Department of Infectious Diseases, College of Medicine, Chosun University, Gwangju 61452, Korea.
Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea.
Viruses. 2022 May 19;14(5):1093. doi: 10.3390/v14051093.
Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus are disorders with similar clinical features; therefore, differentiating between them is difficult. We retrospectively collected data from 183 SFTS and 178 scrub typhus patients and validated an existing scoring system to develop a more sensitive, specific, and objective scoring system. We first applied the scoring systems proposed by Kim et al. to differentiate SFTS from scrub typhus. Multivariable logistic regression revealed that altered mental status, leukopenia, prolonged activated partial thromboplastin time (aPTT), and normal C-reactive protein (CRP) level (≤1.0 mg/dL) were significantly associated with SFTS. We changed the normal CRP level from ≤1.0 mg/dL to ≤3.0 mg/dL and replaced altered mental status with the creatine kinase (CK) level. The modified scoring system showed 97% sensitivity and 96% specificity for SFTS (area under the curve (AUC): 0.983) and a higher accuracy than the original scoring system (p = 0.0308). This study’s scoring system had 97% sensitivity and 98% specificity for SFTS (AUC: 0.992) and a higher accuracy than Kim et al.’s original scoring system (p = 0.0308). Our scoring system that incorporated leukopenia, prolonged aPTT, normal CRP level (≤3.0 mg/dL), and elevated CK level (>1000 IU/L) easily differentiated SFTS from scrub typhus in an endemic area.
严重发热伴血小板减少综合征（SFTS）和恙虫病具有相似的临床特征，因此很难对其进行区分。我们回顾性地收集了 183 例 SFTS 和 178 例恙虫病患者的数据，并验证了现有的评分系统，以开发出更敏感、特异和客观的评分系统。我们首先应用 Kim 等人提出的评分系统来区分 SFTS 和恙虫病。多变量逻辑回归显示，精神状态改变、白细胞减少、活化部分凝血活酶时间（aPTT）延长和正常 C 反应蛋白（CRP）水平（≤1.0 mg/dL）与 SFTS 显著相关。我们将正常 CRP 水平从≤1.0 mg/dL 改为≤3.0 mg/dL，并将精神状态改变替换为肌酸激酶（CK）水平。改良的评分系统对 SFTS 的敏感性为 97%，特异性为 96%（曲线下面积（AUC）：0.983），准确性高于原始评分系统（p=0.0308）。该研究的评分系统对 SFTS 的敏感性为 97%，特异性为 98%（AUC：0.992），准确性高于 Kim 等人的原始评分系统（p=0.0308）。我们的评分系统纳入了白细胞减少、aPTT 延长、正常 CRP 水平（≤3.0 mg/dL）和升高的 CK 水平（＞1000 IU/L），可在流行地区轻松地区分 SFTS 和恙虫病。
