A High Viral Load in Urine Correlates With Acute Kidney Injury and Poor Outcomes in Hospitalized Patients With Severe Fever With Thrombocytopenia Syndrome: A Noninvasive and Convenient Prognostic Marker

Abstract

Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with an extensive geographical distribution and high mortality rate. To date, the role of SFTS virus (SFTSV) in urine is still elusive. We aimed to explore the relationship between urinary bunyavirus and acute kidney injury (AKI) and mortality in patients with SFTS. Methods Urine samples were collected from 102 patients to quantify SFTSV load in urine (U-SFTSV). Patient renal function was evaluated on admission. Receiver operating characteristic (ROC) curve (AUC) and logistic regression analysis were performed to evaluate the predictive value of U-SFTSV. Viral infectivity assays in Vero cells were performed from 10 urine samples. Results The U-SFTSV level was positively correlated with SFTSV load in plasma (r=0.624) and indicators of renal damage. The U-SFTSV level was identified as an independent risk factor for SFTS-associated AKI (odds ratio, 3.631; 95% confidence interval 1.239-10.640; P=0.019). The U-SFTSV showed great value in predicting the fatal outcome of SFTS patients with high AUC (0.881). The Kaplan‒Meier survival comparison showed that patients with U-SFTSV levels greater than 6379 copies/ml were at a higher risk of death within 28 days after onset. In addition, four urine samples with high U-SFTSV levels were infectious. Conclusions Our large cohort study identified that the U-SFTSV level is a novel convenient and noninvasive predictive biomarker for incidence of AKI and poor outcome of patients with SFTS. Urine specimens could be a source of SFTSV infection in humans.

Viral shedding pattern of severe fever with thrombocytopenia syndrome virus in severely ill patients:A Prospective, Multicenter Study

“…We con rmed that U-SFTSV in SFTS patients was signi cantly associated with incidence of AKI, which is in consistent with previous reports [44]. U-SFTSV evaluation can be useful for early diagnosis of AKI in SFTS patients according to this research.…”

“…In this study, we found that SFTSV RNA in fecal/ anal swabs of SFTS patients was associated with diarrhea incident, SFTSV RNA levels in fecal/ anal swab was dependent on virus levels in patient's blood. Acute kidney injury was con rmed as a predictive biomarker for disease severity and poor prognosis [44]. In the current study, the incidence of AKI was 39.2%, higher than previous reports [44,45].…”

“…Acute kidney injury was con rmed as a predictive biomarker for disease severity and poor prognosis [44]. In the current study, the incidence of AKI was 39.2%, higher than previous reports [44,45].…”

Viral shedding pattern of severe fever with thrombocytopenia syndrome virus in severely ill patients: A prospective, Multicenter cohort study

“…In this research, SFTSV RNA in fecal/anal swabs of SFTS patients was found to be associated with diarrhea, SFTSV RNA levels in fecal/anal swab was dependent on virus levels in patient's blood. Acute kidney injury was confirmed as a predictive biomarker for disease severity and poor prognosis [ 44 ]. In the study, the incidence of AKI was 39.2 %, higher than previous reports [ 44 , 45 ].…”

Clinical characteristics and outcomes of acute kidney injury in patients with severe fever with thrombocytopenia syndrome

“…Although the mechanisms of AKI in patients with SFTS are unclear, some studies reported that the SFTS virus was detected in the kidneys ( Chen et al, 2012 ; Jin et al, 2012 ). Recently, a report showed that SFTS viral load in urine is an independent predictor of the incidence of AKI ( Zhang et al, 2023 ). It implies that the SFTS virus may directly induce renal damage.…”