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Abstract：
BACKGROUND: Hantaan virus (HTNV), Seoul virus (SEOV) and Puumala virus (PUUV) are major serotypes of the Hantavirus, which can cause hemorrhagic fever with renal syndrome (HFRS). The pathophysiology of HFRS in humans is complex and the determinants associated with mortality, especially the coagulation and fibrinolysis disorders, are still not been fully elucidated. Severe patients usually manifest multiple complications except for acute kidney injury (AKI). The aim of this study was to observe the levels of peripheral blood routine, biochemical and coagulation parameters during the early stage, so as to find independent risk factors closely related to the prognosis, which may provide theoretical basis for targeted treatment and evaluation.
METHODS: A total of 395 HFRS patients from December 2015 to December 2018 were retrospectively enrolled. According to prognosis, they were divided into a survival group (n = 368) and a death group (n = 27). The peripheral blood routine, biochemical and coagulation parameters were compared between the two groups on admission. The relationship between the parameters mentioned above and prognosis was analyzed, and the dynamic changes of the coagulation and fibrinolysis parameters during the first week after admission were further observed.
RESULTS: In addition to AKI, liver injury was also common among the enrolled patients. Patients in the death group manifested higher levels of white blood cell counts (WBC) on admission. 27.30% (107/392) of the patients enrolled presented with disseminated intravascular coagulation (DIC) on admission and DIC is more common in the death group; The death patients manifested longer prothrombin time (PT) and activated partial thromboplastin time (APTT), higher D-dimer and fibrinogen degradation product (FDP), and lower levels of platelets (PLT) and fibrinogen (Fib) compared with those of the survival patients. The proportion of D-dimer and FDP abnormalities are higher than PT, APTT and Fib. Prolonged PT, low level of Fib and elevated total bilirubin (TBIL) on admission were considered as independent risk factors for prognosis (death).
CONCLUSIONS: Detection of PT, Fib and TBIL on admission is necessary, which might be benefit to early predicting prognosis. It is also important to pay attention to the dynamic coagulation disorders and hyperfibrinolysis during the early stage in the severe HFRS patients.
METHODS: A total of 395 HFRS patients from December 2015 to December 2018 were retrospectively enrolled. According to prognosis, they were divided into a survival group (n = 368) and a death group (n = 27). The peripheral blood routine, biochemical and coagulation parameters were compared between the two groups on admission. The relationship between the parameters mentioned above and prognosis was analyzed, and the dynamic changes of the coagulation and fibrinolysis parameters during the first week after admission were further observed.
RESULTS: In addition to AKI, liver injury was also common among the enrolled patients. Patients in the death group manifested higher levels of white blood cell counts (WBC) on admission. 27.30% (107/392) of the patients enrolled presented with disseminated intravascular coagulation (DIC) on admission and DIC is more common in the death group; The death patients manifested longer prothrombin time (PT) and activated partial thromboplastin time (APTT), higher D-dimer and fibrinogen degradation product (FDP), and lower levels of platelets (PLT) and fibrinogen (Fib) compared with those of the survival patients. The proportion of D-dimer and FDP abnormalities are higher than PT, APTT and Fib. Prolonged PT, low level of Fib and elevated total bilirubin (TBIL) on admission were considered as independent risk factors for prognosis (death).
CONCLUSIONS: Detection of PT, Fib and TBIL on admission is necessary, which might be benefit to early predicting prognosis. It is also important to pay attention to the dynamic coagulation disorders and hyperfibrinolysis during the early stage in the severe HFRS patients.
摘要：
背景：汉坦病毒（HTNV），汉坦病毒（SEOV）和普马马拉病毒（PUUV）是汉坦病毒的主要血清型，可引起肾综合征出血热（HFRS）。人类HFRS的病理生理学是复杂的，与死亡率相关的决定因素，尤其是凝血和纤溶紊乱,仍未完全阐明。除急性肾损伤（AKI）外，重症患者通常表现出多种并发症。本研究的目的是观察外周血常规，早期的生化和凝血参数，从而找出与预后密切相关的独立危险因素,为针对性治疗和评价提供理论依据。
方法：回顾性纳入2015年12月至2018年12月的395例HFRS患者。根据预后,他们被分为存活组(n=368)和死亡组(n=27)。外周血常规,入院时比较两组患者的生化指标和凝血指标.分析上述参数与预后的关系,进一步观察入院后第1周凝血和纤溶参数的动态变化。
结果：除了AKI，肝损伤在入选患者中也很常见.死亡组患者入院时表现出更高水平的白细胞计数（WBC）。27.30%(107/392)的患者入院时出现弥散性血管内凝血(DIC),死亡组DIC更为常见;死亡患者出现凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),高级D-二聚体和纤维蛋白原降解产物（FDP），与存活患者相比，血小板（PLT）和纤维蛋白原（Fib）水平较低。D-二聚体和FDP异常比例高于PT,APTT和Fib。延长PT,入院时Fib水平低和总胆红素(TBIL)升高被认为是预后(死亡)的独立危险因素.
结论：PT的检测，入院时的Fib和TBIL是必要的，这可能有利于早期预测预后。严重HFRS患者早期动态凝血障碍和纤溶亢进也应引起重视。
方法：回顾性纳入2015年12月至2018年12月的395例HFRS患者。根据预后,他们被分为存活组(n=368)和死亡组(n=27)。外周血常规,入院时比较两组患者的生化指标和凝血指标.分析上述参数与预后的关系,进一步观察入院后第1周凝血和纤溶参数的动态变化。
结果：除了AKI，肝损伤在入选患者中也很常见.死亡组患者入院时表现出更高水平的白细胞计数（WBC）。27.30%(107/392)的患者入院时出现弥散性血管内凝血(DIC),死亡组DIC更为常见;死亡患者出现凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),高级D-二聚体和纤维蛋白原降解产物（FDP），与存活患者相比，血小板（PLT）和纤维蛋白原（Fib）水平较低。D-二聚体和FDP异常比例高于PT,APTT和Fib。延长PT,入院时Fib水平低和总胆红素(TBIL)升高被认为是预后(死亡)的独立危险因素.
结论：PT的检测，入院时的Fib和TBIL是必要的，这可能有利于早期预测预后。严重HFRS患者早期动态凝血障碍和纤溶亢进也应引起重视。
