Kitterer Daniel, Segerer Stephan, Dippon Juergen, Alscher M Dominik, Braun Niko, Latus Joerg
Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany.
Nephron. 2016;134(2):89-94. doi: 10.1159/000447783. Epub 2016 Jul 8.
BACKGROUND/AIMS: Hantaviruses are zoonotic pathogens causing emerging diseases worldwide. Patients typically present with fever, acute kidney injury (AKI) and thrombocytopenia. Puumala virus (PUUV) that causes nephropathia epidemica (NE) is common in Germany. Recently, a study from Finland revealed an association between nicotine consumption and the severity of AKI in NE. Differences between individuals in Finland and Germany might modulate the effect; therefore, the aim of our study was to prove that smoking is a risk factor for a severe course of NE in Germany.
A cross-sectional prospective survey of 485 patients with hantavirus infections was performed. Clinical and laboratory data during the acute course of the disease were obtained from medical reports and files, while follow-up (including smoking status) data were collected prospectively.
Smoking information was available for 298 out of 485 patients (61%). Male was the predominant gender (67%), median age at the time of diagnosis was 50 (interquartile range, IQR 41-60) years and 34% of patients were current smokers during the phase of acute NE. Patients in the smoking group were significantly younger than in the non-smoking group (p < 0.0001). Peak serum creatinine levels were significantly higher in the smoking group than in the non-smoking patients (median 301 (IQR 186-469 μmol/l) vs. median 240 (IQR 137-469 μmol/l), p < 0.05). In addition, severe AKI (stages 2 and 3 using KDIGO criteria) was more common in current smokers (80%) than in the non-smokers (68%, p < 0.05).
Current smoking is a risk factor for severity of AKI in patients with acute PUUV infection in Germany. Therefore, information about smoking habits needs to be an integral part of the documentation in patients with suspected acute PUUV infection, and increased monitoring of kidney function should be done in NE patients who are current smokers.
背景/目的：汉坦病毒是一种人畜共患病原体，在全球引发新发疾病。患者通常表现为发热、急性肾损伤（AKI）和血小板减少。引起流行性肾病（NE）的普马拉病毒（PUUV）在德国很常见。最近，芬兰的一项研究揭示了尼古丁消费与NE中AKI严重程度之间的关联。芬兰人和德国人个体之间的差异可能会调节这种影响；因此，我们研究的目的是证明吸烟是德国NE严重病程的一个危险因素。
对485例汉坦病毒感染患者进行了横断面前瞻性调查。疾病急性期的临床和实验室数据从医疗报告和档案中获取，而随访（包括吸烟状况）数据则前瞻性收集。
485例患者中有298例（61%）可获得吸烟信息。男性占主导（67%），诊断时的中位年龄为50岁（四分位间距，IQR 41 - 60），34%的患者在急性NE阶段为当前吸烟者。吸烟组患者明显比非吸烟组年轻（p < 0.0001）。吸烟组的血清肌酐峰值水平显著高于非吸烟患者（中位数301（IQR 186 - 469 μmol/l）对中位数240（IQR 137 - 469 μmol/l），p < 0.05）。此外，当前吸烟者中重度AKI（根据KDIGO标准为2期和3期）比非吸烟者更常见（80%对68%，p < 0.。
在德国，当前吸烟是急性PUUV感染患者AKI严重程度的一个危险因素。因此，关于吸烟习惯的信息需要成为疑似急性PUUV感染患者病历记录的一个组成部分，并且应对当前吸烟的NE患者加强肾功能监测。
