title: Evidence of disseminated intravascular coagulation in a hemorrhagic fever with renal syndrome-scoring models and severe illness.
abstract: BACKGROUND
  Viral hemorrhagic fevers (VHF) are considered to be a serious threat to public health worldwide with up to 100 million cases annually. The general hypothesis is that disseminated intravascular coagulation (DIC) is an important part of the pathogenesis. The study objectives were to study the variability of DIC in consecutive patients with acute hemorrhagic fever with renal syndrome (HFRS), and to evaluate if different established DIC-scores can be used as a prognostic marker for a more severe illness.
  
  
  RESULTS
  In a prospective study 2006-2008, data from 106 patients with confirmed HFRS were analyzed and scored for the presence of DIC according to six different templates based on criteria from the International Society on Thrombosis and Haemostasis (ISTH). The DIC-scoring templates with a fibrinogen/CRP-ratio were most predictive, with predictions for moderate/severe illness (p<0.01) and bleeding of moderate/major importance (p<0.05). With these templates, 18.9-28.3% of the patients were diagnosed with DIC.
  
  
  CONCLUSIONS
  DIC was found in about one fourth of the patients and correlated with a more severe disease. This supports that DIC is an important part of the pathogenesis in HFRS. ISTH-scores including fibrinogen/CRP-ratio outperform models without. The high negative predictive value could be a valuable tool for the clinician. We also believe that our findings could be relevant for other VHFs.
authors: Department of Clinical Microbiology/Infectious Diseases, Umeå University, Umeå, Sweden. erik.sundberg@climi.umu.se
authors: Erik
authors: E
authors: Sundberg
authors: Johan
authors: J
authors: Hultdin
authors: Sofie
authors: S
authors: Nilsson
authors: Clas
authors: C
authors: Ahlm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D004211:Disseminated Intravascular Coagulation / Q000150:complications*; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D055815:Young Adult