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发热伴血小板减少综合征患者急性肾损伤的临床特征及预后

Clinical characteristics and outcomes of acute kidney injury in patients with severe fever with thrombocytopenia syndrome.

作者信息

Zhang Zhongwei, Hu Xue, Jiang Qunqun, Hu Wenjia, Li Anling, Deng Liping, Xiong Yong

机构信息

Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China.

Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Microbiol. 2023 Sep 13;14:1236091. doi: 10.3389/fmicb.2023.1236091. eCollection 2023.

Abstract

BACKGROUND

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis caused by a novel bunyavirus. Until recently, the SFTS related acute kidney injury (AKI) was largely unexplored. This study aimed to investigate the clinical characteristics and outcomes of AKI in patients with SFTS.

METHODS

The non-AKI and AKI groups were compared in terms of general characteristics, clinical features, laboratory parameters and cumulative survival rate. The independent risk factors for in-hospital mortality in patients with SFTS were analyzed by multivariate logistic regression to identify the population with poor prognosis.

RESULTS

A total of 208 consecutive patients diagnosed with SFTS were enrolled, including 153 (73.6%) patients in the non-AKI group and 55 (26.4%) patients in the AKI group. Compared with patients without AKI, patients with AKI were older and had a higher frequency of diabetes. Among these laboratory parameters, platelet count, albumin and fibrinogen levels of patients with AKI were identified to be significantly lower than those of patients without AKI, while ALT, AST, ALP, triglyceride, LDH, BUN, uric acid, creatine, Cys-C, β2-MG, potassium, AMY, lipase, CK-MB, TnI, BNP, APTT, thrombin time, D-dimer, CRP, IL-6, PCT and ESR levels were significantly higher in patients with AKI. A higher SFTS viral load was also detected in the AKI patients than in the non-AKI patients. The cumulative survival rates of patients at AKI stage 2 or 3 were significantly lower than those of patients without AKI or at AKI stage 1. However, there was no significant difference in the cumulative survival rates between patients without AKI and those with stage 1 AKI. Univariate and multivariate binary logistic regression analyses demonstrated that stage 2 or 3 AKI was an independent risk factor for in-hospital mortality in patients with SFTS.

CONCLUSION

AKI is associated with poor outcomes in patients with SFTS, especially patients at AKI stage 2 or 3, who generally have high mortality. Our findings support the importance of early identification and timely treatment of AKI in patients with SFTS.

摘要

背景

发热伴血小板减少综合征(SFTS)是一种由新型布尼亚病毒引起的新发人畜共患病。直到最近,与SFTS相关的急性肾损伤(AKI)在很大程度上仍未得到充分研究。本研究旨在调查SFTS患者AKI的临床特征及预后。

方法

比较非AKI组和AKI组在一般特征、临床特点、实验室指标及累积生存率方面的差异。采用多因素logistic回归分析SFTS患者院内死亡的独立危险因素,以确定预后不良的人群。

结果

共纳入208例连续诊断为SFTS的患者,其中非AKI组153例(73.6%),AKI组55例(26.4%)。与无AKI的患者相比,AKI患者年龄更大,糖尿病发生率更高。在这些实验室指标中,AKI患者的血小板计数、白蛋白和纤维蛋白原水平显著低于无AKI的患者,而AKI患者的ALT、AST、ALP、甘油三酯、LDH、BUN、尿酸、肌酐、Cys-C、β2-MG、钾、AMY、脂肪酶、CK-MB、TnI、BNP、APTT、凝血酶时间、D-二聚体、CRP、IL-6、PCT和ESR水平显著更高。AKI患者的SFTS病毒载量也高于非AKI患者。AKI 2期或3期患者的累积生存率显著低于无AKI或AKI 1期的患者。然而,无AKI患者与AKI 1期患者的累积生存率无显著差异。单因素和多因素二元logistic回归分析表明,AKI 2期或3期是SFTS患者院内死亡的独立危险因素。

结论

AKI与SFTS患者的不良预后相关,尤其是AKI 2期或3期的患者,其死亡率通常较高。我们的研究结果支持早期识别和及时治疗SFTS患者AKI的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/930b/10533938/1eefd5a1d4a8/fmicb-14-1236091-g001.jpg

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