title: Thrombocytopenia as a predictor of severe acute kidney injury in patients with Hantaan virus infections.
abstract: BACKGROUND
  Hematological abnormalities often occur several days before kidney injury in patients with hemorrhagic fever with renal syndrome (HFRS). We aimed to investigate the prevalence and prognostic value of the early hematological markers in patients with HFRS caused by Hantaan virus (HTNV) infection.
  
  
  METHODS
  In a retrospective cohort study, we analyzed the case records of 112 patients with acute HTNV infection and evaluated the hematological markers for early prediction and risk stratification of HFRS patients with acute kidney injury (AKI).
  
  
  RESULTS
  Of 112 patients analyzed, 66 (59%) developed severe AKI, defined as either receipt of acute dialysis or increased serum creatinine ≥ 354 µmol/L. The prognostic accuracy of hematological markers, as quantified by the area under the receiver-operating-characteristic curve (AUC), was highest with the nadir platelet count (AUC, 0.89; 95% CI, 0.83-0.95), as compared with the admission platelet count (AUC, 0.84; 95% CI, 0.77-0.92), and the admission and peak leukocyte counts. The nadir platelet count correlated moderately with the levels of peak blood urea nitrogen (r = -0.616) and serum creatinine (r = -0.589), the length of hospital stay (r = -0.599), and the number of dialysis sessions that each patient received during hospital stay (r = -0.625). By multivariate analysis, decreased nadir platelet count remained independently associated with the development of severe AKI (odds ratio, 27.57; 95% CI, 6.96-109.16; P<0.0001).
  
  
  CONCLUSIONS
  Thrombocytopenia, rather than leukocytosis, is independently associated with subsequent severe AKI among patients with acute HTNV infection.
authors.affiliation: Center for Experimental Medicine, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, Gansu, China. mlwang_2003@yahoo.com
authors.forename: Meiliang
authors.initials: M
authors.lastname: Wang
authors.forename: Jiuping
authors.initials: J
authors.lastname: Wang
authors.forename: Tianping
authors.initials: T
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Ling
authors.initials: L
authors.lastname: Hui
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Ha
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000209:etiology / Q000821:virology; D000328:Adult; D019540:Area Under Curve; D003404:Creatinine / Q000097:blood; D005260:Female; D018063:Hantaan virus / Q000378:metabolism; D006480:Hemorrhagic Fever with Renal Syndrome / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007075:Immunoglobulin M / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000150:complications* / Q000175:diagnosis* / Q000821:virology
chemical_list: D007075:Immunoglobulin M; D003404:Creatinine