Wang Guangjie, Liu Puhui, Xie Hui, Niu Chuanzhen, Lyu Jie, An Youzhong, Zhao Huiying
Department of Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
Department of Critical Care Medicine, Yantai Qishan Hospital, Yantai, People's Republic of China.
J Inflamm Res. 2024 Oct 24;17:7627-7637. doi: 10.2147/JIR.S478520. eCollection 2024.
The high mortality rate associated with the critical stages of severe fever with thrombocytopenia syndrome (SFTS) does not have effective treatment. We aimed to evaluate the 28-day mortality and potential impact of glucocorticoid therapy in these patients.
This retrospective observational study included participants from the intensive care unit between July 2019 and April 2023. The participants were categorized into glucocorticoid (GC) and non-GC groups. Propensity score matching (PSM) was employed to ensure comparability between groups. We used Cox proportional hazard models to examine mortality risk associated with GC use, Kaplan-Meier survival analyses for overall survival, stratified Cox proportional hazard models for subgroup analyses, and likelihood ratio tests to examine interactions between subgroups.
Of 218 patients with SFTS (median age, 71 years; male, 49.1%), 61.9% required mechanical ventilation, 58.3% received GC treatment, and the 28-day mortality rate was 61.5%. After PSM, there were 58 patients in each group; post-PSM analysis revealed improved 28-day mortality rates with GC treatment, particularly for patients with Glasgow coma scale (GCS) score <13 (hazard ratio [HR], 95% confidence interval [CI] for GCS score: 9-12: 0.39, 0.17-0.88, =0.024 and for GCS score: 3-8: 0.09, 0.02-0.35, =0.001); lactate levels >2 mmol/L (0.35, 0.15-0.83, =0.017); and norepinephrine usage (0.26, 0.13-0.49, <0.001). Combining antiviral (0.41, 0.22-0.78, =0.006) or immunoglobulin therapy (0.22, 0.1-0.51, <0.001) with GC treatment significantly decreased the 28-day mortality rates, compared with GC monotherapy.
Using GCs reduced the high 28-day mortality rate in the patients, especially with low GCS score, high lactate levels, norepinephrine intake, and on antiviral or immunoglobulin therapy.
严重发热伴血小板减少综合征（SFTS）关键阶段的高死亡率尚无有效治疗方法。我们旨在评估糖皮质激素治疗对这些患者28天死亡率及潜在影响。
这项回顾性观察性研究纳入了2019年7月至2023年4月期间重症监护病房的参与者。参与者被分为糖皮质激素（GC）组和非GC组。采用倾向评分匹配（PSM）以确保组间可比性。我们使用Cox比例风险模型来检验使用GC与死亡风险的相关性，采用Kaplan-Meier生存分析评估总生存率，使用分层Cox比例风险模型进行亚组分析，并通过似然比检验来检验亚组间的相互作用。
218例SFTS患者（中位年龄71岁；男性占49.1%）中，61.9%需要机械通气，58.3%接受了GC治疗，28天死亡率为61.5%。PSM后，每组有58例患者；PSM后分析显示，GC治疗可提高28天死亡率，尤其是对于格拉斯哥昏迷量表（GCS）评分<13的患者（风险比[HR]，GCS评分9 - 12时95%置信区间[CI]：0.39，0.17 - 0.88，P = 0.024；GCS评分3 - 8时：0.09，0.02 - 0.35，P = 0.001）；乳酸水平>2 mmol/L（0.35，0.15 - 0.83，P = 0.017）；以及使用去甲肾上腺素的患者（0.26，0.13 - 0.49，P < 0.001）。与GC单药治疗相比，联合抗病毒治疗（0.41，0.22 - 0.78，P = 0.006）或免疫球蛋白治疗（0.22，0.1 - 0.51，P < 0.001）与GC治疗可显著降低28天死亡率。
使用糖皮质激素可降低患者的28天高死亡率，尤其是GCS评分低、乳酸水平高、使用去甲肾上腺素以及接受抗病毒或免疫球蛋白治疗的患者。
