Abstract
BackgroundSevere fever with thrombocytopenia syndrome (SFTS), a widely prevalent infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV) that carries with it a high mortality rate, has emerged to be a public health concern. This study aimed to investigate the epidemiological and clinical characteristics of patients infected with SFTSV, seeking novel prognostic risk factors for SFTS.MethodsIn this retrospective and cross-sectional study, confirmed SFTS patients from the First Affiliated Hospital of Anhui Medical University were enrolled from September 1, 2019, to December 12, 2020. Cases were analyzed for epidemiological, demographic, clinical, and laboratory data. Logistic regression models were used to assess the association between predictors and outcome variables. A generalized additive mixed model (GAMM) was conducted to analyze the trending shift of aspartate aminotransferase/alanine transaminase-ratio (AST/ALT-ratio) and platelet (PLT) in SFTS patients treated with ribavirin. p values ≤ 0.05 were considered statistically significant.ResultsClinical and laboratory results of 107 hospitalized patients with SFTSV infection were retrospectively described. The mean age at onset of disease was 60.38 ± 11.29 years old and the ratio between male and female was 1:1.2. Fever and thrombocytopenia are hallmark features of SFTS. Furthermore, multiple cases also experienced neurological complications, gastrointestinal/skeletal muscle symptoms together with other non-specific clinical manifestations; laboratory dataset outcomes reported dysregulated levels for routine blood biomarkers, coagulation function, and biochemistry. Overall, 107 patients were segregated into two groups according to patient condition at the clinical endpoint (survivors/non-survivors). SFTS survivors had a higher level of PLT- counts, total protein (TP), and estimated glomerular filtration rate (eGFR), while levels of activated partial thromboplastin time (APTT), thrombin time (TT), D-dimer (D-D), fibrinogen degradation products (FDP), ALT, AST, AST/ALT-ratio, creatinine (Cr), creatine phosphokinase (CK) and procalcitonin (PCT) was higher in non-survivors. Results from univariate Cox regression revealed that elevated levels of FDP, TT, AST/ALT-ratio, PCT, as well as decreased eGFR level and presence of central nervous system symptoms (CNS), were significant predictors for SFTS prognostic, results from multivariate logistic regression analysis in three adjusted models showed AST/ALT-ratio and PCT were independent risk factors for the prognosis of SFTS patients. Kaplan–Meier survival analysis showed that SFTS patients with AST/ALT-ratio >2.683 were associated with a shorter futime (means survival time), therefore indicating an unfavorable prognosis. Treatment with ribavirin could increase PLT count while decreasing AST/ALT-ratio within SFTS patients.ConclusionSFTS is an emerging infectious disease, possibly leading to multiple-organ injury; AST/ALT-ratio was an independent risk factor for the prognosis of SFTS patients. Further investigation should be performed in order to gain more knowledge on this disease and guide clinical management.
Highlights
Severe fever with thrombocytopenia syndrome (SFTS), a widely prevalent infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV) that carries with it a high mortality rate, has emerged to be a public health concern
A total of 107 patients diagnosed with SFTS were enrolled in our study, the average age of subjects was 60.38 ± 11.29 years old, ranging from 27 to 86 years old, the ratio between male and female was 1:1.2, a total of 32 cases were confirmed to have a tick-bite history prior to illness onset, a total of 10 patients (9.35%) were infected due to close contact with SFTS patients, with one case being an attending nurse who infected through direct contact with SFTS patient body fluid/s
The results show that survivors had a higher level of PLT count, TP, and eGFR, levels of APTT, TT, D-D, FDP, ALT, AST, the AST/ALT-ratio, Cr, CK, and PCT were all higher in non-survivors, indicating that advanced age, thrombopenia, prolonged APTT/TT, together with elevated FDP, ALT, AST, AST/ALT-ratio, CK, D-D, Cr, and PCT and decreased TP and eGFR were all associated with SFTS mortality events (Table 5)
Summary
Severe fever with thrombocytopenia syndrome (SFTS), a widely prevalent infectious disease caused by severe fever with thrombocytopenia syndrome virus (SFTSV) that carries with it a high mortality rate, has emerged to be a public health concern. Severe fever with thrombocytopenia syndrome (SFTS) is a tickborne disease first identified in China in 2009, that rapidly spread to other provinces in central, eastern, and northeastern regions (Yu et al, 2011) no longer restrained to China, SFTS patients were diagnosed in Japan and Korea in 2012, followed by rapid spread into the United States and other countries (Liu et al, 2014; Saijo, 2018). Steroid pulse therapy and plasma exchange were included in proposed treatments for SFTS in recent years (Choi et al, 2018; Nakamura et al, 2018; Takayama-Ito and Saijo, 2020), the effectiveness of all such treatments remains unclear, with mechanisms of disease pathogenesis still being unclear. There is an urgent need to focus on SFTSV-infected patients
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