title: Acute kidney injury and tools for risk-stratification in 456 patients with hantavirus-induced nephropathia epidemica.
abstract: BACKGROUND
  Puumala virus (PUUV) is the most common species of hantavirus in Central Europe. Nephropathia epidemica (NE), caused by PUUV, is characterized by acute kidney injury (AKI) and thrombocytopenia. The major goals of this study were to provide a clear clinical phenotyping of AKI in patients with NE and to develop an easy prediction rule to identify patients, who are at lower risk to develop severe AKI.
  
  
  METHODS
  A cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Data were collected from medical records and prospectively at follow-up visit. Severe AKI was defined by standard criteria according to the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification. Fuller statistical models were developed and validated to estimate the probability for severe AKI.
  
  
  RESULTS
  During acute NE, 88% of the patients had AKI according to the RILFE criteria during acute NE. A risk index score for severe AKI was derived by using three independent risk factors in patients with normal kidney function at time of diagnosis: thrombocytopenia [two points; odds ratios (OR): 3.77; 95% confidence intervals (CI): 1.82, 8.03], elevated C-reactive protein levels (one point; OR: 3.02; 95% CI: 1.42, 6.58) and proteinuria (one point; OR: 3.92; 95% CI: 1.33, 13.35). On the basis of a point score of one or two, the probability of severe AKI was 0.18 and 0.28 with an area under the curve of 0.71.
  
  
  CONCLUSIONS
  This clinical prediction rule provides a novel and diagnostically accurate strategy for the potential prevention and improved management of kidney complications in patients with NE and, ultimately, for a possible decrease in unnecessary hospitalization in a high number of patients.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.affiliation: Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany Department of Clinical Pharmacology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwab
authors.affiliation: Department of Internal Medicine I, Division of Infectious Diseases, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Evelina
authors.initials: E
authors.lastname: Tacconelli
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Friedrich-Michael
authors.initials: FM
authors.lastname: Pieper
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wegener
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Bianka
authors.initials: B
authors.lastname: Rettenmaier
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schwab
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Larissa
authors.initials: L
authors.lastname: Hoffmann
authors.affiliation: Department of Mathematics, University of Stuttgart, Stuttgart, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Dippon
authors.affiliation: Department of Mathematics, University of Stuttgart, Stuttgart, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Müller
authors.affiliation: Institute of Digital Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Fritz
authors.affiliation: Institute of Digital Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Zakim
authors.affiliation: Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Segerer
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kimmel
authors.affiliation: General Practitioner, Grabenstetten, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Gußmann
authors.affiliation: Local Health Authority, Stuttgart, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Priwitzer
authors.affiliation: Local Health Authority, Stuttgart, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mezger
authors.affiliation: Local Health Authority, Böblingen, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Walter-Frank
authors.affiliation: Local Health Authority, Esslingen, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Corea
authors.affiliation: Local Health Authority, Esslingen, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Wiedenmann
authors.affiliation: Local Health Authority, Reutlingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Brockmann
authors.affiliation: Department of Diagnostic and Laboratory Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Pöhlmann
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany niko.braun@rbk.de.
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000378:metabolism / Q000821:virology*; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006476:Orthohantavirus / Q000472:pathogenicity*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000175:diagnosis / Q000378:metabolism / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis / Q000378:metabolism / Q000821:virology; D012307:Risk Factors; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000175:diagnosis / Q000378:metabolism / Q000821:virology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: PUUV; acute kidney injury; hanta virus; nephropathia epidemica; predictors for severe course