Jinan Infectious Disease Hospital, Shandong University, Shandong Province, China.
J Infect Dis. 2012 Oct 1;206(7):1095-102. doi: 10.1093/infdis/jis472. Epub 2012 Jul 30.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus (SFTSV) with an average fatality rate of 12%. The clinical factors for death in SFTS patients remain unclear.
Clinical features and laboratory parameters were dynamically collected for 11 fatal and 48 non-fatal SFTS cases. Univariate logistic regression was used to evaluate the risk factors associated with death.
Dynamic tracking of laboratory parameters revealed that during the initial fever stage, the viral load was comparable for the patients who survived as well as the ones that died. Then in the second stage when multi-organ dysfunction occurred, from 7-13 days after disease onset, the viral load decreased in survivors but it remained high in the patients that died. The key risk factors that contributed to patient death were elevated serum aspartate aminotransferase, lactate dehydrogenase, creatine kinase, and creatine kinase fraction, as well as the appearance of CNS (central nervous system) symptoms, hemorrhagic manifestation, disseminated intravascular coagulation, and multi-organ failure. All clinical markers reverted to normal in the convalescent stage for SFTS patients who survived.
We identified a period of 7-13 days after the onset of illness as the critical stage in SFTS progression. A sustained serum viral load may indicate that disease conditions will worsen and lead to death.
严重发热伴血小板减少综合征（SFTS）是一种由 SFTS 病毒（SFTSV）引起的新发传染病，平均病死率为 12%。SFTS 患者死亡的临床因素仍不清楚。
对 11 例死亡和 48 例非死亡 SFTS 病例进行了临床特征和实验室参数的动态采集。采用单因素逻辑回归分析评估与死亡相关的危险因素。
实验室参数的动态跟踪显示，在发热初期，存活患者和死亡患者的病毒载量相当。然后在第二阶段，即发病后 7-13 天，多器官功能障碍发生时，存活患者的病毒载量下降，但死亡患者的病毒载量仍然很高。导致患者死亡的关键危险因素是血清天门冬氨酸转氨酶、乳酸脱氢酶、肌酸激酶和肌酸激酶同工酶升高，以及出现中枢神经系统（CNS）症状、出血表现、弥散性血管内凝血和多器官衰竭。所有临床标志物在 SFTS 存活患者的恢复期均恢复正常。
我们确定了发病后 7-13 天是 SFTS 进展的关键阶段。持续的血清病毒载量可能表明病情会恶化并导致死亡。
