Clinical epidemiological analysis of hemorrhagic fever with renal syndrome in children and screening of warning indicators of severe cases

LI Xiaofeng; HU Haifeng; LI Yun; LIAN Jianqi; JI Fanpu; DU Hong

doi:10.3969/j.issn.1007-8134.2025.05.009

Abstract：Objective To systematically analyze the clinical epidemiological characteristics of hemorrhagic fever with renal syndrome(HFRS)in children,identify early warning indicators for screening severe case early,and provide scientific basis and practical guidance for the clinical management of pediatric HFRS.Methods A total of 103 pediatric patients with HFRS(aged<16 years)admitted to the Department of Infectious Diseases,Tangdu Hospital of Air Force Medical University from January 2008 to December 2023 were included in this retrospective study.Data including gender,age,seasonal distribution,geographic origin,mortality,as well as symptoms,signs,and laboratory findings during the disease course were collected from the hospital's electronic medical record system to analyze the clinical and epidemiological features.According to the severity of the disease,the patients were divided into mild group(mild-type,moderate-type,78 cases)and severe group(severe-type,critical-type,25 cases).A multivariate Logistic regression model was used to analyze the independent risk factors for severe progression of HFRS in children and screen the early warning indicators for severe cases.Results Among 103 children with HFRS,there were 70 males(68.0%)and 33 females(32.0%),with a gender ratio of 2.12:1.In terms of age distribution,older children(10-15 years old)accounted for the majority.The onset of the disease showed obvious seasonality,with the high-incidence period occurring from October to December each year,peaking in November and December.Geographically,the cases were mainly concentrated in Xi'an(71.8%),and most of the patients resided in rural areas(96.1%).Among 103 children with HFRS,the incidence of severe cases was 24.3%,of which 3 patients died due to disease progression,resulting in a mortality rate of 2.9%.The incidence rates of headache,nausea and vomiting,skin/mucosal bleeding,chemosis and hypotensive shock in the severe case group were all higher than those in the mild case group.Laboratory test results indicated that there were statistically significant differences in the levels of platelets,serum creatinine,aspartate aminotransferase(AST),and alanine aminotransferase(ALT)between the two groups at the time of admission(P<0.05).Results of multivariate Logistic regression analysis showed that chemosis,hypotensive shock,and elevated serum creatinine were early warning indicators for severe HFRS in children.Conclusion The incidence of HFRS in children is relatively low.Clinically,male children are more commonly affected,while the rates of severe cases and mortality are relatively low.The early clinical manifestations may be atypical,making it prone to missed diagnosis or misdiagnosis in clinical practice.Chemosis,hypotensive shock,and elevated serum creatinine can reflect the degree of vascular endothelial damage and renal function impairment in the body at an early stage,and thus can serve as early warning indicators for severe HFRS in children.Clinicians need to closely monitor changes in these indicators,identify high-risk patients with severe conditions as early as possible and promptly implement intervention measures to improve prognosis.