title: Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical characteristics and outcomes of critical patients with hemorrhagic fever with renal syndrome (HFRS) complicated by acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  To observe the demographic, epidemiological and clinical characteristics, and to explore the predictive effects for prognosis in laboratory findings, we conducted a detailed retrospective analysis of clinical records for critical patients with HFRS complicated by ARDS, treated at the center for infectious diseases, Tangdu Hospital, between January 2008 and December 2012.
  
  
  RESULTS
  A total of 48 critical patients with laboratory confirmed HFRS accompanied by ARDS were enrolled in the study, including 27 survivors and 21 non-survivors, with a fatality rate of 43.75%. Thirty-one individuals (64.6%) contracted HFRS between the months of September and December. The non-survivors tended to have lower incidence of overlapping phase (P = 0.025). There were no obvious differences in the needs for mechanical ventilation (MV) and renal replacement therapy (RRT), except for the need for vasoactive drugs between the survivors and non-survivors (P = 0.001). The non-survivors were found to have higher frequencies of encephalopathy, refractory shock and multiple organ dysfunction syndrome (MODS), lower incidences of acute renal failure (ARF) and secondary hypertension (P<0.05). The non-survivors tended to have lower levels of serum creatinine (Scr) (P<0.001) and fibrinogen (Fib) (P = 0.003), higher incidences of prolonged prothrombin time (PT) (P = 0.006) and activated partial thromboplastin time (APTT) (P = 0.020) and higher levels of aspartate aminotransferase (AST) (P = 0.015), and the laboratory parameters mentioned above reached statistical significance for predicting prognosis (P<0.05).
  
  
  CONCLUSIONS
  The high mortality rate of critical patients with HFRS complicated by ARDS emphasizes the importance of clinicians' alertness and timely initiation of systemic supportive therapy.
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Du
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Yu
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Junning
authors.initials: J
authors.lastname: Wang
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Pingzhong
authors.initials: P
authors.lastname: Wang
authors.affiliation: Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Xuefan
authors.initials: X
authors.lastname: Bai
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood; D002681:China / Q000453:epidemiology; D003401:Creatine / Q000097:blood; D005340:Fibrinogen / Q000378:metabolism; D006480:Hemorrhagic Fever with Renal Syndrome / Q000150:complications* / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D011517:Prothrombin Time; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D005340:Fibrinogen; D001219:Aspartate Aminotransferases; D003401:Creatine