Effects of steroid therapy in patients with severe fever with Thrombocytopenia syndrome: A multicenter clinical cohort study.

Sook In Jung,In-Gyu Bae,Young Keun Kim,Dong-Min Kim,Seong Yeol Ryu,Sun Hee Lee,Hyun Ah Kim,Yee Gyung Kwak,Na Ra Yun,Kyungmin Huh,Eu Suk Kim,Ye Eun Kim,Juhyung Lee,Uh Jin Kim,Sun Hee Park,Seong Eun Kim,Mi Ah Han,Jieun Kim,Jung Yeon Heo,Seungjin Lim,Hyungdon Lee,Dong Sik Jung,Sujin Lee,Hye Won Jeong,Shin‐Woo Kim ,Jun Hur ,Choon Mee Kim ,Joon Sup Yeom ,Jihoon Seo

doi:10.1371/journal.pntd.0009128

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Korean patients with SFTS. A retrospective study was performed in a multicenter SFTS clinical cohort from 13 Korean university hospitals between 2013 and 2017. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests. Overall fatality rate was 23.2%, with 39.7% among 58 patients who underwent steroid therapy. Complications were observed in 37/58 (63.8%) and 25/83 (30.1%) patients in the steroid and non-steroid groups, respectively (P < .001). Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score <14; 29.2 (95% CI 27.70-30.73] vs. 24.9 (95% CI 21.21-28.53], P = .022]. Survival times for the early steroid (≤5 days from the start of therapy after symptom onset), late steroid (>5 days), and non-steroid groups, were 18.4, 22.4, and 27.3 days, respectively (P = .005). After steroid therapy, an increase in complications was observed among patients with SFTS. Steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14).

Highlights

Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score
Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus
Severe fever with thrombocytopenia syndrome (SFTS) is an acute febrile disease caused by an SFTS virus (SFTSV) belonging to the Phlebovirus genus [1,2]

Summary

Introduction

Severe fever with thrombocytopenia syndrome (SFTS) is an acute febrile disease caused by an SFTS virus (SFTSV) belonging to the Phlebovirus genus [1,2]. SFTS was first identified in China in 2011 [5], and new patients have been registered annually in Korea since the confirmation of the first Korean patient in 2013 [6]. In Japan and Taiwan, SFTSV-infected patients or ruminants and ticks have been identified [7,8]. The 2011 and 2012 mortality rates for patients with SFTS in China were 6% (n = 123 deaths among 2,017 confirmed patients), whereas those in Korea and Japan exceeded 30% [9,10]. Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. We evaluated the effects of steroid therapy in Korean patients with SFTS

Methods

Results

Conclusion