Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2020 Mar 5;15(3):e0229920. doi: 10.1371/journal.pone.0229920. eCollection 2020.
The prolonged manifestation of concurrent leukopenia, thrombocytopenia and normal C-reactive protein (CRP) (named as SFTS prediction score) in febrile diseases is not usual and may be used to make an initial differential diagnosis, which is a characteristic finding of severe fever with thrombocytopenia syndrome (SFTS).
The dynamics of SFTS prediction scores was investigated in SFTS patients. The study subjects for the comparison were febrile patients aged ≥ 16 years with SFTS scores of 2 (S2) or 3 (S3) who visited an emergency room for a 4-year study period. The dynamic distribution of S2 and S3 at presentation with regards to onset of illness, the characteristics of responsible diseases and the predictability of SFTS in both groups were described.
In 104 patients with SFTS, the daily proportion of S2 or S3 ranged from 58.3 to 100% from day (D) 1 to D12 after the onset of illness. The S2 subtype of 'leukopenia plus thrombocytopenia' and S3 represented 72.7-100% of all scores. In contrast, for the 130 patients in the febrile cohort, 73.8% of evaluations were distributed between D1 and D4 after the onset of illness, and 68.8% of patients had the S2 subtype of 'leukopenia plus normal CRP'. Upper respiratory infection was the most frequent (50.0%) cause of diseases. Pneumonia (13.8%) and urosepsis (6.2%) initially presented with either S2 with normal CRP or S3 but had poor prognosis. The presence of S2 or S3 predicted SFTS with sensitivity and specificity of 0.85 (0.42-0.99; 95% CI) and 0.98 (0.98-0.98; 95% CI), respectively.
The temporal distribution and composition of S2 or S3 were unique in several febrile diseases including SFTS, and the SFTS prediction score may be useful for differentiating febrile diseases in primary care settings of SFTS endemic areas.
发热性疾病中同时出现白细胞减少、血小板减少和正常 C 反应蛋白（CRP）（称为发热伴血小板减少综合征预测评分）的长时间表现并不常见，可能用于进行初步鉴别诊断，这是发热伴血小板减少综合征（SFTS）的特征性发现。
研究人员对 SFTS 患者的 SFTS 预测评分的动态变化进行了研究。比较对象为在发热门诊就诊的年龄≥16 岁、SFTS 评分为 2（S2）或 3（S3）的发热患者，该研究在 4 年的研究期间共纳入了 104 名 SFTS 患者和 130 名发热患者。描述了两组患者就诊时 S2 和 S3 的动态分布与发病时间、致病疾病的特征以及 SFTS 的预测性。
在 104 例 SFTS 患者中，从发病后第 1 天到第 12 天，S2 或 S3 的每日比例范围为 58.3%至 100%。“白细胞减少伴血小板减少”的 S2 亚型和 S3 占所有评分的 72.7%至 100%。相比之下，在发热组的 130 名患者中，73.8%的评估分布在发病后第 1 天至第 4 天，68.8%的患者为“白细胞减少伴正常 CRP”的 S2 亚型。上呼吸道感染是最常见（50.0%）的疾病原因。肺炎（13.8%）和尿脓毒症（6.2%）最初表现为正常 CRP 的 S2 或 S3，但预后较差。S2 或 S3 的存在对 SFTS 的预测具有 0.85（0.42-0.99；95%CI）的敏感性和 0.98（0.98-0.98；95%CI）的特异性。
S2 或 S3 的时间分布和组成在包括 SFTS 在内的几种发热性疾病中是独特的，SFTS 预测评分可能有助于在 SFTS 流行地区的基层医疗机构中区分发热性疾病。
