Study On The Value Of Coagulation Index In Early Warning Of Severity Of Acute Hemorrhagic Fever With Renal Syndrome

Objective: The purpose of this study was to analyze the value of four commonly used coagulation parameters(PLT,PT,APTT,TT,Fib,FDP,DD)and four coagulation fibrinolytic biomarker markers(TF,TM,tPA and pai-1)in early warning of severe HFRS and their clinical significance.Methods: Patients who tested positive for hantavirus-specific IgM and IgG in the second affiliated hospital of the air force medical university from October 2016 to July2018 were included in this study.Plasma samples of all HFRS patients admitted from October 2018 to March 2019 were collected.Exclusion criteria: exclude patients who are pregnant or under 18 years old;Patients with acute renal failure caused by HFRS were excluded.Patients with chronic liver and kidney diseases,cancer,blood diseases and patients who had used anticoagulants before admission were excluded.Eliminate missing data for key indicators.Basic clinical data and laboratory data of HFRS patients were collected to complete the detection of four indicators of TF,TM,tPA and pai-1.According to the clinical typing standard of HFRS,the patients were divided into mild group and severe group.In this study,the acute phase of HFRS patients was defined as fever,hypotensive shock,and oliguria at the early stage of urination.Contents:1.Among the 272 patients,135 were in the mild group and 137 were in the severe group.The expression levels of PT,APTT,TT,Fib,DD and FDP in different groups were compared to analyze their clinical significance.Assess the early warning value of these indicators for disease severity.2.Among the 58 patients with HFRS,26 were in the mild group and 32 were in the severe group.The expression levels of TF,TM,tPA and pai-1 in different disease courses and groups were compared.Assess the early warning value of these indicators for diseaseseverity.Results:1.Value evaluation of clinical coagulation parameters in early warning of hemorrhagic fever with severe renal syndrome(1)In this study,272 patients were included,aged 44.24±15.25(years),ranging in age from 18 to 84 years.There were 216 males(79.6%)and 56 females(20.4%).(2)The age of HFRS patients in the severe group increased significantly(P < 0.05),but there was no significant difference in gender between the two groups(P > 0.05).(3)PT,APTT and TT in the severe group were significantly prolonged than in the mild group,while PLT and Fib levels in the severe group were significantly decreased than in the mild group(P < 0.05).DD and FDP levels were 3-5 times higher than the upper limit of the normal reference value between the two groups,but there was no significant difference between the two groups(P > 0.05).(4)According to binary Logstic regression analysis,PLT and APTT are independent risk factors for the occurrence of severe HFRS(P<0.05).(5)ROC analysis showed that the AUC predicted by PLT and APTT was 0.90 and 0.83,respectively,and the AUC predicted by PLT and APTT combined detection was 0.92,with the sensitivity and specificity being 86% and 85%,respectively,higher than that by single parameter detection(P < 0.05).2.Evaluation of the value of TF,TM,tPA and PAI-1 in early warning of hemorrhagic fever with severe renal syndrome(1)This study included 58 patients,26 patients in mild disease group and 32 patients in severe disease group,with an age range of 18-75 years;(2)The age of HFRS patients in the severe group was significantly increased in the younger group(P < 0.05).In terms of gender,there was no significant difference between the two groups(P > 0.05).(3)The expression levels of TF,tPA and pai-1 in the acute stage and convalescent stage were significantly higher than those in the convalescent stage(P < 0.05),and the expression levels of TM in the acute stage and convalescent stage were no different from those in the control group(P > 0.05).(4)The levels of TF and tPA in the severe group and the mild group were significantly increased(P < 0.05),and there was no significantdifference in TM and pai-1 levels between the two groups(P > 0.05).(5)Binary Logstic regression analysis found that TF was an independent risk factor for the occurrence of severe HFRS(P < 0.05).Clusions:1.The decrease of PLT,the significant prolongation of PT,APTT and TT and the increase of TF indicate that hantavirus infection activates the coagulation system,leading to the consumption of coagulation factors and the increase of thrombase production.2.The significant increase of DD,FDP and tPA indicates that hantavirus infection also leads to the over-activation of the fibrinolysis system,and excessive fibrinolysis leads to the degradation of thrombin,which may be conducive to vascular recanalization and the recovery of the disease.3.PLT,APTT and TF play an important role in the early warning assessment of HFRS disease severity.