Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases
BACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE The aim is to describe...
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| Format: | Article |
| Language: | English |
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Fundação Oswaldo Cruz (FIOCRUZ)
2019-05-01
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| Series: | Memorias do Instituto Oswaldo Cruz |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762019000100327&lng=en&tlng=en |
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| author | Luciana Vilas Boas Casadio Ana Paula Moreira Salles Fernanda de Mello Malta Gabriel Fialkovitz Leite Yeh-Li Ho Michele Soares Gomes-Gouvêa Luiz Marcelo Sá Malbouisson Anna S Levin Raymundo Soares de Azevedo Neto Flair José Carrilho Ana Catharina Seixas Santos Nastri João Renato Rebello Pinho |
| author_facet | Luciana Vilas Boas Casadio Ana Paula Moreira Salles Fernanda de Mello Malta Gabriel Fialkovitz Leite Yeh-Li Ho Michele Soares Gomes-Gouvêa Luiz Marcelo Sá Malbouisson Anna S Levin Raymundo Soares de Azevedo Neto Flair José Carrilho Ana Catharina Seixas Santos Nastri João Renato Rebello Pinho |
| author_sort | Luciana Vilas Boas Casadio |
| collection | DOAJ |
| description | BACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease. |
| first_indexed | 2024-03-12T18:11:50Z |
| format | Article |
| id | doaj.art-fbb5678ec3e14484b201760213c2921c |
| institution | Directory Open Access Journal |
| issn | 1678-8060 |
| language | English |
| last_indexed | 2024-03-12T18:11:50Z |
| publishDate | 2019-05-01 |
| publisher | Fundação Oswaldo Cruz (FIOCRUZ) |
| record_format | Article |
| series | Memorias do Instituto Oswaldo Cruz |
| spelling | doaj.art-fbb5678ec3e14484b201760213c2921c2023-08-02T09:15:30ZengFundação Oswaldo Cruz (FIOCRUZ)Memorias do Instituto Oswaldo Cruz1678-80602019-05-01114010.1590/0074-02760190033S0074-02762019000100327Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever casesLuciana Vilas Boas CasadioAna Paula Moreira SallesFernanda de Mello MaltaGabriel Fialkovitz LeiteYeh-Li HoMichele Soares Gomes-GouvêaLuiz Marcelo Sá MalbouissonAnna S LevinRaymundo Soares de Azevedo NetoFlair José CarrilhoAna Catharina Seixas Santos NastriJoão Renato Rebello PinhoBACKGROUND Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762019000100327&lng=en&tlng=enyellow feverlipasefactor vviral load |
| spellingShingle | Luciana Vilas Boas Casadio Ana Paula Moreira Salles Fernanda de Mello Malta Gabriel Fialkovitz Leite Yeh-Li Ho Michele Soares Gomes-Gouvêa Luiz Marcelo Sá Malbouisson Anna S Levin Raymundo Soares de Azevedo Neto Flair José Carrilho Ana Catharina Seixas Santos Nastri João Renato Rebello Pinho Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases Memorias do Instituto Oswaldo Cruz yellow fever lipase factor v viral load |
| title | Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases |
| title_full | Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases |
| title_fullStr | Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases |
| title_full_unstemmed | Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases |
| title_short | Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases |
| title_sort | lipase and factor v but not viral load are prognostic factors for the evolution of severe yellow fever cases |
| topic | yellow fever lipase factor v viral load |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762019000100327&lng=en&tlng=en |
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