Clinical and laboratory predictors of oliguric renal failure in haemorrhagic fever with renal syndrome caused by Hantaan virus

Kim, Young Keun; Lee, Sang Cheol; Kim, Chang-Soo; Heo, Sang Taek; Choi, Chang‐Min; Kim, June Myung

doi:10.1016/j.jinf.2006.07.006

Cited by 23 publications

(22 citation statements)

References 16 publications

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“…Our study shows that in HTNV cohort, up to 71 of 112 (63%) had a nadir platelet count of 33×10 9 /L or less. The incidence of thrombocytopenia was higher than previously reported both in the PUUV and HTNV cohorts [4], [6].…”

Section: Discussioncontrasting

confidence: 72%

“…By contrast with this study [4], the platelet count was also measured in one other study of acute HTNV infection in which 24 (39%) of 61 patients had thrombocytopenia, defined as admission platelet count ≤38×10 9 /L [6]. The admission leukocyte count, rather than the admission platelet count, was found to be significantly associated with the development of oliguric AKI, which was defined as a urine output <400 mL/24 h (the significant difference of the minimum platelet count between patients with and without AKI was not described further).…”

Section: Discussionmentioning

confidence: 85%

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

Wang

et al. 2013

PLoS ONE

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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.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 85%

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

Wang

et al. 2013

PLoS ONE

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“…Thus, it is tempting to speculate that peripheral blood thrombocytopenia and leucopenia in SFTS patients result from increased peripheral organ damage or circulating anti-platelet antibodies. SFTS symptoms are markedly different from the manifestations of hemorrhagic fever with renal syndrome, caused by hantavirus (a bunyavirus subspecies), where thrombocytopenia in peripheral blood is a major phenotype, but with increased instead of reduced total white blood cell count [7]. The differences in etiology between SFTS and the disease caused by hantavirus requires further exploration.…”

Section: Discussionmentioning

confidence: 99%

A Study of Cytological Changes in the Bone Marrow of Patients with Severe Fever with Thrombocytopenia Syndrome

et al. 2013

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BackgroundPeripheral blood leucopenia and thrombocytopenia are the main manifestations in severe fever with thrombocytopenia syndrome (SFTS) patients. However, the underlying causes are poorly understood. Therefore, we aimed to investigate cytology of bone marrow samples collected from SFTS patients. Methods10 SFTS patients were identified by typical clinical manifestations, detection of peripheral blood leucopenia and thrombocytopenia, and nucleic acid-based detection of the newly identified bunyavirus. SFTS patients, along with 10 participants with acute aplastic anemia and 10 healthy volunteers were enrolled in this study after written informed consent to undergo bone marrow cytological examination.ResultsWe observed similar bone marrow properties in SFTS patients and healthy volunteers, significantly different from the characteristics observed in acute aplastic anemia patients.ConclusionSimilarities between bone marrow samples collected from SFTS patients and healthy volunteers suggest that peripheral blood leucopenia and thrombocytopenia do not result from bone marrow cell plasticity.

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“…In the 34 subjects with serological confirmed HFRS (from 1987 to 2005) in this study who received at least four doses of the drug, HFRS disease was milder compared to nonribavirin-treated historical controls. Oliguria was present in one subject before initiation of ribavirin; no subjects subsequently developed oliguria or required dialysis (compared to 39% to 60% oliguria and 40% dialysis requirement historically in nonribavirin-treated subjects infected with Hantaan virus) (Kim et al, 2006;Lee, 1991;Rusnak et al, 2009). …”

Section: Humans Trials Country Effectmentioning

confidence: 93%

Experience with Ribavirin for Treatment and Postexposure Prophylaxis of Hemorrhagic Fever Viruses: Crimean Congo Hemorrhagic Fever, Lassa Fever, and Hantaviruses

Rusnak

2011

Appl Biosaf.

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The increase in research laboratories with biosafety level-4 (BSL-4) capabilities may be associated with increased research with hemorrhagic fever (HF) viruses. The yellow fever vaccine and an investigational formalin-inactivated Rift Valley fever vaccine are the only vaccines for at-risk laboratory workers available in the United States against HF viruses. Ribavirin is a nucleoside analogue that has been demonstrated to have antiviral activity against a wide range of viruses, including many HF viruses. While intravenous (IV) ribavirin is not FDA-approved and oral ribavirin is approved only for treatment of hepatitis C in the United States, ribavirin has been used for treatment and postexposure prophylaxis for Crimean Congo hemorrhagic fever (CCHF), Lassa fever (LF), and hantaviruses, based mainly on in vitro sensitivity testing and efficacy studies in animals, but only on a limited number of studies and/or anecdotal experience in humans.The literature on both IV and oral ribavirin for treatment and postexposure prophylaxis for CCHF, LF, and hantaviruses is reviewed to aid occupational healthcare providers in the evaluation and recommendation of ribavirin to laboratory workers with exposures or illness from these HF viruses, which are associated with a significant morbidity and mortality.

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Clinical and laboratory predictors of oliguric renal failure in haemorrhagic fever with renal syndrome caused by Hantaan virus

Cited by 23 publications

References 16 publications

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

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

A Study of Cytological Changes in the Bone Marrow of Patients with Severe Fever with Thrombocytopenia Syndrome

Experience with Ribavirin for Treatment and Postexposure Prophylaxis of Hemorrhagic Fever Viruses: Crimean Congo Hemorrhagic Fever, Lassa Fever, and Hantaviruses

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