Xiong Shue, Zhang Wenjing, Li Mingyue, Xiong Yan, Li Mengmeng, Wang Hua, Yang Dongliang, Peng Cheng, Zheng Xin
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2016 Dec;95(52):e5708. doi: 10.1097/MD.0000000000005708.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease with a high fatality rate. The risk factors for death are not clearly identified, and there is no clinical score model to predict the prognosis. We retrospectively collected the clinical information of clinical symptoms and laboratory parameters of SFTS patients on admission. After analyzing the clinical characteristics of 179 SFTS patients, we found that an elevated level of neurologic symptoms, respiratory symptoms, viral load, and a lower level of monocyte percentage were the critical risk factors for mortality. We used the 4 variables to assemble a score formula named the SFTS index [SFTSI = 5 × Neurologic symptoms-level + 4 × Respiratory symptoms-level + 3 × LG10 Viral load - 2 × LN Monocyte% - 7]. The AURC of this model was 0.964, which was higher than the AURC 0.913 of the viral load especially among the patients with higher viral loads (0.936 vs 0.821). We identified that the neurologic symptoms, respiratory symptoms, viral load, and monocyte percentage were the critical risk factors for SFTS mortality. The clinical score model of SFTSI provides a practical method for clinicians to stratify patients with SFTS and to adopt prompt effective treatment strategies.
严重发热伴血小板减少综合征(SFTS)是一种新出现的病死率很高的疾病。死亡的危险因素尚未明确确定,且尚无预测预后的临床评分模型。我们回顾性收集了SFTS患者入院时的临床症状和实验室参数等临床信息。在分析了179例SFTS患者的临床特征后,我们发现神经症状水平升高、呼吸道症状、病毒载量升高以及单核细胞百分比降低是死亡的关键危险因素。我们使用这4个变量构建了一个名为SFTS指数的评分公式[SFTSI = 5×神经症状水平 + 4×呼吸道症状水平 + 3×lg10病毒载量 - 2×ln单核细胞% - 7]。该模型的AURC为0.964,高于病毒载量的AURC 0.913,尤其是在病毒载量较高的患者中(0.936对0.821)。我们确定神经症状、呼吸道症状、病毒载量和单核细胞百分比是SFTS死亡的关键危险因素。SFTSI临床评分模型为临床医生对SFTS患者进行分层并采取及时有效的治疗策略提供了一种实用方法。