Mem Inst Oswaldo Cruz, Rio de Janeiro, FAST TRACK
Lipase and factor V (but not viral load) are prognostic factors for the evolution of severe yellow fever cases
Universidade de São Paulo, São Paulo SP, Brasil
Severe YF cases (n=62) were admitted to ICU and submitted to the routine laboratorial assays on admission. YFVRNA was detected in serum and urine by RT- qPCR and then sequenced. Patients were classified in two groups (“survival” or “death”) after YF diagnosis. Univariate analysis showed the following variables associated with outcome: ALT, AST, AST/ALT, Total bilirubin, CKD-EPI, Ammonia, Lipase, Factor V, INR, Lactate and Bicarbonate. Logistic regression model showed two independent variables associated with death (lipase: OR 1.018, 95% 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 maximizes sensitivity and specificity for death prediction are 147.5 U/L (AUC = 0.879) and 56.5% (AUC = 0.913). The finding of Factor V and Lipase as independent variables associated with death reinforces the importance of hemorrhagic events and pancreatitis for the evolution of the severe YF cases.