Correlation Between APRI And Severity Of Hemorrhagic Fever With Renal Syndrome And Predictive Value For Patients' Prognosis

Background:Hemerrhagic fever with renal syndrome(HFRS)is a rodent-borne disease caused by hantaviruses(HV).HV,a group of enveloped single-stranded negative RNA viruses of the genus orthohantavirus in hantaviridae family under bunyavirales Order.The main epidemic areas of HFRS are in Asia,Southeast Europe and North Africa.China is the most seriously affected country and accounts for over 90% of the total number of HFRS cases all over the world.Accompanied with the development of modern ecsomatics and imageology equipment and intensive care technology,there have been a large number of laboratory and imaging examination data which can be considered as the reference by clinician,while there are still less studies on the selection,integration and analysis of the detective data or parameters of the HFRS patients which could guide clinical pratice more effectively.Therefore,exploring early and new predictive indicators,to detect the severity and prognosis of HFRS patients,and necessary to guide clinicians take effective treatment and effective treatment programs are of great significance for improving the diagnosis and treatment of HFRS patients.HFRS is a systemic inflammatory disease with fever and kidney damage as its main manifestations.Myocardial injury and cardiac dysfunction can also occur in severe patients.Recent studies have found that some non-invasive liver fibrosis indicators may be related to the occurrence of heart disease and kidney disease.So,we speculate that the aspartate aminotransferase/platelet count(APRI)may also be used to determine the severity of HFRS disease and the prognosis of patients.However,to date,no systematic study of APRI has been used to predict disease severity and prognosis in patients with HFRS.Objective:Exploring the predictive value of APRI for assessing the severity of HFRS disease and the prognosis of HFRS patients,and it can provide a practical theoretical basis for clinical diagnosis and treatment.Methods:Collect medical records and laboratory data of patients diagnosed with HFRS from the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to January 2019.The above data were statistically analyzed and plotted with SPSS 25.0 software and R3.5.3 software.The patients were divided into four groups according to their severity: light,medium,severe,and critical.The clinical parameters and laboratory parameters of continuous variables that conformed to the normal distribution were compared using independent sample t-tests or one-way analysis of variance.Non-positive the clinical parameters and laboratory parameters of the state distribution were compared between groups by kruskal-wallis test,and the categorical variables were compared between groups by chi-square test and Fisher exact test,and the factors related to the severity of HFRS disease were analyzed.According to the prognosis of patients with HFRS,they are divided into two groups: survival and death.The clinical and laboratory parameters related to the significance of death are analyzed through comparison between groups.The independent risk factors related to the prognosis of HFRS are determined by univariate and multivariate logistic regression analysis.Based on the selected independent risk factors,a model for predicting the prognosis of HFRS patients was constructed.Based on the selected independent risk factors,a model for predicting the prognosis of HFRS patients was constructed.The R software "rms" and "rmda" packages were used to draw the nomogram of the prognosis prediction model for HFRS patients.The c-index and the calibration curve evaluates the performance of the nomogram,and the "decision curve" package performs a decision curve analysis(DCA)to further evaluate the practical value of the nomogram to clinical work.For all analyses,a p value of less than 0.05 was considered a significant statistical difference.All p values were from two-sided tests.Results:1.Demographic data analysis.A total of 404 cases were retrospectively collected.According to the inclusion and exclusion criteria of this study,a total of 317 cases were finally included.According to the clinical classification of HFRS,the included cases were divided into light(74 cases),medium(88 cases),heavy(58 cases)and critical(97 cases).Among them,a total of 155 patients with severe HFRS(58 severe and 97 severe).The average age of HFRS patients was 43.7 ± 14.7 years,and the majority were male(N = 247,77.9%).There were a total of 15 deaths with a mortality rate of 4.7%.There were no significant differences in the maximum temperature before admission,fever days before admission,smoking,drinking,and blood pressure in each group.2.Correlation between clinical and laboratory parameters and the severity of HFRS disease.Analysis of clinical parameters.Among HFRS-related complications,gastrointestinal bleeding,secondary infection,liver injury,sepsis,shock,multiple organ dysfunction syndrome(MODS),acute respiratory distress syndrome(ARDS)difference is statistically significant.Sepsis,shock,MODS and ARDS mostly occurred in the critically ill group.Acute physiology and chronic health(APACHE II)score,sequential organ failure score(SOFA)score,and quick sequential organ failure score(qSOFA)score were significant among the groups difference.The laboratory parameters were analyzed,and the white blood cell count,platelet count,neutrophil count(NEU),lymphocyte count(LYM),and aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin,platelet count/lymphocyte count(PLR),neutrophil count/lymphocyte count(NLR),APRI,albumin-bilirubin(ALBI),and platelet-albumin-bilirubin(PALBI)are related to the severity of HFRS disease.3.Clinical parameters related to prognosis of HFRS patients.Patients were divided into survival and death groups according to their prognosis.The results showed age(OR: 1.08;95% CI: 1.0-1.16;P = 0.041),sepsis(OR: 236.0;95% CI: 14.67-3799.1;P <0.001),ARDS(OR: 198.22;95 % CI: 6.35-6187.91;P = 0.003)and SOFA score(OR: 1.59;95% CI:1.19-2.13;P = 0.002)are independent risk factors for death in patients with HFRS.4.Laboratory parameters related to prognosis of HFRS patients.The results showed age(OR: 1.101;95% CI: 1.042-1.162;P = 0.001),NLR(OR: 1.105;95% CI: 1.024-1.193;P =0.01),and APRI(OR: 1.061;95% CI: 1.025-1.098;P=0.001)is an independent risk factor for death in patients with HFRS.ROC analysis was performed on age,NLR,and APRI.The AUC of three indicators predicting death was 0.776,0.787,and 0.954,and the AUC of three indicators predicting death was 0.966(95% CI: 0.945-0.988).APRI prediction is better than age(P = 0.0035)and NLR(P = 0.0008).When the cutoff value is 6.15,the sensitivity and specificity are 93.3% and 86.8%,respectively.Based on the independent risk factors,a nomogram for predicting the prognosis model of HFRS patients was constructed and corrected.The decision curve was used to analyze the benefits of the prediction model for actual clinical work.The results showed that the prediction model had a good net benefit.5.Clinical and laboratory parameters related to the prognosis of severe HFRS patients.The analysis of demographic data found that deaths mostly occurred in the group of severe HFRS patients.Therefore,the patients with severe HFRS were further divided into survival and death groups according to the prognosis,and the clinical and laboratoryparameters related to the prognosis of the severe HFRS patients were analyzed.The results were basically consistent with the independent prognosis risk analysis results of the HFRS patients.Conclusion:1.White blood cell count,platelet count,NEU,LYM,AST,ALT,albumin,PLR,NLR,APRI,ALBI,and PALBI at the time of admission are laboratory parameters that assess the severity of disease in HFRS patients.APRI is an independent risk predictor of the prognosis of HFRS patients.NLR is also an independent risk factor for predicting the prognosis of HFRS patients,and the predictive value of APRI is better than NLR.2.Age,sepsis,ARDS,and SOFA scores can also be used as independent risk factors that affect the prognosis of HFRS patients.Early detection and early diagnosis,active symptomatic supportive treatment can be given to delay disease progression and reduce the occurrence of HFRS-related complications,which can further reduce mortality in HFRS patients.In summary,APRI can be used as a predictor of the severity of HFRS disease and the prognosis of patients with HFRS,and its changes are closely related to the severity of HFRS disease and patient survival.