Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study
Abstract Background Glucocorticoids (GC) are commonly administered during the febrile and hypotensive phases of hemorrhagic fever with renal syndrome (HFRS) to alleviate inflammation and capillary leakage. However, clinical dosing regimens show marked variability. This study aims to evaluate the cli...
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2025-05-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-11148-2 |
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| author | Denghui Yu Jiayi Zhan Hong Du Pingping Zhu Haifeng Hu Hongkai Xu Ludan Zhang Fei Hu Zhanhu Bi Xiaofei Yang Yanping Li Jianqi Lian |
| author_facet | Denghui Yu Jiayi Zhan Hong Du Pingping Zhu Haifeng Hu Hongkai Xu Ludan Zhang Fei Hu Zhanhu Bi Xiaofei Yang Yanping Li Jianqi Lian |
| author_sort | Denghui Yu |
| collection | DOAJ |
| description | Abstract Background Glucocorticoids (GC) are commonly administered during the febrile and hypotensive phases of hemorrhagic fever with renal syndrome (HFRS) to alleviate inflammation and capillary leakage. However, clinical dosing regimens show marked variability. This study aims to evaluate the clinical necessity of high-dose GC therapy during the acute phase of HFRS. Methods A retrospective study involving 807 HFRS patients admitted to two centers was conducted. Propensity score matching and multivariate logistic regression models were used to compare the effects of conventional-dose and high-dose GC on HFRS treatment outcomes and the risk of secondary infections. Results There were no significant differences in hospital stay, acute-phase fluid requirement, renal replacement rates, mechanical ventilation needs, severe hemorrhagic complications, or mortality between HFRS patients receiving conventional or high-dose GC. Among patients with a shock phase, the secondary infections rate was significantly higher with high-dose GC compared to conventional-dose (43.48% vs. 23.91%, p = 0.005). High-dose GC emerged as an independent risk factor for secondary infections (OR 2.88, 95%CI 1.41–5.88), while prophylactic antibiotics served as an independent protective factor (OR 0.29, 95%CI 0.13–0.65). In patients without a shock phase, no significant difference was observed in the effect of the two GC doses on secondary infections. However, GC therapy ≥ 4 days was an independent risk factor (OR 2.54, 95%CI 1.21–5.37). Conclusions High-dose GC show no superiority over conventional-dose GC on hospital stay, acute-phase fluid requirement, renal replacement rates, mechanical ventilation needs, severe hemorrhagic complications, or mortality. High-dose GC may increase secondary infections in HFRS patients with a shock phase. GC therapy ≥ 4 days may also increase secondary infections in patients without a shock phase. |
| format | Article |
| id | doaj-art-beca6e834f9848d38d9b6fa009c8089d |
| institution | OA Journals |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-beca6e834f9848d38d9b6fa009c8089d2025-08-20T02:39:02ZengBMCBMC Infectious Diseases1471-23342025-05-0125111010.1186/s12879-025-11148-2Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort studyDenghui Yu0Jiayi Zhan1Hong Du2Pingping Zhu3Haifeng Hu4Hongkai Xu5Ludan Zhang6Fei Hu7Zhanhu Bi8Xiaofei Yang9Yanping Li10Jianqi Lian11Department of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Rehabilitation Medicine, Air Force Hospital of Southern Theater Command of PLADepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, the Eighth Hospital of Xi ’anDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityDepartment of Infectious Diseases, the Eighth Hospital of Xi ’anDepartment of Infectious Diseases, Tangdu Hospital of the Fourth Military Medical UniversityAbstract Background Glucocorticoids (GC) are commonly administered during the febrile and hypotensive phases of hemorrhagic fever with renal syndrome (HFRS) to alleviate inflammation and capillary leakage. However, clinical dosing regimens show marked variability. This study aims to evaluate the clinical necessity of high-dose GC therapy during the acute phase of HFRS. Methods A retrospective study involving 807 HFRS patients admitted to two centers was conducted. Propensity score matching and multivariate logistic regression models were used to compare the effects of conventional-dose and high-dose GC on HFRS treatment outcomes and the risk of secondary infections. Results There were no significant differences in hospital stay, acute-phase fluid requirement, renal replacement rates, mechanical ventilation needs, severe hemorrhagic complications, or mortality between HFRS patients receiving conventional or high-dose GC. Among patients with a shock phase, the secondary infections rate was significantly higher with high-dose GC compared to conventional-dose (43.48% vs. 23.91%, p = 0.005). High-dose GC emerged as an independent risk factor for secondary infections (OR 2.88, 95%CI 1.41–5.88), while prophylactic antibiotics served as an independent protective factor (OR 0.29, 95%CI 0.13–0.65). In patients without a shock phase, no significant difference was observed in the effect of the two GC doses on secondary infections. However, GC therapy ≥ 4 days was an independent risk factor (OR 2.54, 95%CI 1.21–5.37). Conclusions High-dose GC show no superiority over conventional-dose GC on hospital stay, acute-phase fluid requirement, renal replacement rates, mechanical ventilation needs, severe hemorrhagic complications, or mortality. High-dose GC may increase secondary infections in HFRS patients with a shock phase. GC therapy ≥ 4 days may also increase secondary infections in patients without a shock phase.https://doi.org/10.1186/s12879-025-11148-2Hemorrhagic fever with renal syndromeGlucocorticoidsClinical efficacySecondary infectionsPropensity score matching |
| spellingShingle | Denghui Yu Jiayi Zhan Hong Du Pingping Zhu Haifeng Hu Hongkai Xu Ludan Zhang Fei Hu Zhanhu Bi Xiaofei Yang Yanping Li Jianqi Lian Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study BMC Infectious Diseases Hemorrhagic fever with renal syndrome Glucocorticoids Clinical efficacy Secondary infections Propensity score matching |
| title | Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study |
| title_full | Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study |
| title_fullStr | Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study |
| title_full_unstemmed | Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study |
| title_short | Comparison of clinical efficacy and secondary infections between conventional-dose and high-dose glucocorticoid in hemorrhagic fever with renal syndrome: a dual-center retrospective cohort study |
| title_sort | comparison of clinical efficacy and secondary infections between conventional dose and high dose glucocorticoid in hemorrhagic fever with renal syndrome a dual center retrospective cohort study |
| topic | Hemorrhagic fever with renal syndrome Glucocorticoids Clinical efficacy Secondary infections Propensity score matching |
| url | https://doi.org/10.1186/s12879-025-11148-2 |
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