypotensive, and oliguric phases and the early three days of the diuretic phase in this study, and the convalescent stage was defined as the diuretic and convalescent phase except the early three days of the diuretic phase.…”

Spatio-Temporal Pattern and Influencing Factors of Hemorrhagic Fever with Renal Syndrome (HFRS) in Hubei Province (China) between 2005 and 2014

“…Hubei Province is known as the "land of a thousand lakes". The climate and ecological conditions in Hubei Province provide an ideal habitat for rodents [45]. Xiao et al demonstrated that moist environments are help for the vitality and infectivity of Hantaan virus and the distribution of rodents [41].…”