ANALYSIS OF THE RELATIONSHIP OF CLINICAL FND LABORATORY PARAMETERS WITH THE COURSE OF HEMORRHAGIC FEVER WITH RENAL SYNDROME IN THE REPUBLIC OF BELARUS

Full Text

Relevance
Hemorrhagic fever with renal syndrome (HFRS) is an acute natural focal disease caused by viruses from the Hantaviridae family of the Hantaan genus, characterized by systemic damage to small vessels, hemorrhagic diathesis, hemodynamic disorders and a peculiar kidney lesion similar to acute interstitial nephritis with the development of acute renal failure up to 150 thousand cases of HFRS are detected annually in the world [1].
For the first time in 1976, the Korean virologist H. W. Lee isolated Hantavirus from the lung tissue of a field mouse. The genetic diversity of hantaviruses increases every year (hantaan, puumala, seoul, manjon, chopitulos, Hill Avenue). Currently, more than 40 hantavirus genotypes have been identified. Viruses of the genus Hantaan, Puumala and Dobrava have been registered in Belarus [2].
In the Republic of Belarus (RB), the largest outbreak was described in 1969 in the Brest region - 60 people fell ill. 5 patients had a lethal outcome. Based on the materials of the Brest outbreak, the first description of the epidemiology of HFRS in Belarus was made, an analysis was made of the seasonal dynamics of the incidence with confinement to the autumn-winter period, the relationship of diseases with rodents was indicated as a result of contact with them during agricultural work and in places with an increased number of rodents in settlements [ 3].

Target
The aim of the study was to analyze clinical and laboratory data for the relationship with the course of HFRS.

Materials and methods
The paper analyzed the case histories of 51 patients who were treated at the ME "City Clinical Infectious Diseases Hospital" in Minsk for the period from 01/01/2017 to 10/18/2022.
The study is retrospective, single center, cohort. Statistical and analytical research methods were applied. Data processing was carried out using Microsoft Excel 2016, IBM SPSS Statistics 23 using the non-parametric Mann-Whitney U-test and Spearman paired correlation analysis (where r is the correlation coefficient). The results were considered significant at a significance level of p < 0.05.

results
A total of 51 patients were hospitalized during the observation period. Among them, 38 men (74.51%) and 13 women (25.49%). The mean age of patients was 47.2 ± 2.02 years, median (Me) 51 years, while the mean age of men was 45.2 ± 2.2 years, Me = 43 years, and the mean age of women was 53.18 ± 4 ,21 years, Me = 57 years (no statistically significant difference in age between patients by sex was found).
The average length of stay of patients in the hospital was 11.08 ± 0.549 bed-days. The maximum duration of hospitalization was 21 bed-days, the minimum was 3 bed-days. All patients were discharged from the hospital with clinical recovery.
Of all patients, 5 people (9.8%) permanently live in rural areas, and 27 people (52.94%) noted being outside the city in the nearest distant period from the onset of symptoms.
In men, the hemoglobin level (mean value (av.) 151.11 ± 2.809 g/l, Me = 151 g/l) is higher than in women (avg. 135.23 ± 4.23 g/l, Me = 129 g /l) (U = 375, p = 0.006).
In men, the level of creatinine (av. 156.84 ± 15.37 µmol/l, Me = 126 µmol/l) is higher than in women (av. 84.26 ± 8.32 µmol/l, Me = 68 µmol/l ) (U=418, p=0.0001).
In women, the level of Na in the blood (average 138.93 ± 1.41 mmol/l, Me = 139.79 mmol/l) is higher than in men (average 135.93 ± 1 mmol/l, Me = 135, 93 mmol/l) (U=153, p=0.041).
In the general analysis of urine, the average protein content was 0.697 ± 0.163 g/l, Me = 0.213 g/l, the minimum value was 0 g/l, the maximum value was 5.8 g/l.
Bacteria were detected in 33 patients (64.71), with "+" observed in 15 patients (45.45%), "++" in 14 patients (42.42%), "+++" in 2 patients ( 6.06%), "++++" in 2 patients (6.06%).
26 patients had an AT titer of 1:1024 and above, 25 - below 1:1024 (and 2 cases - a negative titer). Moderate severity of HFRS was observed in 41 patients, severe severity - in 10 patients.
When conducting a subgroup analysis, there were no differences between women and men in terms of age, length of stay in the hospital and titer of antibodies (U = 160, p = 0.058; U = 206, p = 0.373 and U = 206, p = 0.360, respectively). When comparing patients with moderate and severe HFRS, no statistically significant differences were also found (p > 0.05). The duration of treatment in patients with AT titers of 1:1024 and above was not significantly longer than in patients with lower titers of AT (U = 233, p = 0.080).

Discussion
Within the framework of this study, no differences were determined between women and men in terms of age, length of stay in the hospital and titer of antibodies. Men are subject to higher hemoglobin and creatinine levels, women to higher sodium levels. Patients with HFRS are characterized by mild to moderate bacteriuria in the urine test.
A higher antibody titer is not a predictor of a longer inpatient stay. The relatively small number of patients can be considered as disadvantages of the study. An increase in the sample may lead to a clearer reflection of intra-group relationships.

Conclusion
Currently, hemorrhagic fever with renal syndrome does not lose its significance, especially in people who live or spend a lot of time in rural areas. HFRS is quite widespread in the Republic of Belarus. Viruses that are the etiological agents of HFRS can serve as a trigger for the development of chronic renal failure in more than half (57%) of patients in the Republic of Belarus.
At the stage of admission to the emergency department, most patients present non-specific complaints, on the basis of which it is difficult to suspect HFRS. An objective examination, complete blood count, biochemical blood test, urinalysis may also not reveal specific changes. As a result, the therapy is mainly pathogenetic and symptomatic. There is also an excessive prescription of antibacterial drugs from various groups empirically without their real need, which is a direct consequence of the difficulty of diagnosis.
Among the analyzed patients, men were more often affected by HFRS (74.5% of the entire group). Mostly, HFRS proceeded with moderate severity, however, no effects on the length of stay in the hospital and the relationship with the titer of antibodies were found. Clinical and laboratory dependences in patients with HFRS were analyzed. It was determined that a higher (1:1024 and above) titer of antibodies is not a reliable predictor of a more severe course of HFRS (U = 233, p = 0.080), which, however, requires an expansion of the sample to obtain statistically significant results and further study of diagnostics and treatment of patients with HFRS.

About the authors

Yan Alexandrovich Astrazhynski

Belarusian State Medical University

Author for correspondence.
Email: astrazhynski@gmail.com
ORCID iD: 0000-0003-1125-6514
https://vk.com/komandor_yan

student of the 5th year of the Faculty of General Medicine

Belarus, Dzerzhinski Ave., 83, Minsk, Republic of Belarus, 220083

Maksim A. Kastsou

Belarusian State Medical University

Email: kostsov.00@mail.ru
ORCID iD: 0000-0001-9821-7344

student of the 5th year of the Faculty of General Medicine

Belarus, Dzerzhinski Ave., 83, Minsk, Republic of Belarus, 220083

References