Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
The First Clinical Medical School of Anhui Medical University, Hefei, China.
Am J Trop Med Hyg. 2024 May 28;111(1):113-120. doi: 10.4269/ajtmh.23-0811. Print 2024 Jul 3.
There are no effective therapies for severe fever with thrombocytopenia syndrome (SFTS), and existing predictors of mortality are still controversial. This retrospective study aimed to identify reliable early-stage indicators for predicting fatal outcomes in 217 patients hospitalized with an SFTS diagnosis between March 2021 and November 2023; 157 of the patients survived, and 60 died. Demographics, clinical characteristics, and laboratory parameters were reassessed in both groups. The mean age of participants was 64.0 (interquartile range: 54.5-71.0) years, and 42.4% (92/217) were males. Based on a multivariate Cox regression analysis, the blood urea nitrogen-to-serum albumin ratio (BAR) (hazard ratio [HR]:4.751; 95% CI: 2.208-10.226; P <0.001), procalcitonin level (HR: 1.946; 95% CI: 1.080-3.507; P = 0.027), and central nervous system symptoms (HR: 3.257; 95% CI, 1.628-6.513; P = 0.001) were independent risk factors for mortality in SFTS patients. According to a receiver operating characteristic curve analysis, a BAR with an area under the curve of 0.913 (95% CI: 0.873-0.953; P <0.001), a sensitivity of 76.7%, and a specificity of 90.4% showed better predictive performance for fatal outcomes than other classical indicators reported. The Kaplan-Meier survival curve confirmed that an increased BAR was linked with an unfavorable prognosis in SFTS patients (P <0.001 by log-rank test). In conclusion, the results indicate that high BAR levels are markedly related to substandard outcomes and are a reliable and readily accessible predictor of fatal outcomes in SFTS patients.
目前尚无针对严重发热伴血小板减少综合征(SFTS)的有效治疗方法,现有的病死率预测指标仍存在争议。本回顾性研究旨在确定 217 例 2021 年 3 月至 2023 年 11 月期间因 SFTS 住院的患者中可靠的早期指标,以预测其死亡结局;其中 157 例患者存活,60 例患者死亡。在两组患者中重新评估了人口统计学、临床特征和实验室参数。参与者的平均年龄为 64.0(四分位距:54.5-71.0)岁,42.4%(92/217)为男性。基于多变量 Cox 回归分析,血尿素氮与血清白蛋白比值(BAR)(风险比 [HR]:4.751;95%置信区间:2.208-10.226;P<0.001)、降钙素原水平(HR:1.946;95%置信区间:1.080-3.507;P=0.027)和中枢神经系统症状(HR:3.257;95%置信区间:1.628-6.513;P=0.001)是 SFTS 患者死亡的独立危险因素。根据受试者工作特征曲线分析,BAR 的曲线下面积为 0.913(95%置信区间:0.873-0.953;P<0.001),灵敏度为 76.7%,特异性为 90.4%,对病死率的预测性能优于其他已报道的经典指标。Kaplan-Meier 生存曲线证实,BAR 升高与 SFTS 患者不良预后相关(log-rank 检验 P<0.001)。总之,研究结果表明,高 BAR 水平与不良结局显著相关,是 SFTS 患者病死率的可靠且易于获取的预测指标。