Clinical Features of and Risk Factors for Rhabdomyolysis Among Adult Patients with Dengue Virus Infection

Huang, Shi-Yu; Lee, Ing-Kit; Liu, Jien-Wei; Kung, Chia-Te; Wang, Lin

doi:10.4269/ajtmh.14-0343

Cited by 25 publications

(19 citation statements)

References 39 publications

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“…To further strengthen the joint reactivity of anti-dsDNA, -nucleosome or -histone antibodies in LN patients, odds ratio (OR) was calculated in different groups of patients within LN or non-LN patients. The OR value greater than one represents a risk factor, whereas less than one a protective factor [ 21 ]. Consistent with our previous results [ 9 ], the group of patients with joint reactivity of the three antibodies (3-pos) not only had the highest number of patients among different LN groups, but also significantly higher than that in non-LN patients, with 41.0% in 921 LN vs 11.2% in 778 non-LN patients, p< 0.001; in addition, 3-pos patients had the highest OR value of 5.529; 95% CI 4.269–7.162, in comparison to other groups with single, double or null reactivity of the three antibodies.…”

Section: Resultsmentioning

confidence: 99%

Co-Positivity for Anti-dsDNA, -Nucleosome and -Histone Antibodies in Lupus Nephritis Is Indicative of High Serum Levels and Severe Nephropathy

Yang

Sui

et al. 2015

PLoS ONE

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ObjectiveTo characterize the significance of correlated autoantibodies in systemic lupus erythematosus (SLE) and its complication lupus nephritis (LN) in a large cohort of patients.MethodsClinical data were statistically analyzed in 1699 SLE patients with or without nephritis who were diagnosed and treated during 2002–2013 in the northeast region of China. Reactivity to a list of 16 autoantibodies was detected by the serum test Euroline ANA profile (IgG). Serum titers of the anti-nucleosome autoantibodies were measured by ELISA assays. Kidney biopsies were examined by pathologists. Immune complex deposition was identified by immunohistochemistry stain.ResultsSimultaneous positivity of anti-dsDNA, -nucleosome and -histone antibodies (3-pos) was prevalent in SLE patients with LN compared to Non-renal SLE patients (41% vs 11%, p< 0.001). Significant correlations were found between any two of the above three anti-nucleosome antibodies in LN patients. In comparison to non-3-pos cohorts, 3-pos patients with LN had significantly higher serum levels of the three antibodies and more active disease; was associated with type IV disease; suffered from more severe renal damages; received more intensive treatment and had worse disease outcome. The serum levels of these three autoantibodies in 3-pos LN patients were significantly decreased when they underwent clinical recovery.ConclusionsSimultaneous reactivity to anti-dsDNA, -nucleosome and -histone antibodies by Euroline ANA profile (IgG) may indicate severe nephropathy in patients with SLE.

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Section: Resultsmentioning

confidence: 99%

Co-Positivity for Anti-dsDNA, -Nucleosome and -Histone Antibodies in Lupus Nephritis Is Indicative of High Serum Levels and Severe Nephropathy

Yang

Sui

et al. 2015

PLoS ONE

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“…Similarly, diabetes with hypertension remained an independent risk factor of severe organ involvement. Hypertension was reported to be a risk factor of rhabdomyolysis28. In addition, diabetes with hyperlipidemia, diabetes with cardiac disorders and cardiac disorders with hyperlipidemia were observed to be independent risk factors of severe organ involvement.…”

Section: Discussionmentioning

confidence: 98%

“…Dengue associated severe organ involvement were cardiovascular18, hepatic141920, renal2122, as well as central nervous systems2324, and to some extent, respiratory252627 and muscular systems2829. Different dengue serotypes may have different severe organ involvements30.…”

mentioning

confidence: 99%

Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study

Pang

Hsu

Yeo

et al. 2017

Sci Rep

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Progression to severe organ involvement due to dengue infection has been associated with severe dengue disease, intensive care treatment, and mortality. However, there is a lack of understanding of the impact of pre-existing comorbidities and other risk factors of severe organ involvement among dengue adults. The aim of this retrospective case-control study is to characterize and identify risk factors that predispose dengue adults at risk of progression with severe organ involvement. This study involved 174 dengue patients who had progressed with severe organ involvement and 865 dengue patients without severe organ involvement, matched by the year of presentation of the cases, who were admitted to Tan Tock Seng Hospital between year 2005 and 2008. Age group of 60 years or older, diabetes, cardiac disorders, asthma, and having two or more pre-existing comorbidities were independent risk factors of severe organ involvement. Abdominal pain, clinical fluid accumulation, and hematocrit rise and rapid platelet count drop at presentation were significantly associated with severe organ involvement. These risk factors, when validated in a larger study, will be useful for triage by clinicians for prompt monitoring and clinical management at first presentation, to minimize the risk of severe organ involvement and hence, disease severity.

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“…Histological analysis revealed circulatory and parenchymal damage, presenting acute tubular necrosis, characterized by desquamation of necrotic cells and loss of the basal membrane mainly in contorted proximal tubules, thrombotic microangiopathy, and glomerulopathy [20,[35][36][37][38]. Studies have reported immune complex-mediated lesion in the glomerulus in patients with DENV infections, and have suggested this as a possible mechanism for urinary abnormalities [39,40]. The histopathological changes observed here exhibited a characteristic lesion of tubular necrosis, seen in cases with co morbidities, such as in diabetes [41].…”

Section: Discussionmentioning

confidence: 99%

Renal Injury in DENV-4 Fatal Cases: Viremia, Immune Response and Cytokine Profile

et al. 2019

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Dengue virus (DENV) infections may result in asymptomatic cases or evolve into a severe disease, which involves multiple organ failure. Renal involvement in dengue can be potentially related to an increased mortality. Aiming to better understand the role of DENV in renal injury observed in human fatal cases, post-mortem investigations were performed in four DENV-4 renal autopsies during dengue epidemics in Brazil. Tissues were submitted to histopathology, immunohistochemistry, viral quantification, and characterization of cytokines and inflammatory mediators. Probably due the high viral load, several lesions were observed in the renal tissue, such as diffuse mononuclear infiltration around the glomerulus in the cortical region and in the medullary vessels, hyalinosis arteriolar, lymphocytic infiltrate, increased capsular fibrosis, proximal convoluted tubule (PCT) damage, edema, PCT debris formation, and thickening of the basal vessel membrane. These changes were associated with DENV-4 infection, as confirmed by the presence of DENV-specific NS3 protein, indicative of viral replication. The exacerbated presence of mononuclear cells at several renal tissue sites culminated in the secretion of proinflammatory cytokines and chemokines. Moreover, it can be suggested that the renal tissue injury observed here may have been due to the combination of both high viral load and exacerbated host immune response.

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Clinical Features of and Risk Factors for Rhabdomyolysis Among Adult Patients with Dengue Virus Infection

Cited by 25 publications

References 39 publications

Co-Positivity for Anti-dsDNA, -Nucleosome and -Histone Antibodies in Lupus Nephritis Is Indicative of High Serum Levels and Severe Nephropathy

Co-Positivity for Anti-dsDNA, -Nucleosome and -Histone Antibodies in Lupus Nephritis Is Indicative of High Serum Levels and Severe Nephropathy

Diabetes, cardiac disorders and asthma as risk factors for severe organ involvement among adult dengue patients: A matched case-control study

Renal Injury in DENV-4 Fatal Cases: Viremia, Immune Response and Cytokine Profile

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