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Clinical Progress and Risk Factors for Death from Severe Fever with Thrombocytopenia Syndrome: A Multihospital Retrospective Investigation in Anhui, China
ABSTRACT
Knowledge of the clinical progress of severe fever with thrombocytopenia syndrome (SFTS) and the associated predictors of mortality is important for providing appropriate treatment in severe cases. A multihospital retrospective study was conducted in three SFTS-endemic cities, in 2018. Of the 208 SFTS-confirmed cases, there were 189 survivors and 19 deaths. The median age was 64 years; 104 (50.0%) patients were men, and 188 (90.4%) were farmers. Furthermore, 203 (97.6%) patients reported fever and 70 (33.7%) reported fatigue. Most fatal cases had complications including multiple-organ failure, central nervous syndrome (CNS) abnormalities, and disseminated intravascular coagulation. During the fever phase, alanine transaminase, aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatinine, D-dimer, glucose, hydroxybutyrate dehydrogenase, lactate dehydrogenase (LDH), procalcitonin, prothrombin time, and uric acid levels were higher in fatal than in nonfatal cases (P < 0.05). Creatine kinase (CK), CK-MB (CKMB), AST, and LDH levels were significantly lower in nonfatal than in fatal cases (P < 0.05). Central nervous syndrome abnormalities (odds ratio [OR] = 20.9, 95% CI: 4.3, 100), body temperature ≥ 38.5°C (OR = 23.2, 95% CI: 3.4, 158), BUN levels ≥ 6.4 mmol/L (OR = 9.9, 95% CI: 2.2, 44), CKMB levels ≥ 100 U/L (OR = 33.2, 95% CI: 5.8, 192), and LDH levels ≥ 1,000 U/L (OR = 8.3, 95% CI: 1.9, 37) were predictors of mortality. Our findings reveal that the presence of specific complications and laboratory parameters may serve as predictors of mortality and aid in early identification of severe SFTS cases in clinical practice.
Author Notes
Financial support: This study was supported by a grant of Anhui Provincial Department of Science and Technology, Anhui Provincial Health Commission Emergency Research Project of Novel Coronavirus Infection (Grant numbers 202004a07020002; 202004a07020004).
Authors’ addresses: Lei Gong, Jiabing Wu, Siqi Lu, Meng Zhu, Dandan Song, Bin Su, and Zhirong Liu, Anhui Provincial Center for Disease Control and Prevention, Hefei, China, E-mails: gong0516@sina.com, wjb0386@163.com, yuanruoqi@163.com, mengmeng11280904@126.com, dandansodan@126.com, sub602@sina.com, and liuzhirong66@126.com. Lei Zhang, Hefei Municipal Center for Disease Control and Prevention, Hefei, China, E-mail: 469022307@qq.com. Yong Lyu, Lu’an Municipal Center for Disease Control and Prevention, Lu’an, China, E-mail: lyong@lacdc.com.cn. Boxi Liu, Inner Mongolia Autonomous Regional Center for Disease Control and Prevention, Hohhot, China, E-mail: only_lbx@qq.com. Yuliang Zhu, Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China. E-mail: 348137217@qq.com.
These authors contributed equally to this work.