Biomarkers for assessing the severity of patients with hemorrhagic fever with renal syndrome

Introduction. Hemorrhagic fever with renal syndrome (HFRS) holds a leading position among natural focal infections in the Russian Federation. Currently, routine evaluation of HFRS primarily includes general clinical tests (complete blood count with differential, platelet count; urinalysis for proteinuria/hematuria), biochemical parameters (creatinine, urea, liver enzymes, electrolytes, coagulation profile), and C-reactive protein (CRP). These indicators provide a general understanding of disease severity. Since the initial investigations of HFRS, numerous studies have identified biomarkers associated with disease severity, which, however, are not utilized in clinical practice for various reasons

— one of the main ones being insufficient awareness among healthcare providers.

The aim. To analyze modern laboratory tests that may be employed for predicting severe forms of HFRS.

Materials and methods. A review of published data (both Russian and international, including the results of our own research) on HFRS severity biomarkers was conducted using PubMed, Google Scholar, and CyberLeninka databases over the past 15 years.

Results. The review included biomarkers associated with HFRS complications: immune and inflammatory markers, indicators of endothelial injury, coagulation factors, and specific markers of renal damage.

Conclusion. Cytokines such as IL-6, IL-8, and IL-10 are consistently associated with HFRS severity. Acute-phase inflammatory markers (ferritin, procalcitonin) aid in assessing the degree of systemic inflammation. Markers of endothelial dysfunction (PTX3, galectin-3BP, suPAR, YKL-40, resistin) help predict the severity of hypotension, edema, and acute kidney injury. Coagulation indicators (platelet count, D-dimer, fibrinogen, PT/aPTT) reflect the risk of bleeding and multiorgan failure. Specific renal biomarkers (NGAL, KIM-1, urinary IL-18) allow for early prediction of acute kidney damage before irreversible renal failure develops. Combined application of these biomarkers can significantly improve early identification of high-risk patients and ultimately enhance the effectiveness of HFRS treatment.

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