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Cvetko Krajinović L, Bodulić K, Laškaj R, Žibrat B, Svoboda Karić P, Kurolt IC, Kordun M, Topić A, Čivljak R, Skuhala T, Markotić A. Hemorrhagic Fever with Renal Syndrome Patients Exhibit Increased Levels of Lipocalin-2, Endothelin-1 and NT-proBNP. Life (Basel) 2023; 13:2189. [PMID: 38004329 PMCID: PMC10672301 DOI: 10.3390/life13112189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is an acute zoonotic disease caused by viruses of the Orthohantavirus genus. This syndrome is characterized by renal and cardiopulmonary implications detectable with different biomarkers. Here, we explored the role of serum and urine levels of lipocalin-2, endothelin-1 and N-terminal pro-brain natriuretic peptide (NT-proBNP) in HFRS pathology. A total of twenty-eight patients hospitalized due to a Puumala orthohantavirus infection were included, with serum and urine samples collected on patient admission (acute phase) and discharge (convalescent phase). In comparison to healthy individuals, patients exhibited significantly higher acute-phase serum and urine levels of lipocalin-2, serum levels of endothelin-1 and serum and urine levels of NT-proBNP. Patients in the convalescent phase showed a significant decrease in urine lipocalin-2, serum endothelin-1 and serum and urine NT-proBNP levels. We recorded a strong correlation between serum levels of lipocalin-2 and endothelin-1 and urine levels of lipocalin-2 with several kidney injury markers, such as serum creatinine, urea, urine white blood cell count and proteinuria. We also demonstrated an independent correlation of serum and urine lipocalin-2 levels with acute kidney injury in HFRS. All in all, our results show an involvement of NT-proBNP, lipocalin-2 and endothelin-1 in the renal and cardiac pathology of HFRS.
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Affiliation(s)
| | - Kristian Bodulić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Renata Laškaj
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Branka Žibrat
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Petra Svoboda Karić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Ivan-Christian Kurolt
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Mihaela Kordun
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Antea Topić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Tomislava Skuhala
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, 51 000 Rijeka, Croatia
- Faculty of Medicine, Catholic University of Croatia, 10 000 Zagreb, Croatia
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Vaheri A, Smura T, Vauhkonen H, Hepojoki J, Sironen T, Strandin T, Tietäväinen J, Outinen T, Mäkelä S, Pörsti I, Mustonen J. Puumala Hantavirus Infections Show Extensive Variation in Clinical Outcome. Viruses 2023; 15:v15030805. [PMID: 36992513 PMCID: PMC10054505 DOI: 10.3390/v15030805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
The clinical outcome of Puumala hantavirus (PUUV) infection shows extensive variation, ranging from inapparent subclinical infection (70-80%) to severe hemorrhagic fever with renal syndrome (HFRS), with about 0.1% of cases being fatal. Most hospitalized patients experience acute kidney injury (AKI), histologically known as acute hemorrhagic tubulointerstitial nephritis. Why this variation? There is no evidence that there would be more virulent and less virulent variants infecting humans, although this has not been extensively studied. Individuals with the human leukocyte antigen (HLA) alleles B*08 and DRB1*0301 are likely to have a severe form of the PUUV infection, and those with B*27 are likely to have a benign clinical course. Other genetic factors, related to the tumor necrosis factor (TNF) gene and the C4A component of the complement system, may be involved. Various autoimmune phenomena and Epstein-Barr virus infection are associated with PUUV infection, but hantavirus-neutralizing antibodies are not associated with lower disease severity in PUUV HFRS. Wide individual differences occur in ocular and central nervous system (CNS) manifestations and in the long-term consequences of nephropathia epidemica (NE). Numerous biomarkers have been detected, and some are clinically used to assess and predict the severity of PUUV infection. A new addition is the plasma glucose concentration associated with the severity of both capillary leakage, thrombocytopenia, inflammation, and AKI in PUUV infection. Our question, "Why this variation?" remains largely unanswered.
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Affiliation(s)
- Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Teemu Smura
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Hanna Vauhkonen
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Jussi Hepojoki
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Tomas Strandin
- Department of Virology, Medicum, University of Helsinki, 00290 Helsinki, Finland
| | - Johanna Tietäväinen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Tuula Outinen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Satu Mäkelä
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland
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Deng HL, Zhang YF, Li YP, Zhang Y, Xie Y, Wang J, Wang XY, Dang SS. N-terminal pro-brain natriuretic peptide levels associated with severe hand, foot and mouth disease. BMC Infect Dis 2016; 16:585. [PMID: 27760526 PMCID: PMC5069980 DOI: 10.1186/s12879-016-1929-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022] Open
Abstract
Background Severe hand, foot, and mouth disease (HFMD) is sometimes associated with serious complications such as acute heart failure that can cause substantial child mortality. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive and specific biomarker of congestive heart failure. The aim of this study was to use plasma NT-proBNP levels to establish the severity of childhood HFMD. Methods A retrospective study was performed in 128 Chinese patients with severe HFMD and 88 patients with mild HFMD treated between January 2014 and October 2015. Univariate and multiple logistic regression analyses were used to analyze the risk factors for severe HFMD. NT-proBNP levels were analyzed in 128 severe HFMD patients, and the predictive value of NT-proBNP was assessed by receiver operating characteristic analyses. Results Multivariate analysis controlling for several potential confounders showed that enterovirus 71 infection [odds ratio (OR) 19.944, 95 % confidence interval (CI) 6.492–61.271], peripheral WBC count (OR 3.428, 95 % CI 1.186–9.914), fasting glucose (OR 19.428, 95 % CI 2.236–168.784), procalcitonin (OR 9.084, 95 % CI 3.462–23.837, and NT-proBNP (>125 pg/mL) (OR 16.649, 95 % CI 4.731–58.585) were each associated with the severity of HFMD. The 45 dead severe patients had higher pre-procedural levels of NT-proBNP than the 83 cured severe patients (12776 ± 13115 versus 1435 ± 4201 pg/mL, P < 0.001). An NT-proBNP cutoff value of 982 pg/mL predicted mortality with 87 % sensitivity and 86 % specificity. Conclusion Plasma NT-pro-BNP level appears to be a useful biological marker for predicting the severity and mortality of HFMD. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1929-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui-Ling Deng
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, 710004, China.,Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Yu-Feng Zhang
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Ya-Ping Li
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yu Zhang
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Yan Xie
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Jun Wang
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Xiao-Yan Wang
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, 710003, China
| | - Shuang-Suo Dang
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, 710004, China.
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Partanen T, Koivikko M, Leisti P, Salmela P, Pääkkö E, Karttunen A, Sintonen H, Risteli L, Hautala N, Vapalahti O, Vaheri A, Kauma H, Hautala T. Long-term hormonal follow-up after human Puumala hantavirus infection. Clin Endocrinol (Oxf) 2016. [PMID: 26202013 DOI: 10.1111/cen.12863] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Nephropathia epidemica (NE) is a haemorrhagic fever with renal syndrome (HFRS) caused by Puumala hantavirus (PUUV). Pituitary haemorrhage and hypopituitarism may complicate recovery from acute NE. DESIGN Forty-seven of our recent cohort of 58 NE patients volunteered to be re-examined in order to estimate the burden of hormonal deficiency 4 to 8 years after the acute illness. Two patients had suffered from pituitary haemorrhage, but many others exhibited pituitary oedema during their acute infection. In this study, we searched for symptoms of hormonal deficiency, performed hormonal laboratory screening, and most patients underwent pituitary MRI examination. RESULTS The pituitary size had diminished in all patients in whom MRI was performed (P < 0·001). One patient with acute phase haemorrhage had made a complete recovery while the other continued to require hormonal substitution. In addition, hormonal laboratory abnormalities were observed in nine other patients; these being attributable to several reasons, for example independent peripheral hormonal diseases, side effects of medication or other secondary causes such as obesity. None of them had signs of late-onset pituitary insufficiency caused by their previous NE. Health-related quality of life (mean and median 15D score) of patients was comparable to that of age-standardized general population. CONCLUSIONS None of our patients had developed obvious late-onset hypopituitarism despite of the fact that pituitary gland can be affected during acute NE. We recommend requesting a history of hantavirus infection whenever the possibility of pituitary dysfunction is suspected at least in patients originating from regions with high NE infection rate.
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Affiliation(s)
- Terhi Partanen
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Minna Koivikko
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Päivi Leisti
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Pasi Salmela
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Eija Pääkkö
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Ari Karttunen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Nina Hautala
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
| | - Olli Vapalahti
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Vaheri
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heikki Kauma
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Timo Hautala
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
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