Latus Joerg, Schwab Matthias, Tacconelli Evelina, Pieper Friedrich-Michael, Wegener Daniel, Rettenmaier Bianka, Schwab Andrea, Hoffmann Larissa, Dippon Juergen, Müller Simon, Fritz Peter, Zakim David, Segerer Stephan, Kitterer Daniel, Kimmel Martin, Gußmann Karl, Priwitzer Martin, Mezger Barbara, Walter-Frank Birgit, Corea Angela, Wiedenmann Albrecht, Brockmann Stefan, Pöhlmann Christoph, Alscher M Dominik, Braun Niko
Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany Department of Clinical Pharmacology, University Hospital Tuebingen, Tuebingen, Germany.
Nephrol Dial Transplant. 2015 Feb;30(2):245-51. doi: 10.1093/ndt/gfu319. Epub 2014 Oct 13.
Puumala virus (PUUV) is the most common species of hantavirus in Central Europe. Nephropathia epidemica (NE), caused by PUUV, is characterized by acute kidney injury (AKI) and thrombocytopenia. The major goals of this study were to provide a clear clinical phenotyping of AKI in patients with NE and to develop an easy prediction rule to identify patients, who are at lower risk to develop severe AKI.
A cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Data were collected from medical records and prospectively at follow-up visit. Severe AKI was defined by standard criteria according to the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification. Fuller statistical models were developed and validated to estimate the probability for severe AKI.
During acute NE, 88% of the patients had AKI according to the RILFE criteria during acute NE. A risk index score for severe AKI was derived by using three independent risk factors in patients with normal kidney function at time of diagnosis: thrombocytopenia [two points; odds ratios (OR): 3.77; 95% confidence intervals (CI): 1.82, 8.03], elevated C-reactive protein levels (one point; OR: 3.02; 95% CI: 1.42, 6.58) and proteinuria (one point; OR: 3.92; 95% CI: 1.33, 13.35). On the basis of a point score of one or two, the probability of severe AKI was 0.18 and 0.28 with an area under the curve of 0.71.
This clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patients.
普马拉病毒（PUUV）是中欧最常见的汉坦病毒种类。由PUUV引起的流行性肾病（NE）的特征为急性肾损伤（AKI）和血小板减少。本研究的主要目的是对NE患者的AKI进行清晰的临床表型分析，并制定一个简单的预测规则以识别发生严重AKI风险较低的患者。
对456例血清学确诊的成年NE患者进行了一项横断面前瞻性调查。数据从病历中收集，并在随访时前瞻性收集。根据RIFLE（风险、损伤、衰竭、丧失、终末期肾病）分类的标准对严重AKI进行定义。开发并验证了更全面的统计模型以估计发生严重AKI的概率。
在急性NE期间，根据RILFE标准，88%的患者在急性NE期间患有AKI。通过使用诊断时肾功能正常的患者中的三个独立危险因素得出了严重AKI的风险指数评分：血小板减少[两分；比值比（OR）：3.77；95%置信区间（CI）：1.82，8.03]、C反应蛋白水平升高（一分；OR：3.02；95%CI：1.42，6.58）和蛋白尿（一分；OR：3.92；95%CI：1.33，13.35）。基于一分或两分的评分，严重AKI的概率分别为0.18和0.28，曲线下面积为0.71。
这一临床预测规则为NE患者潜在的肾脏并发症预防和改善管理提供了一种新颖且诊断准确的策略，并最终可能减少大量患者不必要的住院治疗。
