Zhang Qian, Zhao Jie, Dai Yan, Jiang Zhengyi, Chen Tianyan, Hu Nannan, Jin Ke, Li Jun
Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Respiratory Disease, Yixing No.2 People's Hospital, Yixing, Jiangsu, China.
Open Forum Infect Dis. 2023 Feb 18;10(4):ofad085. doi: 10.1093/ofid/ofad085. eCollection 2023 Apr.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with an extensive geographical distribution and high mortality rate. To date, the role of SFTS virus (SFTSV) in urine is still elusive. We aimed to explore the relationship between urinary bunyavirus and acute kidney injury (AKI) and mortality in patients with SFTS.
Urine samples were collected from 102 patients to quantify SFTSV load in urine (U-SFTSV). Patient renal function was evaluated on admission. Receiver operating characteristic (ROC) curve and logistic regression analysis were performed to evaluate the predictive value of U-SFTSV. Viral infectivity assays in Vero cells were performed from 10 urine samples.
The U-SFTSV level was positively correlated with SFTSV load in plasma (r = 0.624) and indicators of renal damage. The U-SFTSV level was identified as an independent risk factor for SFTS-associated AKI (odds ratio, 3.631; = .019). The U-SFTSV showed great value in predicting the fatal outcome of SFTS patients with high area under curve (0.881). The Kaplan-Meier survival comparison showed that patients with U-SFTSV levels greater than 6379 copies/mL were at a higher risk of death within 28 days after onset. In addition, 4 urine samples with high U-SFTSV levels were infectious.
Our large cohort study identified that the U-SFTSV level is a novel convenient and noninvasive predictive biomarker for incidence of AKI and poor outcome of patients with SFTS. Urine specimens could be a source of SFTSV infection in humans.
发热伴血小板减少综合征（SFTS）是一种新兴的传染病，地理分布广泛，死亡率高。迄今为止，SFTS病毒（SFTSV）在尿液中的作用仍不清楚。我们旨在探讨SFTS患者尿液中的布尼亚病毒与急性肾损伤（AKI）及死亡率之间的关系。
收集102例患者的尿液样本，以定量尿液中的SFTSV载量（U-SFTSV）。入院时评估患者的肾功能。采用受试者工作特征（ROC）曲线和逻辑回归分析来评估U-SFTSV的预测价值。从10份尿液样本中进行Vero细胞中的病毒感染性测定。
U-SFTSV水平与血浆中的SFTSV载量（r = 0.624）及肾损伤指标呈正相关。U-SFTSV水平被确定为SFTS相关AKI的独立危险因素（比值比，3.631；P = 0.019）。U-SFTSV在预测SFTS患者的致命结局方面具有很大价值，曲线下面积高（0.881）。Kaplan-Meier生存比较显示，U-SFTSV水平大于6379拷贝/mL的患者在发病后28天内死亡风险更高。此外，4份U-SFTSV水平高的尿液样本具有传染性。
我们的大型队列研究表明，U-SFTSV水平是一种新型的方便且无创的预测生物标志物，可用于预测SFTS患者AKI的发生率和不良结局。尿液标本可能是人类SFTSV感染的一个来源。
