Department of Infectious Diseases, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, Zhejiang 318000, China.
Department of Infectious Diseases, Affiliated Taizhou Hospital of Wenzhou Medical University, Linhai, Zhejiang 317000, China.
Int J Infect Dis. 2017 Oct;63:88-94. doi: 10.1016/j.ijid.2017.08.003. Epub 2017 Aug 10.
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.
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.
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.
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.
肾综合征出血热（HFRS）是由汉坦病毒引起的自然感染性疾病，其临床特征为发热、出血和肾功能损害。中国是世界上 HFRS 流行最严重的地区。近年来，基于定量分类的危急评分系统已成为预测和评估危急重症预后的重要临床工具，并为临床实践提供了指导。
该研究纳入了 2006 年 1 月至 2017 年 2 月在台州医院治疗的 384 例 HFRS 患者。根据临床特征将患者分为重症组和轻症组，通过比较两组间临床症状、体征和实验室数据的差异，探索 HFRS 重症化的临床相关指标。根据既往研究，我们将粪便潜血阳性（FOBT）纳入脓毒症相关器官衰竭评估（SOFA）工具中，并制定了专门针对 HFRS 的新评分系统，命名为 H-SOFA。通过比较两组简化急性生理学评分 II（SAPS II）、SOFA 和 H-SOFA 评分，评估其对 HFRS 进展的预测价值。
与轻症组相比，重症组患者的住院时间更长，恶心、呕吐、腹痛、充血和出血体征的发生频率更高，肝肾功能损害更明显。血小板（PLT）、血小板计数与外周血白细胞乘积（PCT）、总胆红素（TB）和 FOBT 水平与 HFRS 进展呈正相关（P<0.001）。HFRS 重症组患者 SAPS II、SOFA 和 H-SOFA 评分显著升高（P<0.001）。SAPS II、SOFA 和 H-SOFA 评分与 HFRS 严重程度显著相关，其 AUC 值分别为 0.90、0.96 和 0.98。
PLT、PCT、TB 和 FOBT 是 HFRS 重症化的独立预测指标；SAPS II、SOFA 和 H-SOFA 对 HFRS 重症化进展具有较高的预测价值，其中 H-SOFA 最高。
Zotero 插件