Platelet Distribution Width at First Day of Hospital Admission in Patients with Hemorrhagic Fever with Renal Syndrome Caused by Hantaan Virus May Predict Disease Severity and Critical Patients' Survival.

Xiude Fan,Zhengwen Liu,Zitong Liu,Xiaoge Zhang,Fang Li,Qunying Han,Shiqi Fu,Huan Deng,Na Li,Jiao Sang

doi:10.1155/2018/9701619

Xiude Fan, Zhengwen Liu + Show 8 more

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https://doi.org/10.1155/2018/9701619

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Abstract

Thrombocytopenia is one of the main characteristics of hemorrhagic fever with renal syndrome (HFRS). This study aimed to evaluate the associations of platelet distribution width (PDW) with the disease severity and critical patients' survival of HFRS. The demographics, clinical data, and white blood cell and platelet parameters including PDW in 260 patients hospitalized for HFRS were analyzed. The results showed that PDW on the first day (PDW1) was positively associated with the disease severity (p = 0.005). Multiple regression analysis showed that in addition to age (odds ratio [OR], 1.091; 95% confidence interval [CI], 1.015–1.172) and occurrence of sepsis (OR, 22.283; 95% CI, 2.985–166.325), PDW1 (OR, 0.782; 95% CI, 0.617–0.992) was a risk factor of the mortality, having an area under the receiver operating characteristic curve of 0.709 (95% CI, 0.572–0.846, p = 0.013) for predicting mortality, with a sensitivity of 70% and a specificity of 67% at a cutoff of 16.5 fL, in patients with critical HFRS. These results suggest the potential of PDW at the first day of hospitalization as a valuable parameter for evaluating the severity of HFRS and a moderate parameter for predicting the prognosis of critical HFRS patients. A prospective study in large patient population is needed to validate these findings.

Highlights

Hemorrhagic fever with renal syndrome (HFRS), a zoonotic disease caused by pathogenic hantaviruses, is characterized by altered vascular permeability all over the body and may exhibit severe profile with sudden fever, acute renal failure, shock, and hemorrhage [1]
Multiple logistic regression analysis showed that age (OR, 1.091; 95% confidence interval (CI), 1.015–1.172; p = 0 018), platelet distribution width (PDW) levels at the first day of hospital admission (OR, 0.782; 95% CI, 0.617– 0.992; p = 0 043), and sepsis secondary to HFRS (OR, 22.283; 95% CI, 2.985–166.325; p = 0 002) were independent risk factors for the mortality in HFRS patients after adjustment for MPV1, PDW1/PDW3, SBP, diastolic blood pressure (DBP), secondary infection, and MODS (Table 3)
This study shows that PDW1 may only moderately predict mortality and caution should be exercised when using this marker

Summary

Introduction

Hemorrhagic fever with renal syndrome (HFRS), a zoonotic disease caused by pathogenic hantaviruses, is characterized by altered vascular permeability all over the body and may exhibit severe profile with sudden fever, acute renal failure, shock, and hemorrhage [1]. According to the criteria of clinical classification of China, HFRS is classified into four clinical types: mild, medium, severe, and gravis [8]. These criteria of clinical classification depend largely on doctors’ subjective judgment, and the incidence of atypical patients with unusual clinical manifestations has increased. No reliable prognostic parameters have been available for the patients, especially the critically ill patients. These may hamper the early diagnosis and treatment of HFRS. Exploring new and early predictors to assess the severity and prognosis of HFRS

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