Evaluation of clinical and laboratory predictors of fatality in patients with Hantavirus infection

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KOSTAKOĞLU U., YILMAZ G., Serkan V., Sevinç K. S., KAYA S., iftihar K.

Journal of Microbiology and Infectious Diseases, 2012 (Peer-Reviewed Journal)


Objectives: To determine the clinical and laboratory predictors of fatality among patients with Hantavirus infection.

Material and methods: A retrospective study was conducted on the patients with Hantavirus infection between April 2009 and October 2011 at the Black Sea and the Mediterranean regions in Turkey. Demographic, clinical and laboratory findings of fatal cases and non-fatal cases at the admission were compared.

Results: Twenty-two patients with confirmed Hantavirus infection were evaluated. Five patients died (22.7%). The cause of death was massive bleeding. The rate of hemorrhage was significantly higher in the fatal cases than non-fatal cases (p<0.001). Massive gastrointestinal hemorrhage was seen in four of these patients, cerebral hemorrhage in two and both gastrointestinal and pulmonary hemorrhage in one. Disseminated intravascular coagulation (DIC) was present in four of the fatal cases and a remarkable cause of the bleeding (p=0.02). White blood cell count (WBC) (p=0.002), creatine phosphokinase (CPK) (p=0.011), blood-urea-nitrogen (BUN) (p=0.014), C reactive protein (CRP) (p=0.005) and D-dimer levels (p=0.001), prothrombin time (PT) (p=0.023), activated partial thromboplastin time (aPTT) (p=0.001) and international normalized ratio (INR) (p=0.021) were significantly higher, and platelet counts (p=0.038) significantly lower in the fatal cases. Optimum diagnostic cut-off points for specific laboratory parameters which may be predictive of fatality were; WBC=16,000 µL-1, PLT=30000 µL-1, PT=19.7 s, aPTT=36 s, INR=1.2, D-dimer=9.3 µg/mL, CPK=600 U/L, BUN=47 mg/dL and CRP=13.4 mg/dL.

Conclusions: Physicians should be aware of the high fatality risk for patients with Hantavirus infection with hemorrhage, elevated WBC, CPK, BUN, CRP, PT, aPTT, INR and D-dimer and reduced platelet counts.

Key words: Hantavirus; hemorrhagic fever with renal syndrome; predictors of fatality; predictive factors