Cui Ning, Yang Xin, Ge Hong-Han, Yin Xiao-Hong, Yuan Yi-Mei, Zhou Chao, Wang Xi, Pan Hai-Feng, Li Hao, Zhang Xiao-Ai, Fang Li-Qun, Hu Li-Fen, Bao Peng-Tao, Liu Wei
The 154th Hospital, China RongTong Medical Healthcare Group Co.Ltd, Xinyang, China.
State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science, Beijing, China.
PLoS Negl Trop Dis. 2025 Aug 12;19(8):e0013276. doi: 10.1371/journal.pntd.0013276. eCollection 2025 Aug.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease characterized by a high case fatality rate. Despite extensive research on acute-phase manifestations, the long-term clinical sequelae in survivors remain poorly characterized.
In this prospective cohort study from 2010 to 2024, 1,197 SFTS survivors and 188 age/sex-matched febrile controls without SFTS were enrolled from the highest endemic region in China. Participants underwent face-to-face interview, serial clinical evaluations and laboratory testing at 6, 12, 18 and 24 months post-discharge, with extended follow-up for a subset (n = 294) over 11 years. Propensity score matching and multivariate logistic regression were used to determine the factors associated with long-term sequelae risk.
A total of 62.57% (749/1,197) of survivors developed persistent sequelae, significantly higher than controls (51.60%, 97/188; P < 0.05). Key manifestations included memory impairment (33.50%, 401/1,197), arthralgia (33.08%, 396/1,197), alopecia (32.25%, 386/1,197) and visual decline (31.08%, 372/1,197). Laboratory abnormalities persisted for ≥10 years in 0.33% of survivors, notably thrombocytopenia, elevated lactate dehydrogenase, and cystatin C. Compared to non-SFTS group, a significantly higher proportion of SFTS survivors had decreased white blood cell count, eosinophil percentage and mean corpuscular hemoglobin. The long-term sequelae risk exhibited distinct patterns across factors: encephalitis development was associated with significantly higher risks of memory impairment (adjusted OR = 2.39) and thrombocytopenia (adjusted OR = 3.36); corticosteroid usage during hospitalization showed increased risks of arthralgia (adjusted OR=2.17) and elevated BUN (adjusted OR=3.87); while high viral load (≥1 × 106 copies/mL) exhibited significantly higher incidences of most prevalent clinical manifestations and multiple laboratory abnormalities (all P < 0.05).
SFTS survivors exhibit multisystemic sequelae, with high viral load and acute-phase neurological involvement serving as critical prognostic indicators. These findings underscore the need for long-term monitoring and targeted therapeutic strategies for SFTS.
发热伴血小板减少综合征（SFTS）是一种新出现的蜱传传染病，病死率高。尽管对急性期表现进行了广泛研究，但幸存者的长期临床后遗症仍缺乏充分描述。
在这项2010年至2024年的前瞻性队列研究中，从中国流行率最高的地区招募了1197名SFTS幸存者和188名年龄/性别匹配的无SFTS发热对照者。参与者在出院后6、12、18和24个月接受面对面访谈、系列临床评估和实验室检测，对其中一部分人（n = 294）进行了长达11年的随访。采用倾向得分匹配和多因素逻辑回归分析确定与长期后遗症风险相关的因素。
共有62.57%（749/1197）的幸存者出现持续后遗症，显著高于对照组（51.60%，97/188；P < 0.05）。主要表现包括记忆障碍（33.50%，401/1197）、关节痛（33.08%，396/1197）、脱发（32.25%，386/1197）和视力下降（31.08%，372/1197）。0.33%的幸存者实验室异常持续≥10年，尤其是血小板减少、乳酸脱氢酶升高和胱抑素C升高。与非SFTS组相比，SFTS幸存者中白细胞计数、嗜酸性粒细胞百分比和平均红细胞血红蛋白降低的比例显著更高。长期后遗症风险在不同因素间呈现不同模式：发生脑炎与记忆障碍（调整后OR = 2.39）和血小板减少（调整后OR = 3.36）的风险显著升高相关；住院期间使用皮质类固醇显示关节痛（调整后OR = 2.17）和血尿素氮升高（调整后OR = 3.87）的风险增加；而高病毒载量（≥1×106拷贝/mL）在大多数常见临床表现和多项实验室异常中的发生率显著更高（均P < 0.05）。
SFTS幸存者存在多系统后遗症，高病毒载量和急性期神经系统受累是关键的预后指标。这些发现强调了对SFTS进行长期监测和针对性治疗策略的必要性。
