Performance assessment of the SAPS II and SOFA scoring systems in Hanta virus Hemorrhagic Fever with Renal Syndrome

Abstract

Background: Hemorrhagic Fever with Renal Syndrome (HFRS), caused by the hantavirus, is a natural infectious disease characterized by fever, hemorrhage and renal damage. China is the most severely endemic area for HFRS in the world. In recent years, critical scoring systems based on quantitative classification have become an important clinical tool for predicting and evaluating the prognosis of critical illness, and provide guidelines for clinical practice. Methods: The sample comprised 384 patients with HFRS treated in the Taizhou Hospital from January 2006 to February 2017. The patients were divided into the severe group and the mild group according to their clinical characteristics. By comparing the differences in clinical symptoms, signs and laboratory data between the two groups, the clinically relevant indicators of severe HFRS were explored. According to the previous studies, we incorporated the positive fecal occult blood test (FOBT) into the sepsis-related organ failure assessment (SOFA) tool and formulated a new scoring system specifically for HFRS, named H-SOFA. By comparing the simplified acute physiology score II (SAPS II), SOFA and H-SOFA scores of the two groups, their predictive values for the progression of HFRS were assessed. Results: Compared to the mild group, patients in the severe group had longer hospital stays; higher frequencies of nausea, vomiting, abdomen pain, signs of congestion and hemorrhage; and more pronounced impairment of liver and renal function. The levels of PLT, PCT, TB, and FOBT were positively correlated with the progression of HFRS (P < 0.001). Patients with HFRS in the severe group got significantly higher scores on the SAPS II, SOFA, and H-SOFA scoring systems (P < 0.001). The values of SAPS II, SOFA and H-SOFA, were significantly correlated with the severity of HFRS, and the AUC values were 0.90, 0.96, and 0.98, respectively. Conclusion: PLT, PCT, TB, and FOBT were independent predictors of severe HFRS; SAPS II, SOFA, and H-SOFA had high predictive value for the progression of severe HFRS, with H-SOFA being the highest.

A Case Report of Empty Sella Syndrome secondary to Hantaan Virus Infection and Review of the Literature

“…It was reported that elevated levels of CRP and PCT were present in more than 90% of patients with HFRS [9]. The elevated level of PCT in HFRS may be related with and immune activation caused by hantavirus [10]. As well as elevated C-reactive protein levels were shown to in patients with hantavirus infection.…”

“…As well as elevated C-reactive protein levels were shown to in patients with hantavirus infection. But whether the elevation of CRP and PCT were associated with the severity of HFRS is still a controversial issue [10][11][12].…”

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

“…Activation of the coagulation system [ 26 , 27 ], severe infection [ 13 – 15 , 21 , 25 ], inflammatory diseases [ 18 ], trauma [ 28 ], cardiovascular diseases [ 19 ], and thrombotic diseases [ 29 ] could all result in changes in platelet parameters. Previous study showed that PLT counts were negatively correlated with the progression of HFRS, and the AUC values were 0.814 for the severity of HFRS, which indicated the better predictive efficacy of PLT counts [ 11 ]. However, the patients in that study [ 11 ] were just divided into mild group and severe group, and no analysis of the predictive value of platelet parameters was conducted in HFRS patients in relation to the patients' survival.…”

“…Previous study showed that PLT counts were negatively correlated with the progression of HFRS, and the AUC values were 0.814 for the severity of HFRS, which indicated the better predictive efficacy of PLT counts [ 11 ]. However, the patients in that study [ 11 ] were just divided into mild group and severe group, and no analysis of the predictive value of platelet parameters was conducted in HFRS patients in relation to the patients' survival.…”

“…Platelet parameters obtained by automated cell counters consist of PLT count, platelet distribution width (PDW), mean platelet volume (MPV), platelet-large cell rate (P-LCR), and plateletcrit (PCT). Decreased PLT count was shown to precede acute kidney failure in patients with Puumala virus infections [ 10 ], and PLT count was an independent predictor of severe HFRS [ 11 ] and critically ill patients in intensive care unit (ICU) [ 12 ]. In addition, PDW, MPV, P-LCR, and PCT are associated with platelet activation and function and have recently been shown to be useful markers for predicting occurrence and prognosis of certain inflammatory diseases and vascular diseases, such as Crimean-Congo hemorrhagic fever [ 13 ], sepsis [ 14 ], pulmonary embolism [ 15 ], ascitic fluid infection [ 16 ], obstructive sleep apnea [ 17 ], Crohn's disease [ 18 ], and coronary artery disease [ 19 ].…”