Guo Chunxia, Li Ruixue, Wang Xia, Peng Xiulan
Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Internal Medicine, The Hospital of Wuhan University, Wuhan, Hubei, China.
Front Immunol. 2025 Jan 17;15:1471511. doi: 10.3389/fimmu.2024.1471511. eCollection 2024.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high mortality rate caused by . The aspartate aminotransferase to platelet ratio index (APRI) is a biomarker of liver injury and inflammation. This study aimed to examine the correlation between APRI and SFTS prognosis using clinical data analysis and attempt to explain its prognostic significance through metabolic analysis.
Data from hospitalized patients with a confirmed diagnosis of SFTS virus infection at Wuhan Union Hospital were retrospectively collected. The low and high APRI groups were 1:1 matched using propensity score matching (PSM) analysis. Fresh plasma was collected from patients with SFTS on admission and used for metabolic tests.
A total of 617 patients with SFTS who met the inclusion criteria were selected for analysis. Survival analysis revealed that patients with SFTS with high APRI (> 35.3) had a substantially higher death rate than those with low APRI (≤ 35.3). Receiver operating characteristic analysis showed the predictive performance of APRI for SFTS prognosis is 0.77, with a 95% CI of 0.73-0.80, which was superior to NLR (area under the curve (AUC): 0.65), platelet-to-lymphocyte ratio (AUC: 0.54), and systemic immune-inflammation index (AUC: 0.58). The prognostic value and predictive performance of APRI were more substantial after PSM than before PSM. Metabolomic testing identified several differential serum metabolites, with alanine, aspartate, glutamate, glycerophospholipid, and tryptophan metabolism being the most important metabolic pathways.
A high APRI score was associated with relatively higher mortality in patients with SFTS, and its predictive performance for the survival outcome of SFTS was superior to that of well-recognized inflammatory scores. Alanine, aspartate, and glutamate metabolism are involved in the progression of SFTS.
发热伴血小板减少综合征（SFTS）是一种由[病原体未提及]引起的新兴传染病，死亡率很高。天冬氨酸转氨酶与血小板比值指数（APRI）是肝损伤和炎症的生物标志物。本研究旨在通过临床数据分析探讨APRI与SFTS预后之间的相关性，并试图通过代谢分析解释其预后意义。
回顾性收集武汉协和医院确诊为SFTS病毒感染的住院患者的数据。采用倾向评分匹配（PSM）分析将低APRI组和高APRI组进行1:1匹配。收集SFTS患者入院时的新鲜血浆用于代谢检测。
共纳入617例符合纳入标准的SFTS患者进行分析。生存分析显示，APRI高（>35.3）的SFTS患者死亡率显著高于APRI低（≤35.3）的患者。受试者工作特征分析显示，APRI对SFTS预后的预测性能为0.77，95%CI为0.73 - 0.80，优于中性粒细胞与淋巴细胞比值（曲线下面积（AUC）：0.65）、血小板与淋巴细胞比值（AUC：0.54）和全身免疫炎症指数（AUC：0.58）。PSM后APRI的预后价值和预测性能比PSM前更显著。代谢组学检测确定了几种差异血清代谢物，其中丙氨酸、天冬氨酸、谷氨酸、甘油磷脂和色氨酸代谢是最重要代谢途径。
APRI评分高与SFTS患者相对较高的死亡率相关，其对SFTS生存结局的预测性能优于公认的炎症评分。丙氨酸、天冬氨酸和谷氨酸代谢参与SFTS的进展。
