New microbes and new infections · 2026
Is activated partial thromboplastin time prolongation an independent predictor of bleeding in patients with Kyasanur Forest Disease? A retrospective cohort study from southern India.
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Gupta Nitin, Sebastian Anjely, Swathikiran Pothumarthy Venkata, Varma Muralidhar, Mukhopadhyay Chiranjay, Tirlangi Praveen Kumar
Аннотация
BACKGROUND: Major bleeding contributes substantially to morbidity in Kyasanur Forest Disease, but predictors of severe hemorrhage remain poorly defined. We aimed to determine whether prolonged baseline activated partial thromboplastin time (APTT) independently predicts major bleeding in patients with Kyasanur Forest Disease.
METHODS: We conducted a retrospective cohort study at a tertiary-care referral center in southern India, including adults (≥15 years) hospitalized with RT-PCR-confirmed Kyasanur Forest Disease from January 2019 to May 2025. Major bleeding was defined as a clinically significant bleed involving the gastrointestinal, respiratory, genitourinary, or central nervous systems. Clinical and laboratory parameters were compared between patients with and without major bleeding, with multivariable logistic regression used to assess whether APTT prolongation independently predicted major bleeding.
RESULTS: Among 387 patients with Kyasanur Forest Disease, 39 (10.1%) experienced major bleeding. Gastrointestinal hemorrhage was most common (6.2%), followed by genitourinary bleeding (4.1%). Major bleeders more frequently had thrombocytopenia (97.4% vs 85.9%; p = 0.042), transaminitis (74.4% vs 50.6%; p = 0.005), hypoalbuminemia (54.8% vs 30.8%; p = 0.007), minor mucocutaneous bleeding (17.9% vs 4.6%; p = 0.001), and APTT >40 s (73.3% vs 44.0%; p = 0.002). APTT prolongation remained independently associated with major bleeding (adjusted OR 2.50, 95% CI 1.02-6.14; p = 0.046).
CONCLUSION: Prolonged APTT at presentation is an independent predictor of significant bleeding in Kyasanur Forest Disease and may serve as a practical marker for early hemorrhagic risk stratification. Prospective validation is warranted to inform clinical decision-making and integrate APTT into severity assessment frameworks.
METHODS: We conducted a retrospective cohort study at a tertiary-care referral center in southern India, including adults (≥15 years) hospitalized with RT-PCR-confirmed Kyasanur Forest Disease from January 2019 to May 2025. Major bleeding was defined as a clinically significant bleed involving the gastrointestinal, respiratory, genitourinary, or central nervous systems. Clinical and laboratory parameters were compared between patients with and without major bleeding, with multivariable logistic regression used to assess whether APTT prolongation independently predicted major bleeding.
RESULTS: Among 387 patients with Kyasanur Forest Disease, 39 (10.1%) experienced major bleeding. Gastrointestinal hemorrhage was most common (6.2%), followed by genitourinary bleeding (4.1%). Major bleeders more frequently had thrombocytopenia (97.4% vs 85.9%; p = 0.042), transaminitis (74.4% vs 50.6%; p = 0.005), hypoalbuminemia (54.8% vs 30.8%; p = 0.007), minor mucocutaneous bleeding (17.9% vs 4.6%; p = 0.001), and APTT >40 s (73.3% vs 44.0%; p = 0.002). APTT prolongation remained independently associated with major bleeding (adjusted OR 2.50, 95% CI 1.02-6.14; p = 0.046).
CONCLUSION: Prolonged APTT at presentation is an independent predictor of significant bleeding in Kyasanur Forest Disease and may serve as a practical marker for early hemorrhagic risk stratification. Prospective validation is warranted to inform clinical decision-making and integrate APTT into severity assessment frameworks.