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.
Highlights
Hemorrhagic fever with renal syndrome (HFRS) is a combination of fever, hemorrhage, thrombocytopenia and acute kidney injury (AKI), among which severe AKI is the leading cause of death in patients with hemorrhagic fever with renal syndrome (HFRS), in the late stage
Hantaan virus (HTNV) infections usually result in a severe form of HFRS, but the illness can range from a mild illness without oliguria, to an extremely severe illness requiring hemodialysis
In a cohort of patients infected with PUUV, which causes a mild form of HFRS in Europe, previous study showed that low platelet count (,606109/L) was significantly associated with the subsequent severe AKI [4]
Summary
Hemorrhagic fever with renal syndrome (HFRS) is a combination of fever, hemorrhage, thrombocytopenia and acute kidney injury (AKI), among which severe AKI is the leading cause of death in patients with HFRS, in the late stage. Most of the symptoms and signs currently used in classifying HFRS [1,2], such as oliguria, anuria and kidney injury, do not appear until the later stages of illness. In a cohort of patients infected with PUUV, which causes a mild form of HFRS in Europe, previous study showed that low platelet count (,606109/L) was significantly associated with the subsequent severe AKI [4]. Hematological 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
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