RESUMO
A prospective, randomized, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin (loading dose of 33 mg/kg, 16 mg/kg every 6 h for 4 days, and 8 mg/kg every 8 h for 3 days) was conducted in 242 patients with serologically confirmed hemorrhagic fever with renal syndrome (HFRS) in the People's Republic of China. Mortality was significantly reduced (sevenfold decrease in risk) among ribavirin-treated patients, when comparisons were adjusted for baseline risk estimators of mortality (P = .01; two-tailed). HFRS typically consists of five consecutive but frequently overlapping clinical phases. Only occurrence of oliguric phase and hemorrhage was associated with severity of clinical disease in the placebo group. Ribavirin therapy also resulted in a significant reduction in the risk of entering the oliguric phase and experiencing hemorrhage. The only ribavirin-related side effect was a well-recognized, fully reversible anemia after completion of therapy.
Assuntos
Febre Hemorrágica com Síndrome Renal/tratamento farmacológico , Ribavirina/uso terapêutico , Anemia Hemolítica/induzido quimicamente , Método Duplo-Cego , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Seguimentos , Orthohantavírus/imunologia , Febre Hemorrágica com Síndrome Renal/complicações , Febre Hemorrágica com Síndrome Renal/mortalidade , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/etiologia , Imunoglobulina M/sangue , Injeções Intravenosas , Tábuas de Vida , Masculino , Oligúria/tratamento farmacológico , Oligúria/etiologia , Poliúria/tratamento farmacológico , Poliúria/etiologia , Prognóstico , Estudos Prospectivos , Análise de Regressão , Ribavirina/administração & dosagem , Ribavirina/efeitos adversosRESUMO
Hemorrhage is a prominent feature of hemorrhagic fever with renal syndrome (HFRS) in China. It occurs in all phases of the disease and is an important cause of death. Petechiae involving skin and oropharyngeal mucosa are the commonest manifestation of hemorrhage, occurring in more than 90% of patients. Gastrointestinal hemorrhage is the next commonest manifestation, occurring in approximately 50% of patients. Suggested mechanisms of hemorrhage include vascular injury, thrombocytopenia and platelet dysfunction, disseminated intravascular coagulation, circulating heparin-like activity, and uremia. Controlled trials of treatment regimens for hemostatic impairment in HFRS have not been performed. Support of blood pressure can lessen hemorrhage by limiting the adverse consequences of hypotension and shock. Dialysis is of benefit in patients with hemorrhage and significant renal failure.
