Thrombocytopenia as a Predictor of Severe Acute Kidney Injury in Patients with Hantaan Virus Infections

Abstract

BackgroundHematological abnormalities often occur several days before kidney injury in patients with hemorrhagic fever with renal syndrome (HFRS). We aimed to investigate the prevalence and prognostic value of the early hematological markers in patients with HFRS caused by Hantaan virus (HTNV) infection.MethodsIn a retrospective cohort study, we analyzed the case records of 112 patients with acute HTNV infection and evaluated the hematological markers for early prediction and risk stratification of HFRS patients with acute kidney injury (AKI).ResultsOf 112 patients analyzed, 66 (59%) developed severe AKI, defined as either receipt of acute dialysis or increased serum creatinine ≥354 µmol/L. The prognostic accuracy of hematological markers, as quantified by the area under the receiver-operating-characteristic curve (AUC), was highest with the nadir platelet count (AUC, 0.89; 95% CI, 0.83–0.95), as compared with the admission platelet count (AUC, 0.84; 95% CI, 0.77–0.92), and the admission and peak leukocyte counts. The nadir platelet count correlated moderately with the levels of peak blood urea nitrogen (r = –0.616) and serum creatinine (r = –0.589), the length of hospital stay (r = –0.599), and the number of dialysis sessions that each patient received during hospital stay (r = –0.625). By multivariate analysis, decreased nadir platelet count remained independently associated with the development of severe AKI (odds ratio, 27.57; 95% CI, 6.96–109.16; P<0.0001).ConclusionsThrombocytopenia, rather than leukocytosis, is independently associated with subsequent severe AKI among patients with acute HTNV infection.

Thrombocytopenia associates with the severity of inflammation and variables reflecting capillary leakage in Puumala Hantavirus infection, an analysis of 546 Finnish patients

“…[12][13][14] Also, in Hantaan virus (HTNV) induced HFRS, thrombocytopenia has predicted severe AKI. [15] However, in our previous studies, the severity of AKI did not correlate with the level of thrombocytopenia in NE. [7,16,17] Furthermore, PUUV-infected carriers of plasminogen activator inhibitor (PAI)-1 G-allele have more severe AKI and coincidentally less severe thrombocytopenia.…”

“…[13,37] Furthermore, in HFRS caused by HTNV, thrombocytopenia predicted the development of severe AKI. [15] On the other hand, in HCPS patients, thrombocytopenia has predicted cure. [38] The fatal cases might, however, progress so rapidly that thrombocytopenia does not have time to develop.…”

Community Acquired Severe Acute Kidney Injury Caused by Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Has a Favorable Outcome

“…However, in these studies the research approach was different from our study and the number of patients was quite small, which may explain the divergent results. In patients with HFRS caused by the more severe Asian prototype hantavirus species, Hantaan virus, trombocytopenia has also predicted severe AKI [51]. On the other hand, PUUV-infected carriers of plasminogen activator inhibitor-1 G-allele have more severe AKI and coincidently less severe thrombocytopenia [19].…”

Hantaviruses—Infections, Epidemiology and Hosts

“…Genetic factors associated with severe or mild course of NE are specific human leukocyte antigen (HLA) genotypes and polymorphisms of cytokine genes (Mustonen et al 1996Kanerva et al 1998;Makela et al 2001). A predictive marker for severe course of NE and HFRS represents the number of thrombocytes (Rasche 2004;Wang et al 2013).…”