Shuto Hisayuki, Komiya Kosaku, Usagawa Yuko, Yamasue Mari, Fushimi Kiyohide, Hiramatsu Kazufumi, Kadota Jun-Ichi
Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan.
Research Center for Global and Local Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan.
Open Forum Infect Dis. 2023 Aug 1;10(8):ofad418. doi: 10.1093/ofid/ofad418. eCollection 2023 Aug.
Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening infectious disease for which no effective treatment strategy has been established. Although corticosteroids (CSs) are widely administered to patients with SFTS, their efficacy remains uncertain. This study aimed to assess the impact of CS therapy on the in-hospital mortality of patients with SFTS.
In this nationwide observational study using the Japanese Diagnosis Procedure Combination database, patients hospitalized for SFTS from April 2013 to March 2021 were reviewed. We compared patients who were treated with CSs to those who were treated without them after propensity score matching to adjust for their background, disease severity, and combination therapy.
We included 494 patients with SFTS, and 144 pairs of them were analyzed after propensity score matching. No significant difference in the 30-day mortality (19% vs 15%, = .272) and the number of survival days (log-rank test, = .392) was found between the CS treatment group and the non-CS treatment group. However, in subgroup analyses, the CS treatment group tended to have better survival among patients with impaired consciousness on admission and/or shock status within 7 days after admission.
CS therapy does not seem effective for all patients with SFTS; however, the impact might be altered by disease severity assessed by the consciousness level and shock status. A large-scale interventional study is required to determine its efficacy, especially for critically ill patients with SFTS.
重症发热伴血小板减少综合征（SFTS）是一种危及生命的传染病，目前尚未确立有效的治疗策略。尽管皮质类固醇（CSs）被广泛应用于SFTS患者，但它们的疗效仍不确定。本研究旨在评估CS治疗对SFTS患者院内死亡率的影响。
在这项使用日本诊断程序组合数据库的全国性观察性研究中，对2013年4月至2021年3月因SFTS住院的患者进行了回顾。在倾向评分匹配以调整其背景、疾病严重程度和联合治疗后，我们比较了接受CSs治疗的患者和未接受CSs治疗的患者。
我们纳入了494例SFTS患者，其中144对在倾向评分匹配后进行了分析。CS治疗组和非CS治疗组在30天死亡率（19%对15%，P = 0.272）和生存天数（对数秩检验，P = 0.392）方面没有显著差异。然而，在亚组分析中，CS治疗组在入院时意识障碍和/或入院后7天内处于休克状态的患者中生存情况往往更好。
CS治疗似乎对所有SFTS患者都无效；然而，其影响可能会因意识水平和休克状态评估的疾病严重程度而改变。需要进行大规模的干预性研究来确定其疗效，特别是对于重症SFTS患者。
