Activated partial thromboplastin time predicts mortality in patients with severe fever with thrombocytopenia syndrome: A multicenter study in north China
Wenjuan Peng,
Junnan Li,
Hong Yu,
Wei Zhou,
Ling Lin,
Ziruo Ge,
Jianming Lai,
Zhihai Chen,
Liuluan Zhu,
Zhenghua Zhao,
Yi Shen,
Ronghua Jin,
Jianping Duan,
Wei Zhang
Affiliations
Wenjuan Peng
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
Junnan Li
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
Hong Yu
Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
Wei Zhou
Department of Public Health Clinical Center, Dalian, China
Ling Lin
Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
Ziruo Ge
Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Jianming Lai
Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China
Zhihai Chen
Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
Liuluan Zhu
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
Zhenghua Zhao
Department of Infectious Disease, Tai'an City Central Hospital, Tai'an, China
Yi Shen
Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
Ronghua Jin
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; Corresponding author. 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.
Jianping Duan
Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China; Corresponding author. Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China.
Wei Zhang
Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China; Corresponding authors.
Background: 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. Methods: 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. Results: 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 P < 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. Conclusions: 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.