Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.
Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.
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DOI：
10.1371/journal.pone.0089740
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Bai X
中科院分区：
文献类型：
--
作者：
Du H;Li J;Jiang W;Yu H;Zhang Y;Wang J;Wang P;Bai X
本研究旨在探讨肾综合征出血热（HFRS）合并急性呼吸窘迫综合征（ARDS）危重患者的临床特点及预后。为观察人口学、流行病学和临床特点，探讨实验室检查结果对预后的预测作用，我们对2008年1月至2012年12月唐都医院感染性疾病中心收治的HFRS合并ARDS危重患者的临床资料进行了详细的回顾性分析。共纳入48例实验室确诊HFRS合并ARDS的危重患者，其中幸存者27例，非幸存者21例，病死率为43.75%。在9月至12月期间，31人（64.6%）感染了HFRS。未存活者重叠期发生率较低（P = 0.025）。在机械通气（MV）和肾脏替代治疗（RRT）的需求方面，幸存者和非幸存者之间除了对血管活性药物的需求外，无明显差异（P = 0.001）。非幸存者脑病、难治性休克和多器官功能障碍综合征（MODS）发生率较高，急性肾功能衰竭（ARF）和继发性高血压发生率较低（P<0.05）。未存活患者血清肌酐（Scr）、纤维蛋白原（Fib）水平较低（P<0.001），凝血酶原时间延长（P = 0.006）、部分凝血活酶活性时间（APTT）延长（P = 0.020）、天冬氨酸转氨酶（AST）升高（P = 0.015）发生率较高（P<0.05），上述实验室指标对预后的预测均有统计学意义（P<0.05）。HFRS合并ARDS危重患者的高死亡率强调了临床医生的警惕和及时启动系统支持治疗的重要性。
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). 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. 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). 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.
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