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Title: Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases
Authors: CASADIO, Luciana Vilas BoasSALLES, Ana Paula MoreiraMALTA, Fernanda de MelloLEITE, Gabriel FialkovitzHO, Yeh-LiGOMES-GOUVEA, Michele SoaresMALBOUISSON, Luiz Marcelo SaLEVIN, Anna S.AZEVEDO NETO, Raymundo Soares deCARRILHO, Flair JoseNASTRI, Ana Catharina Seixas SantosPINHO, Joao Renato Rebello
Citation: MEMORIAS DO INSTITUTO OSWALDO CRUZ, v.114, article ID UNSP e190033, 8p, 2019
Abstract: 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 Sao 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.
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Artigos e Materiais de Revistas Científicas - FM/MGT
Departamento de Gastroenterologia - FM/MGT

Artigos e Materiais de Revistas Científicas - FM/MIP
Departamento de Moléstias Infecciosas e Parasitárias - FM/MIP

Artigos e Materiais de Revistas Científicas - FM/MPT
Departamento de Patologia - FM/MPT

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

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Instituto de Medicina Tropical - IMT

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LIM/01 - Laboratório de Informática Médica

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LIM/03 - Laboratório de Medicina Laboratorial

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LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental

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LIM/49 - Laboratório de Protozoologia

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ODS/03 - Saúde e bem-estar

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