Peng Wenjuan, Li Junnan, Yu Hong, Zhou Wei, Lin Ling, Ge Ziruo, Lai Jianming, Chen Zhihai, Zhu Liuluan, Zhao Zhenghua, Shen Yi, Jin Ronghua, Duan Jianping, Zhang Wei
Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Infectious Diseases, Beijing, China.
Heliyon. 2024 May 22;10(11):e31289. doi: 10.1016/j.heliyon.2024.e31289. eCollection 2024 Jun 15.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high lethality. This study aimed to determine whether prolonged activated partial thromboplastin time (APTT) predicted SFTS mortality.
SFTS patients were enrolled from 6 hospitals in the north China. Subjects were divided into training cohort and 5 externally validation cohorts. The least absolute shrinkage and selection operator Cox regression model was performed to screen potential prognostic factors. Risk factors were analyzed using multivariable regression models. Prognostic models were established by Cox regression and random survival forest (RSF) methods, and evaluated regarding discrimination, validity and clinical benefit. Time-dependent receiver operating characteristic (ROC) curve was used to evaluate the predictive effectiveness of variables.
1332 SFTS cases were included, in which 211 patients died. Six potential prognostic factors were screened, and pulse, breath, APTT and aspartic transaminase (AST) were independently associated with mortality in both training cohort (Yantai, N = 791) and external validation cohort (N = 541). APTT was steadily correlated with the fatality (HR: 1.039-1.144; all < 0.01) in each five sub-validation cohorts (Dandong, Dalian, Tai'an, Qingdao and Beijing). RSF model with variables of APTT, AST, pulse and breath had considerable prognostic effectiveness, which APTT showed the highest prognostic ability with the area under the curve of 0.848 and 0.787 for 7-day and 14-day survival, respectively. Survival differences were found between high and low levels of APTT for mortality using 50s as the optimal cut-off.
SFTS patients have prolonged APTT, which is an independent risk factor for fatality. APTT≥50s was recommended as a biomarker to remind physicians to monitor and treat patients more aggressively to improve clinical prognosis.
发热伴血小板减少综合征（SFTS）是一种新出现的致死率较高的传染病。本研究旨在确定活化部分凝血活酶时间（APTT）延长是否可预测SFTS患者的死亡率。
从中国北方6家医院招募SFTS患者。将受试者分为训练队列和5个外部验证队列。采用最小绝对收缩和选择算子Cox回归模型筛选潜在的预后因素。使用多变量回归模型分析危险因素。通过Cox回归和随机生存森林（RSF）方法建立预后模型，并对其判别能力、有效性和临床效益进行评估。采用时间依赖性受试者工作特征（ROC）曲线评估变量的预测有效性。
共纳入1332例SFTS病例，其中211例死亡。筛选出6个潜在的预后因素，脉搏、呼吸、APTT和天门冬氨酸转氨酶（AST）在训练队列（烟台，N = 791）和外部验证队列（N = 541）中均与死亡率独立相关。在每一个五个子验证队列（丹东、大连、泰安、青岛和北京）中，APTT均与死亡率呈稳定相关（HR：1.039 - 1.144；均P < 0.01）。包含APTT、AST、脉搏和呼吸变量的RSF模型具有相当的预后效果，其中APTT的预后能力最强，7天和14天生存曲线下面积分别为0.848和0.787。以50秒作为最佳截断值，发现APTT高低水平之间在死亡率方面存在生存差异。
SFTS患者APTT延长，这是死亡的独立危险因素。建议将APTT≥50秒作为生物标志物，提醒医生更积极地监测和治疗患者，以改善临床预后。
