Latus Joerg, Kitterer Daniel, Segerer Stephan, Artunc Ferruh, Alscher M Dominik, Braun Niko
Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany.
Kidney Blood Press Res. 2015;40(1):22-30. doi: 10.1159/000368479. Epub 2015 Jan 31.
BACKGROUND/AIMS: Puumala virus causes nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome that occurs in Central and Northern Europe. Several studies have sought to identify risk factors for severe NE. However, elevated procalcitonin (PCT) levels have not previously been investigated as a predictive marker for a severe course of NE.
A cross-sectional prospective survey of 456 adults with serologically confirmed NE was performed.
PCT levels at the time of diagnosis were available for 43 out of 456 patients, and in 24 of these patients (56%) PCT levels were elevated ("PCT positive"). C-reactive protein (CRP) levels at admission to hospital and peak CRP levels during the acute course of the disease were higher in the PCT-positive compared with the PCT-negative group (p<0.05). Severe acute kidney injury (AKI) (RIFLE I and F) was present in similar numbers of PCT-positive and -negative patients (p=0.7), but antibiotics were more frequently used in the PCT-positive than the PCT-negative group (p<0.05). Within the PCT-positive group, PCT levels were similar among those receiving and not receiving antibiotics (p=0.13), and neither the duration of hospital stay nor CRP peak levels were lower in those treated with antibiotics (p=0.12 and p=0.13, respectively).
Elevated PCT levels are common in patients with acute NE. There was no association between PCT levels and severity of disease, including AKI or thrombocytopenia. It is important to distinguish Puumala virus infection from other causes of AKI with thrombocytopenia. However, PCT might not be useful in differentiating hantavirus infection from bacterial infection.
背景/目的：普马拉病毒可引发流行性肾病（NE），这是一种发生在中欧和北欧的症状相对较轻的肾综合征出血热。多项研究试图确定重症NE的危险因素。然而，此前尚未将降钙素原（PCT）水平升高作为重症NE病程的预测指标进行研究。
对456例血清学确诊为NE的成年人进行了一项横断面前瞻性调查。
456例患者中有43例在诊断时的PCT水平数据可用，其中24例患者（56%）的PCT水平升高（“PCT阳性”）。与PCT阴性组相比，PCT阳性组入院时的C反应蛋白（CRP）水平以及疾病急性期的CRP峰值水平更高（p<0.05）。PCT阳性和阴性患者中出现严重急性肾损伤（AKI）（RIFLE I和F级）的人数相似（p=0.7），但PCT阳性组比PCT阴性组更频繁使用抗生素（p<0.05）。在PCT阳性组中，接受和未接受抗生素治疗的患者PCT水平相似（p=0.13），接受抗生素治疗的患者住院时间和CRP峰值水平均未降低（分别为p=0.12和p=0.13）。
急性NE患者中PCT水平升高很常见。PCT水平与疾病严重程度（包括AKI或血小板减少症）之间无关联。将普马拉病毒感染与其他导致血小板减少的AKI病因区分开来很重要。然而，PCT在区分汉坦病毒感染和细菌感染方面可能并无用处。
