Kim Se Woo, Shin Cheong-Il, Kang Min Woo, Kim Min Cheol, Kim Donghwan
Department of Radiology, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea.
Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Emerg Radiol. 2025 Jun;32(3):377-385. doi: 10.1007/s10140-025-02322-9. Epub 2025 Mar 12.
To develop of a novel computed tomography (CT) severity score for hemorrhagic fever with renal syndrome (HFRS) and evaluate its correlation with disease severity and adverse outcomes.
This retrospective study included 37 patients diagnosed with HFRS from January 2012 to December 2023 who had available clinical laboratory and abdominal CT data during the acute phase. The CT severity score (range 0-5) was based on perirenal fat stranding, pararenal fascia thickening, anterior pararenal space fat stranding, ascites, and pleural effusion. Correlations between the score and markers of inflammation, thrombocytopenia, proteinuria, and adverse outcomes-including nephrotic range proteinuria and renal replacement therapy (RRT)-were analyzed.
The CT severity score exhibited moderate to strong correlations with markers of inflammation (white blood cell count, ρ = 0.65, p < 0.001), thrombocytopenia (platelet count, ρ = -0.54, p < 0.001), and proteinuria (urine protein-to-creatinine ratio, ρ = 0.56, p < 0.001). Higher scores were associated with increased nephrotic range proteinuria in Chi-squared test for trend (p-for-trend = 0.001). A one-point increase in the score significantly increased odds of requiring RRT in logistic regression analysis (odds ratio: 9.89, p = 0.047). The score achieved an area under the receiver operating characteristics curve of 0.819 for predicting RRT.
The CT severity score correlates well with disease severity and adverse outcomes in HFRS and can be assessed using noncontrast CT, making it a valuable prognostic tool in young male population. Further validation in diverse populations is warranted.
开发一种新型的肾综合征出血热（HFRS）计算机断层扫描（CT）严重程度评分系统，并评估其与疾病严重程度和不良结局的相关性。
这项回顾性研究纳入了2012年1月至2023年12月期间诊断为HFRS的37例患者，这些患者在急性期有可用的临床实验室和腹部CT数据。CT严重程度评分（范围0 - 5）基于肾周脂肪条索状影、肾旁筋膜增厚、肾前间隙脂肪条索状影、腹水和胸腔积液。分析了该评分与炎症标志物、血小板减少、蛋白尿以及不良结局（包括肾病范围蛋白尿和肾脏替代治疗（RRT））之间的相关性。
CT严重程度评分与炎症标志物（白细胞计数，ρ = 0.65，p < 0.001）、血小板减少（血小板计数，ρ = -0.54，p < 0.001）和蛋白尿（尿蛋白与肌酐比值，ρ = 0.56，p < 0.001）呈中度至强相关性。在趋势卡方检验中，较高的评分与肾病范围蛋白尿增加相关（趋势p值 = 0.001）。在逻辑回归分析中，评分每增加1分，需要RRT的几率显著增加（比值比：9.89，p = 0.047）。该评分在预测RRT时的受试者工作特征曲线下面积为0.819。
CT严重程度评分与HFRS的疾病严重程度和不良结局相关性良好，可通过非增强CT进行评估，使其成为年轻男性人群中有价值的预后工具。有必要在不同人群中进一步验证。
